Inducing Labor Better for Big Babies

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The study below has made a compelling argument for induction for babies who are thought to be large for their gestational age. The first thing to ascertain before deciding on a course of action, is that the baby is truly larger than expected. All methods of judging a baby's size in the uterus are prone to error, for example ultrasound has a 15% margin of error. Therefore we need to take this into account when we are advising women of the safest options. Many inductions (and even caesareans) are performed for "big" babies, only to have the induction go pear-shaped and lead to a caesarean ... for a 3.5Kg baby. On the other hand, an earlier induction for a genuinely large baby may well prevent a caesarean, forceps birth, perineal trauma (tears, episiotomy) and so on.

Large-for-date babies are more likely to experience neonatal trauma if nature is allowed to take its course than if labor is induced ...

Among fetuses estimated sonographically to be above the 95th percentile for weight, adverse events such as shoulder dystocia were three times less likely if labor was induced ...

Induction of labor also was associated with a greater likelihood of spontaneous vaginal delivery ...

Previous observational studies have suggested that induction of labor may lower birth weight and decrease the chance for neonatal injury such as shoulder dystocia, brachial plexus injury, and death.

However, studies also found increased rates of cesarean section with induction, and the reliability of fetal weight estimation has been questioned.

... 817 women ... were assigned to be induced within three days of enrollment or to expectant management.

They averaged 37 weeks gestation, and fetal weight was estimated at an average of 3,700 grams.

The difference between the groups was approximately nine days additional gestation in the expectant management group along with a 287-g (10 oz.) higher birth weight.

In the expectant management group, 6.6% of neonates experienced shoulder dystocia, compared with 2.2% in the induced group ...

Also significant was the difference in vaginal deliveries, which occurred in 58.7% of the induced births and 51.7% of expectant births.

Cesarean section was needed in 28% of the induction group and 31.7% of the expectant group.

Secondary outcomes -- including clavicular fracture and brachial plexus injury -- were similar between the two groups.

There were no serious or permanent brachial plexus injuries or deaths.

... The study demonstrated that prevention of macrosomia at birth can lead to safe birth outcomes ...

The other aspect that has not been mentioned in this study is the importance of caring for women and providing advice that will help them to grow a baby who is appropriate for their pelvis, to maximise the chance of a normal birth. This is an essential aspect of the care that I provide to women.

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