Tuesday, October 16, 2012

When Bigger is Not Better

Baby boy is nearly a man. He's estimated by ultrasound measurements to weigh >6 lbs at 35 weeks. Although this method is error-prone, it's all that's available and his extrapolated weight by 39 weeks is between 8-9 lbs. Where 9 lbs is the cut-off for converting the induction plan to a C-section, because big babies get stuck in vaginal deliveries and injuries all around can hypothetically ensue. So. I have another ultrasound in 3 weeks (the week before the scheduled induction) to recheck his estimated weight, and a decision may be made then. Or not. Nobody seems able to say. That's perhaps the worst part. Second only to the fact that the doctor on call the day of my scheduled induction is one of my least favorite in the practice -- she's not awful or anything, I just am very lukewarm toward her and vice versa (plus some info from a friend about the doctor's Catholicism and its impact on patient care leaves me unsettled as a secular person/patient) -- and my attempt to have the scheduling nurse move the induction up by one day, so I can have my absolute favorite doctor in the practice deliver my baby the day before, was met with the Great Wall of Hospital Policy. They simply won't schedule anything a minute before 39 weeks without an amniocentesis to confirm lung maturity is what I'm told. I had a meltdown on the phone with this nurse, explaining that the Great Hospital Policy is protecting their liability with regard to a procedure (induction) I don't even want and certainly don't want to have my least favorite doctor perform. This is not an elective procedure after all, it's being mandated for medical reasons. She offered to move it back, which would allow more time for baby to gain more weight and almost certainly require a C-section, another Great Policy (as I know several moms who've safely delivered 9+ lbs babies) that exposes me to increased risk in order to further minimize hospital liability. What choices am I permitted regarding my pregnant body and my baby in this actuarial calculation? Did the election happen already and the GOP (win or lose) plant a flag in my vagina? Her final offer was to leave a note on the (favorite) doctor's desk to follow up with me. Super. I expect little at this point. It seems the best way to not be massively disappointed.

My greatest aspiration now is for an early labor. I'll be full-term by Halloween, in 2 weeks, and will start doing any voodoo suggested to promote labor in the hopes that he will come spontaneously between 37-38 weeks, before he can be declared too big to birth. Bug bucks, no whammies.

Fucking diabetes. My body is spectacular at failing me and now this baby, too.



Lisa said...

Fingers crossed for a 37 or 38 week spontaneous birth! It's not right that they won't move you up one damn day. Can you bring it up again at your next appointment?

kdactyl said...

I do not understand why they are so fast to push you to c-section. This is not your first baby. How big was Jackson and did you have a hard time with him? I know really little people who deliver 9+lb babies...Most people I know deliver 8+lb babies on their first pregnancy. What risk factors from your first delivery are causing them to be so C-section gung ho? I delivered both my babies by c-section at 38 weeks 4 days without anyone batting and eye (1st breech baby determined this...so both pre-scheduled)....no amnio and no issues. As for size...usually they at least let you TRY before pushing you to a c-section. I understand diabetes carries a risk...but you have been controlling this fine and therefore your baby should not be growing too big BECAUSE of the diabetes...but maybe just because he is going to be a big boy. If you did not have GD and were not having NST's every week...they may not even bat an eye at his size. Just wondering. I feel like you are getting "pressured and pushed" to do this but it doesn't seem to me like baby is really that much bigger than most. But...I don't know your size or any issues you may have had delivering Jackson.
Sorry this is such a pain in the butt.

JB said...

KD -- they've actually barely addressed the need for a C-section other than to initially inform me of the usual practice (where 9 lbs at 39 wks is the cutoff for making that decision). It's mostly just me freaking out. Because you are right, babies can get big without any prior indication and then deliver just fine. Jackson was 8 lbs 2 oz, which is around the average for the hospital where I delivered/am delivering again and there were no birth complications to my knowledge. Also, the diabetes has been just marginally controlled....numbers started creeping up a bit in the past week so we upped my morning dose of glyburide. Now it's fine again. But yeah, he was probably going to be a bigger baby like his brother, anyway. I feel like the hospital policy on scheduling before 39 weeks only with amnio or whatever is probably designed to cut down on elective inductions/C-sections, but this is different and 24 hours earlier than 39 weeks is not a big deal. I will bring it up at my next appointment but I still expect resistance. Still hoping for spontaneous labor in the next 2-3 weeks to avoid any shenanigans.

bunny said...

I'm just so flummoxed and SAD about all this crap. What a giant sack of worries you've been handed. Hey, I guess that's what you get for getting knocked up so "easily". *Laughs cruelly*

I will hope mainly for an early labor, but a little that talking with an actual doctor may be more useful than talking with scheduling toads. There's no "switch to a new practice" option is there?

Mina said...

Doctors are over cautious in US, aren't they? Both my babies have been 8 pounders and ~ 22 in long. Parents are not huge, but on the long-normal and upper normal BMI level. Both delivered via a 2nd degree tear, via induction due to GD and low fluid. So, it IS possible. If only one tries. And over here, normal birth weight is 8-9 lbs.
I hope your zweiling slows down enough for them to let you either go spontaneously in labour or need a little, very leeeeeettle medical encouragement to start labour.if everything else looks normal, induction should be the first option, not c-section, right?
I am keeping my crossable crossed for you to get what you want FOR ONCE this pregnancy. It would be such a change, but at least it would be a pleasant one.
Now, how about a picture of the awesomeness that is a full term pregnant belly in its glory?