So, Anyway

Where were we? Oh yes, my gigantor baby story. VM has been my patient since I started practicing here in Whooville. I delivered her first baby shortly before the Bean, so imagine my surprise (and hers) when she came to me last spring, pregnant with her second child. VM had gestational diabetes with her last pregnancy, but it was very well controlled with diet. This pregnancy was a different story. We tested early, and began the diabetic diet and teaching very quickly, but her sugars waged out of control for a good 2 weeks. There were some ups and downs with her insulin control, but we finally struck a good balance. She remained well controlled for the remainder of the pregnancy...on paper, any way. Long about 36 weeks, VM's fundal height began to measure larger than her dates by more than 2 cm. (2 cm above gestational age or 2 cm below are considered in the "normal range.") The ultrasound revealed a fetal weight extending into the 90th percentile.

Due to her early gestational age, we decided to observe the fetal growth and aim for induction of labor at 39 weeks (the week after Christmas). All progressed merrily, with an ultrasound at 38 weeks predicting an estimated fetal weight of 10 pounds 7 ounces. "Ha ha!" we laughed. How *funny* that would be if it were *true*? In the back of my mind visions of shoulder dystocias danced in my head, but I kept repeating the mantra that "Macrosomia is not an indication for induction." over and over until the voices were quashed. VM presented for induction of labor for insulin dependent gestational diabetes at 39 weeks and 2 days. She received ce.rvi.dil overnight, and pit.ocin was initiated in the morning. Her previous pregnancy had been a spontaneous labor at 38 weeks, and had lasted a little over 4 hours. By 10 AM, VM was comfortable, with a good epidural, and she was *frustrated* that the baby had not been born already! I reassured her that induced labors were different, and that this baby was probably just a wee bit bigger than her last (8 pound 3 oz) baby. Right about noon, she began to feel the telltale "pressure." Sure enough, she was complete and at +1 station. She had no discomfort at all, and not much urge to push, so we turned back the epidural and let her "labor down." Nearly 30 minutes later, VM was ready to push. I remember that she was laughing, because she couldn't feel what she was doing. What she was doing was pushing like a champ. She laughed/pushed for about 4 contractions.

Then, the head completely crowned....and I just about died. It was a very, very, large head. The delivery was very well controlled, but the head just kept coming and coming and coming. I made eye contact with the nurse, and, mirrored in her eyes, I saw my own concern. She maneuvered the patient into McRobert's and prepared for suprapubic pressure. We wouldn't need it. The anterior shoulder slid under the pubic bone with only the slightest pressure. I think I actually breathed again once I felt that shoulder deliver. I lifted the small toddler, erm, baby into the waiting arms of her mother, and she cried and the baby cried with her. There was a very small second degree laceration that was easily repaired. The head circumference as 16", and the weight was 10 pounds 15.7 ounces. VM asked if she could "get credit" for having an 11 pound baby. "Without a doubt!" I said. So that is my eleven pound baby story; the largest baby I have delivered vaginally. (The largest by C-section was 13 pounds, ack!)

SO, what is the moral of this story? Well, I think there are a few things. For one, sometimes, despite all of the talk of ultrasounds being incredibly inaccurate in the third trimester, your baby *is* as big as the ultrasound says it is. But second! Even if your baby is ginormous, and you have to undergo a god-forsaken medical induction, you can still have a smooth, successful delivery. And third, as a physician, it reinforces to me that it is always best to prepare for the absolute worst, while trusting the process, and hoping for the best.