Tuesday, January 27, 2009

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.

22 comments:

T1 Mom said...

GASP!! Go for you and VM what a team!!

THAT GIRL said...

That would have scared the CRAP out of me. So glad that shoulder delivered nicely for you.

Holy cow.

audrey said...

Holy snot! I can't imagine delivering an 11lb baby vaginally! My 8lb 8oz guy was enough baby for me.

Lisa Marie said...

Great story! So glad you keep an open mind about the possibilities :)

Amy said...

I delivered a 10 pound, 8.5 ounce baby boy on July 16 of 2007. It was my fourth baby and my first three ranged from 7 lbs. 2 oz. to 8 lbs, 6.75 oz. They were all 3 a bit early though and this one was a week late. My fundal height was right on target but when they did an ultrasound at 40 weeks they said the baby weighed 9.4 pounds and all his measurements were in excess of 40 weeks except for his legs which were right at 40 weeks. My doctor was nervous I think and I'm sure he was worried about shoulder dystocia as well. But, with a very strong epidural I pushed that baby out in less than 15 minutes, with very minimal tearing and stitches. Maybe a second degree, I think. I was hardly even sore afterwards. My doctor said that I was made for childbirth and that I could have fit a bigger one. So, you just never can tell how it's going to work out. Oh, and my glucose level at 24 weeks was 120 after drinking the orange stuff. I've always wondered if I could have had undiagnosed gestational diabetes and some swear that I had to have it with such a large baby but I really don't think so. My husband's dad was 10 pounds 2 ounces and so I just think it's genetic.

Jody said...

lol I Loveee big baby storys. My first was 11lbs 7oz. I was not a L&D nurse at the time so I have no real idea if there was any problems getting baby out or not.

He was born vaginally with a epis.
I had 3 more after him. Smallest was 10 lbs 15oz.

I'm glad I didn't know then what I know now =)

determinednspoken said...

wow! amazing!!

Tracie said...

I must say I get all excited when I see you have a new post. I enjoy your blog, thanks for being a blogger, please don't stop.

This entry was of interest to me because of what 'could've been' had I made it to term with my pregnancy. I was induced at 35 weeks for preeclamptic symptoms and virtually no amniotic fluid, and delivered a 7 lb, 8 oz bouncing baby boy. I can only imagine how big he'd have been at 40 weeks. I did not have gestational diabetes, either.
Another reason this was interesting is all the stories you hear of inductions ending in c-sections. I was sent in for induction and they wouldn't do cervidil because I was already contracting regularly on my own. So, began Pit. After 30 hours(!!!)I was only at a 6, at that point I began having a lot of pain, when it was discovered my epidural was not working below my belly button...and at that moment I began transitioning...I went from 6 to 10 in a matter of about 7 minutes, wound up delivering baby with the nurse and my husband after 2 pushes. I meant business after 30 hours! The Doc was suprised to walk in the room to find a baby already delivered with a first time mom! So, I have a question...Is it normal for a patient to be left on Pit for 30 hours? I all the time hear of women only being allowed to labor on pit for so long before they'll go for c-section for 'failed inducion'. Boy am I glad I got to avoid surgery!
Thanks, sorry this was so long!

DoctorMama said...

I don't think anyone who hasn't been down there quite gets the incredible visual of "the head just kept coming and coming and coming" -- I can so see that -- when you're thinking, where in the hell is the FACE?

Nice work!

Anonymous said...

Glad to hear all went well. Ang God Bless, whoever carried that 13 pound baby!
-Amy in OH

MomTFH said...

So glad the birth went well.

Have you seen this study? It seems to me that induction for suspected macrosomia will actually dramatically INCREASE the risk of dystocia. What is the justification for inducing one week early? The difference of a few ounces of weight for the child if you wait for spontaneous labor to begin may not be as much of a risk.

4daughters said...

You just proved that "fat is squishy" :). I'm glad that there are still OBs out there who don't automatically section for a big baby. Thank you for being one of those OBs.

Deb said...

Ack! My 8-pounder with an almost 14 inch head was big enough for me! And I thought my son had a big head.

AtYourCervix said...

WTG momma with your 11 lb baby! WTG Dr Whoo for not inducing for macro :-) And yes, I've seen several births where the head just keeps coming and coming and coming......very scary, because you just start going through what you need to do for shoulders - just in case.

PE Mommy said...

HOLY COW. My baby was just 5lbs 7 ozs two weeks ago. I could not imagine having a baby that big!!!!!

Anonymous said...

Enjoy your blog and love this very happy story.
I'll keep watching carefully as I work on growing my 3rd baby. Driving my very patient doctor insane. You give me hope she'll forgive me when it's all over.

1st = 8 14oz
2nd = 9 13 oz
3rd = who knows, but hopefully less than 10 12oz!

candus said...

Hi, thanks for your entries because I hoped online to see what it's really like to be an OBGYN since that's what I'd like to be. I wanted to be midwife in the natural realm only doing home births and working in partnership with hospitals but I need something that's going to bring in income since we've been living on 19,000-29,000 for the last seven years with two kids. I've always had an interest in the sciences and some people relations. (I wanted to be a veterinarian and a physicist). I'm that familiar with how blogs work but would it be possible for you to help me decide if this is what I should be doing? I get so excited when I think about it and I'm willing to do whatever it takes to get through anything as my life as shown already. I know every profession has its ups and downs. Well. I'll visit again and thanks again for starting your blog.

CappuccinoLife said...

Wow! I'm glad you let her deliver vag. :)

My last was 10 lb 8 oz and delivered without a hitch. No GD, either. The way you started your post I was thinking surely the one you were talking about must have been 12 or 14 lb!

Jenny said...

I wish I had you for my OB. My son was guessed to be 9 pounds, 11 ounces. He was actually 9 pounds, 8 ounces. My OB used the scare tactics (which worked) to get me to have a C/S. My son was also 22 inches, so he was long and lean. :/

Irish Eyes said...

I delivered my fifth baby, a girl, 11 lbs 4 oz.

Vicki said...

My first was 8 lbs 3 oz. My second was 9 lbs 15. My third, and my first vaginal birth, was a surprise 12 lb'er. LOL! What a surprise when the 37 week ultrasound said 7 lbs 12 oz. I later ran into the US tech who said that everyone in the office watched the video of the ultrasound!

As previous commenters said, thanks helping her deliver with out a c/s. And I enjoy your blog too! Good luck on your job transition and move.

eulogos said...

I had one baby who was 11 pounds, in the hospital, and one at home who was somewhere between 12 and 13, closer to 13 before he peed and pooped. When my doctor examined me after that birth he said I had " a tiny little tear that I don't even really need to stitch." No stuck shoulders with either. But as I wrote in another comment, the doctor was very worried with the 11 pounder that they would be.
Susan Peterson