QuestionI'm 33, have 2 kids (8 & 13) and am pregnant. My last period started on either 6/29 or 30, 2005. My orig due date was 4/7, but because of size of baby (seen in 2 ultrasounds) it was bumped up to 3/22. Last week @ the dr, the midwife suggested to me that I might not have a choice in whether or not I have a cesarean - if the baby is over 10 pounds, they might not even let me try to deliver vaginally. Kept talking about the litigious nature of today's medical society, and how it's considered too high risk to attempt vaginal delivery. I am completely freaked out by this, to the point of having nightmares. My first 2 births were easy (I know, I'm lucky), crowning on the 1st push for both, and having the 1st out in 4 pushes, the 2nd in 3, and both were 7lb babies. I've done some research online, and nothing I've seen regarding the necessity for cesarean applies to me: I'm not diabetic, I've not gained an excessive amount of weight, and I'm not of tiny build - 6'2" and 275lbs before I got pregnant. But most of the research I've seen is a couple of years old, and most of it is repetitive. And while I was avg size at birth, my partner was 11lbs 15oz; all his brothers and nephews were also 10+lb babies at birth. I do have a final ultrasound scheduled for 3/13, to assess the baby's size. And I plan on having a sit-down with my OB at my next appt, because at no point thus far has he mentioned that a cesarean might be a 1st approach. But I am completely freaked out. What is modern medical research saying? How much can I insist on being given a chance to deliver vaginally? What would be some good questions to ask my doctor? I was concerned about delivering such a large baby before, but I'm terrified about the idea of a cesarean. Don't I have the right to try first? And should I?
AnswerThe recommendation of ACOG (American Collete of ObGyn) is that, if the estimated fetal weight on sonogram is greater than 9.5 pounds, the baby should be delivered by cesarean section. This is to avoid the risk of shoulder dystocia and subsequent Erb's Palsy (difficulty moving the arms). It is not worth the risk of vaginal delivery. However, if the EFW is less than 9lbs, you certainly can attempt a vaginal delivery. Ultimately, the decision is yours and yours alone. You can refuse to sign the consent for cesarean section. A cesarean section is the safer way to go.
