Big Baby: Is Induction of Labor Necessary?

Inducing labor for a suspected big baby increases the odds of c-section compared with starting labor on your own. Most, though not all, studies conclude this (2,5,9-10,16). This could be the belief that women can’t, or shouldn’t, birth big babies vaginally coming into play. It could also be the fact that labor induction, even with pretreatment to prepare the cervix, is more likely to end in a cesarean in first-time mothers than starting labor spontaneously.

While shoulder dystocia and birth injuries are more likely in bigger babies, they occur in non-macrosomic babies and occur rarely even in big babies. For this reason, a policy of induction could have little effect on outcomes even if it reduced the incidence of these problems. To give you an idea of the numbers, an analysis of nearly 15,000 births reported shoulder dystocia rates of twelve percent in non-diabetic mothers of babies weighing 4,000 grams or more and one percent in babies weighing less than this. A similar analysis of birth injuries in nearly 20,000 babies found that less than two percent of babies weighing 4,000 grams or more experienced a birth injury as did less than half a percent of smaller babies (8).

Further diminishing any potential benefit, few cases of shoulder dystocia result in injury. In one study, of 825 cases of shoulder dystocia in infants weighing 4,000 grams or more, only thirty-six, four percent, experienced five minute Apgar scores less than 7, a broken bone, or a brachial plexus injury. Of these thirty-six complications, eight were a broken bone. Breaking a bone is not serious because bones heal. Subtracting the eight instances of fracture, only three percent of babies with shoulder dystocia were at risk for long-term consequences. Even so, more than nine out of ten babies with brachial plexus injuries will completely recover as will eighty-eight percent of infants with five minute Apgars of 7 or less (12-13).

What are the potential problems with inducing labor?
While conferring no benefits, inducing labor increases the likelihood of overly strong contractions, fetal distress and, as documented above, probably cesarean section (6).

How might having an induced labor affect your birth experience and postpartum recovery?
Having labor induced will medicalize your experience, in that you will need an IV and continuous electronic fetal monitoring. You will likely be confined to bed for most or all of the labor. Contractions will probably be more painful, so if you wanted to avoid pain medication, this will make it more difficult to achieve that goal. An epidural will help eliminate the pain, but introduces a long list of potential problems of its own. You may run a additional risk of the labor ending in a cesarean, with all that entails in complications, pain, and recovery time.

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