Large Baby: Early Induction Next Time?

My son weighed 10 pounds, 8 ounces at birth and was delivered by cesarean. My doctor said he'll monitor my next pregnancy and induce labor before the baby gets too large to deliver vaginally. I did not have gestational diabetes -- just a big healthy baby! I would hate to compromise the health of my next child by inducing early. Is early induction necessary?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

I always lean in the direction of avoiding unnecessary intervention as you seem to be doing. Monitoring baby's growth is still an inexact science. Even ultrasound can be inaccurate at predicting fetal weight later in the pregnancy.

In my experience, induction at term, even with certain dates and a favorable cervix, still involves monitors, IVs, confinement to bed and perhaps rupturing the amniotic membranes. These are all interventions which can lead to more intervention and increase the chances for a cesarean.

The "New England Journal of Medicine" (Sept. 5, 1996) has shed some new insight into vaginal birth after cesarean. They state that although 60 to 80 percent of women do go on to deliver vaginally after a cesarean, it is a challenge to identify those who are most likely to have a successful birth with the next pregnancy. If the woman has a previous dysfunctional labor, no prior vaginal delivery, an abnormal fetal heart rate tracing, induction of labor, fetal pelvic disproportion and fetal growth abnormalities (too large or too small), these all increase the chance of a repeat cesarean after an unsuccessful trial of labor.

In the study cited, the risk of major complications was greater for women who chose a trial of labor than for those who had a second cesarean without a trial of labor. Again in this study, women were more likely to have a successful trial of labor if they were under 35 years of age and if the child's birth weight was less than 4000 grams.

A second cesarean might be less hazardous for you than a lengthy induction with an unfavorable cervix. I would maintain a wait-and-see attitude. Maybe this baby will be a bit smaller, and if your cervix is very ripe and a few centimeters dilated at term, induction will seem more realistic. I would only seek care from a provider who is open to your input on this.

I hope this helps and I wish you success.

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