# An induction or c-section for a truly big baby?



## 2sweetboysmom (Aug 1, 2006)

LONG BACKGROUND:-----
I am 37 weeks. I have excelently controled (diet) GD (one or 2 readings out of range per 4 weeks). Due to a history of loss I've seen a high risk perinatologist group for this pregnancy.
At 30 weeks I began to feel like my belly was getting big too fast.
At 31 weeks fundal measurement was 36cm, but fluid was normal at 12.5cm. Also at 31 weels labor was stopped, and shots given to develop lungs.
At 32 weeks an ultrasound by the perinatologist showed a baby measuring 6.5lbs with all measurements indicating a baby of 37 weeks, fluid still normal at 13cm and fundal height was 38.
At 36 weeks ultrasound by peri showed baby measuring 9lb9oz, 14inch head circumfreance,with all measurements indicating a baby of 41-42 weeks, fluid normal, fundus at 44cm. (between the two ultrasounds it would seem my boy is gaining 12 oz/week)
I have poured over the studies and statistics regarding various means of measuring babies in utero being "off" I am however confident (between my own sense of things, the fundal measurements, and the ultrasounds by a peri)that this guy is quite big.
I have 3 children already 2 were in the 7.5lb range at birth and one was 8.5lbs with a 15 inch head.
I have been having all day/night labor since 35weeks, but I simply don't make rapid progress or feel pain with my ctx until my water is broken, & I have always made wicked strong amniotic sacks. Also, his head will not stay engaged. He gets it down there LOA and I feel him start to drop and go for a walk and come home with that 'cannon ball in your crotch' feeling only to find him floating again the next morning.








I feel pretty confident in my ability to vaginally birth this "little" guy up to about 10.5+ lbs, but beyond that I think the risks to him and me for distocia are more than I can justify and my instincts say to not attempt it beyond that point. The peri I saw this week said he would rather I carry to 39 or 40 weeks and have a c-section than to induce/augment at 37/38 weeks (when I still feel able to potentially birth vaginally)

SHORT QUESTION: -----
For the sake of argument, assuming the weight estimates to be within 1 lb +/- if you had to choose between an induction at 37/38 weeks, or a c-section at 39/40 weeks, which would you choose and why?
Can you link me to any studys showing an earlier vaginal birth being superior to a later c-section for baby?

Thanks.


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## kittywitty (Jul 5, 2005)

Neither. Both have huge risks and people give birth to "big" babies with no problems every single day. Fat squishes. They told me my son was "big" and u/s confirmed it. He was born at 7lbs. 2 oz. after a harsh induction and thanks to the u/s being wrong, he was also nearly premature at 36 weeks and has neurological and digestive issues still. His birth was far harder than my much bigger other children.

c-section triples maternal and fetal death rates and has much higher risk of respiratory distress. I would never choose that if the reason was "big baby". And isn't a prolapsed cord a big risk in induction/PROM when a baby is not engaged?

Some more threads: http://www.mothering.com/discussions...d.php?t=832449
http://www.mothering.com/discussions...d.php?t=834605
http://www.mothering.com/discussions....php?t=1130443

"The American College of Obstetrics and Gynecology does not support prophylactic cesarean delivery for suspected fetal macrosomia with estimated weights of less than 5,000 g, stating that "&#8230;it is safe to allow a trial of labor for estimated fetal weight of more than 4,000 g.""
http://www.theunnecesarean.com/avoid-an-unnecesarean/

Evidence is lacking to support labor induction or elective cesarean delivery in women without diabetes who are at term when a fetus is suspected of having macrosomia.

Benacerraf BR, Gelman R, Frigoletto FD Jr. Sonographically estimated fetal weights: accuracy and limitation. Am J Obstet Gynecol 1998;159:1118-21.

From ACOG's Guidelines on Fetal Macrosomia :

"In cases of term patients with suspected fetal macrosomia, current evidence does not support early induction of labor. Results from recent reports indicate that induction of labor at least doubles the risk of cesarean delivery without reducing the risk of shoulder dystocia or newborn morbidity"
http://www.ncbi.nlm.nih.gov/pubmed/11456432


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## loveneverfails (Feb 20, 2009)

I would ask for a 3d ultrasound to confirm things, because those are going to give you a better weight estimate. Those are generally within 5%, and would probably give you greater clarity in your plans going forwards.

There are trade offs either direction. A later birth means more brain development in an uterine environment. However, c-section carries greater likelihood of breathing issues at birth and lack of exposure to vaginal bacterial flora. Also, keep in mind the risk of c-section to future pregnancies down the line.

I personally would go for the induction, but I also know that I've given birth to 11 lbs before. I don't know. It's just a hard situation!


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## triscuitsmom (Jan 11, 2007)

Regardless of reason (assuming non emergent) I'd go for induction but push it as late as possible over cesarean with no labour.

That being said I understand you feel the baby is big and I believe Mamas can be right on about these things. The ultrasound would do nothing for me though. I had the opposite problem. Was told my baby was 5lbs at 41 weeks after many ultrasounds showing him small (so that last one wasn't a shock).

He was born weighing 8lbs 12oz. That's more than 1.5 times bigger than they had him being on the ultrasound. They can be really really wrong.

On the flip side a Mama I know pregnant at the same time as I was kept having her due date moved back because her baby was so huge. They ended up inducing her at around 36 weeks because she wasn't going to be able to birth the baby safely vaginally (according to her OB) if she went any farther. They were wrong. Baby was 5.5lb.

Good luck deciding Mama


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## 2sweetboysmom (Aug 1, 2006)

I *am* Gestational diabetic *...I am 37 weeks. I have excelently controled (diet) GD...*
and at aprox 12oz/week I am seriously looking at (5,000g)11lbs being a very real possibility by this time next week.


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## kittywitty (Jul 5, 2005)

Even with GD and fetal macrosomia as a real possibility, the evidence stands in my post. It's *about* macrosomia regardless of GD. I have a friend who is type 2 who just had an 11 lb. girl yesterday vaginally. Such a cute little thing.


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## cappuccinosmom (Dec 28, 2003)

What about giving labor a try and having c-section as a backup plan (it is anyway, afterall, in hospital births)?


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## weliveintheforest (Sep 3, 2005)

Quote:


Originally Posted by *cappuccinosmom* 
What about giving labor a try and having c-section as a backup plan (it is anyway, afterall, in hospital births)?

Yes, I agree. I honestly would not induce or plan a c-section, especially since you are a multip.


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## BetsyS (Nov 8, 2004)

Especially with the GD, I would opt to keep your baby inside as long as possible. GD babies are notorious for having slow maturing lungs, and I wouldn't want to chance any breathing issues at birth with an almost-term baby.

This coming for someone who has big babies (two of them over 11 lbs), and I've had 3 c-sections. My last baby was born at 40+3. The first two were 41 and 42 weeks. I'm happy that I waited for them to be more full cooked, even though it meant a bigger baby, which led to my c-sections. I don't have any regrets about forcing them to come out before their time, you know?

BUT...I also think this is something you have to be comfortable about yourself. Only you can know which way you'll have more regrets--having an induction with a baby that ends up in the NICU or waiting and ending up with a c-section.


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## terra-pip (Aug 30, 2008)

I've always been told I look and feel like I carry small babies..but both were 9 pounds. I even had a u/s with my first indicating he was big...and my EDD was off by nearly a month. Nope... He was a week late! And I had them vaginally no problem.

I have heard so many stories of mom's getting csections for "big baby's" and they ended up being 6-8 pounds. I know of one mom who ended up having a baby life flighted because her "big baby" was way too small to breathe on his own. I even have a friend recently who was induced for a "big baby" just a few days before her due date...6 pounds. I would never consider a non vaginal birth if weight was the only concern. Especially since you said your diet was well controlled. And your measurements can be 2-4 cm on either side of your weeks, right?

Ultrasounds can be way off. I think people get a bit too concerned about the weight issue...what weight makes for a healthy baby. I would be more concerned with things being wrong and the baby being too small actually as well as the other problems that arise with induction/sections. And there are laboring positions you can try if you should be concerned about SD...hands and knees pushing, counter pressure, etc. I dealt with a mild case of that with my first. Everything went well.

I would keep researching, and keep asking questions, listen to your instincts. Hard choice to make. Hoping it all works out well for you.


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## loveneverfails (Feb 20, 2009)

I am not thinking straight today and missed the GD mention. In that case, I would confirm size with a 3d ultrasound (just so that I really, really knew what we were looking at) and schedule a c-section.

Here is why I would choose a c-section:

I've had a shoulder dystocia, a pretty severe one, in a baby who was 10 lbs 2 oz. We are lucky that she is alive. While "fat squishes" is somewhat true, fat also impacts the ability that you have to maneuver a stuck baby. Unless you've seen or experienced a shoulder dystocia in a truly macrosomic infant, I don't think you can really see how bad this can be. You're not just up against extra padding. This isn't just a chubby baby. You can be giving birth to a baby who has the frame size of your average 3 month old, and go from a perfectly wonderful baby on the inside to a baby Apgaring at 0 in 3 minutes flat. This isn't something to write off.

Beyond that, the shoulder dystocia rate for moms with gestational diabetes is significantly higher than for moms without gestational diabetes even if the baby's birthweight is the same. It's been a long time since I looked at it, but my understanding was that the shape of babies born to mothers with GDM is different enough that a baby is more likely to get caught up.

I would want the ultrasound in 3d as a final confirmation that your son really is looking that big. But the previous poster is correct about lung maturation in babies born to diabetic mothers, so the scales *for me* would tip more towards c-section at this point.


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## Storm Bride (Mar 2, 2005)

I'd sit around crying for week...then, I'd _probably_ go with the c-section, to give the baby the extra time to mature. However, I think I'd do everything I could to at least go into labour first, instead of scheduling. Of my three scheduled c-sections, the one I hated the most, and the one where my baby had the most trouble, was the one where I didn't have any labour beforehand. My other two were as good as a scheduled section can get, imo - labour started spontaneously just before the surgery (the night before in one case and about an hour before I left for the hospital in the other).

I don't really know a lot about GD, but I'm very edgy about early inductions...

Honestly, the more I think about it, the more I don't know what I'd do...I have a real thing about choosing a section, but I'd also hate to choose induction.

I'm am curious about one thing. If one does attempt induction, can you just leave if it doesn't "take"? I hear so many stories about emergency c-sections for failure to progress when labour's being induced, and I'm just wondering if there's a reason why they can't just stop the induction and either wait for spontaneous labour or schedule a c-section later (barring an induction for pre-e or something like that). Is there a reason or is just a "once we've started, we'll finish" thing?


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## 34me (Oct 2, 2006)

This is only coming from my experience, so definitely take what you can use and throw the rest away. I was having issues with phlebitis in my pregnancy with my dd so my gp decided to induce her at 38 wks so that I would stop retaining fluid in my legs. I went in the night before and started induction and the pit was started at about 9am. I went home about 9pm because you know what - it doesn't always work







. No one told this formerly mainstream mamma this little fact 16 years ago. She was born 2 weeks later on her due date at 8lbs even. Her brother was born at 41+4 by emergency (general anesthesia and everything) c section and was 9lbs 3 oz after he went into distress with induction.

So really it is whatever you are comfortable with as your mileage may vary...


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## kittywitty (Jul 5, 2005)

As for weight and shoulder dystocia (From the unnecessarean):

One half of all cases of shoulder dystocia occur at birth weights of less than 4,000 g (8 lbs., 13 oz.).

Acker DB, Sachs BP, Friedman EA. Risk factors for shoulder dystocia in the average-weight infant. Obstet Gynecol 1986;67:614-8.

In a 1993 study to test the hypothesis that elective induction of labor, compared to spontaneous labor, reduces the cesarean rate in women with a sonographic diagnosis of fetal macrosomia, researchers concluded that because elective induction of labor increased the cesarean rate and did not prevent shoulder dystocia, mothers with macrosomic fetuses can safely labor spontaneously. [Combs CA, Singh NB, Khoury JC. Elective induction versus spontaneous labor after sonographic diagnosis of fetal macrosomia. Obstet Gynecol. 1993 Apr;81(4):492-6.]

Also, shoulder dystocia only occurs in about 0.5% of births.
http://www.shoulderdystociainfo.com/anticipated.htm

http://www.library.nhs.uk/Diabetes/V...x?resID=236711

http://www.gentlebirth.org/archives/gdhgoer.html

http://journals.lww.com/greenjournal..._Fetal.10.aspx


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## loveneverfails (Feb 20, 2009)

The flip side to the 50% of shoulder dystocias being in babies who are under 4000 grams is that the other 50% of shoulder dystocias are happening in only the top 10% by weight of babies. 50% of a given complication happening in only 10% of the birthing population is enough to give one pause. Weight is a relevant factor if you are concerned about shoulder dystocia, and the OP *is* concerned about that complication.


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## kittywitty (Jul 5, 2005)

And the research shows an increase risk of sd in inductions. But still in a very small percentage of births compared to the tripling of death rates and respiratory distress with c-sections. I'm just providing information as she requested on the subject.


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## 2sweetboysmom (Aug 1, 2006)

*StormBride*- I am throwing at least one full on temper tantrum over this daily. I feel like I am in a position of deciding between 3 things which all have genuine risk and weighing in the balance my lil guy and his health and my own ongoing health too as the mom of 4 busy boys. My ability to be an active part of their lives going forward has value too, YK.
I am having some pretty intense prodromal stuff for weeks now and alternate encourageing it and ignoring it. It really seems to me that he is just not finding a good position. In addition to having followed spinning babies stuff the whole pregnancy (last baby was a late breach) I am continuing to do all of the positioning stuff and my regular chiro.

*Kittywitty*- Thank you. I appreciate your links and such. I have been researching this for a few weeks now and want to make as informed a decision as possible. I honestly never thought I'd be _here_. My last birth was to an IUGR babe!










Quote:


Originally Posted by *kittywitty* 
As for weight and shoulder dystocia (From the unnecessarean):
One half of all cases of shoulder dystocia occur at birth weights of less than 4,000 g (8 lbs., 13 oz.).
Acker DB, Sachs BP, Friedman EA. Risk factors for shoulder dystocia in the average-weight infant. Obstet Gynecol 1986;67:614-8.

Which seems reassuring to the mother of a LGA baby, but the other side of that equation is...One half of all shoulder dystocias occur at birth weights _greater_ than 4,000g (8lb13oz)
Incidently 4,000g is the 90th% line for birth weight. So the 10% of births (which happen to be over 4,000g) get 50% of all occuring shoulder dystocias.
Babes born with weight in excess of 4500g experienced dystocias 22.6% of the time. Acker (1985)

"The overall incidence of shoulder dystocia varies based on fetal weight, occurring in 0.6 to 1.4 percent of all infants with a birth weight of 2,500 g (5 lb, 8 oz) to 4,000 g (8 lb, 13 oz), increasing to a rate of 5 to 9 percent among fetuses weighing 4,000 to 4,500 g (9 lb, 14 oz) born to mothers without diabetes.2-4 Shoulder dystocia occurs with equal frequency in primigravid and multigravid women, although it is more common in infants born to women with diabetes."
Shoulder Dystocia
ELIZABETH G. BAXLEY, M.D., University of South Carolina School of Medicine, Columbia, South Carolina
ROBERT W. GOBBO, M.D., University of California at Davis Family Practice Network, Merced, California
Am Fam Physician. 2004 Apr 1;69(7):1707-1714


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## loveneverfails (Feb 20, 2009)

2sweetboysmom, scroll down further on the shoulderdystocia info page. They've got the chart for diabetic moms on there. I know you've been controlling your diet really really carefully, and the "diabetic mom" group here includes the entire population from you to the mom who drinks 56 oz slushies 8 times a day.

According to the diabetic chart, you've got the following likelihood of encountering shoulder dystocia:

Weight Non-Diabetic Diabetic
< 4000 g 1.1% 3.7%
4000-4499 g 10.0% 30.6%
> 4500 g 22.6% 50%

Now, even if you encounter shoulder dystocia, that doesn't mean you get a permanent injury. It runs the gamut from simple repositioning to the last ditch trying to put the head back in the uterus and perform an emergency c-section. There are some temporary things you can run into after a shoulder dystocia that more or less resolve on their own. But shoulder dystocia can cause permanent nerve damage, bone fracture (arm or clavicle), and hypoxic brain injury. It can be fatal.

And another factor to consider is that if you induce, your baby may be somewhat oxygen deprived from the pitocin already going into a shoulder dystocia scenario. That is worrisome to think about.


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## April422 (Nov 28, 2007)

Another factor everyone is leaving out (or I've missed it entirely) is how our birthing practices contribute to shoulder dystocias. Supine positions, epidurals, etc. Further control for those factors and the risk can be reduced.

I'd never have an elective cesarean for a suspected or even "confirmed" LGA baby.

There's also some room for debate about a "diabetic" who is diet controlled only, vs a true diabetic who requires insulin, etc. If your "diabetes" is controlled you don't have the same risk factors that diabetics who can't get control even with insulin do.

Twice in over a decade have I seen ultrasound correctly predict a LGA baby. Twice.


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## seren (Jul 11, 2003)

I have thought about this a lot in the last two years. There are times I look at my 25 month old as he conducts music (his favorite activity) and it literally brings me to tears. I thank God every day for the miracle that He blessed us with. I am overweight. I did not have gd for most of my pregnancy, I tested frequently. I stopped towards the end and we think I developed it then. Or maybe I had it all along, I was just very careful and when I quit testing I wasn't so careful. I also had a football sized fibroid on top of ds in my uterus, so it was hard for my midwife to accurately gauge how big ds was. Even I didn't realize. When I was pregnant with my third, I knew she was bigger than my other two and she was 1.5-2 lbs bigger than they were. When ds's head came out he got stuck. Nothing I did helped, no way I moved, no position I got it. I was pushing with everything I had. I could tell it wasn't doing anything. THe midwife used what she called "the corkscrew method" to get him out. He was 10 lbs 6 oz. He had gone into distress. He did not breathe on his own for four minutes. His 1 minute apgar was either 0 or 1. I can't remember right off the top of my head right now. By 5 minutes he was up to 8. It took a bit for us to realize ds wasn't moving his arm. The midwife had bruised his nerves. He had perfect finger print bruises on his arm and shoulder. He had a brachial plexus injury. We took him to the dr at 4 days old (he was born Thursday) and they did x-rays. They sent us to a physical therapist. I cried when we met with her. She told us that ds might never clap his hands, he might never crawl, he might never be able to use his left hand to feed himself. Let's not even talk about the mommy guilt. Ds was in therapy for 13 months. He healed so quickly he astounded all the therapists at the place we went. He only went for so long because he got so used to not putting weight on his arm he wouldn't crawl properly, so we worked on that until he could walk. My son literally is a miracle baby. His story could have had many different endings. I never realized just how dangerous dystocia can be. We're lucky he only had a brachial plexus injury. Where he had therapy, they have 4-6 year olds who are not doing as well as ds was at 6 months. I thank God every day, I truly believe he work a miracle to heal ds.

Now, after all that. Would I have had a c-section instead? Absolutely! I would have saved him from all that if I had known it was even a possibility. The birth was traumatic. Physical therapy was hard, he hated it. As much as I fear a c-section, I would have done it for him.


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## kittywitty (Jul 5, 2005)

Seren-I have a friend whose dd died from shoulder dystocia. It's so immeasurably scary. Luckily her second did not have sd and was fine. Even the experts say it's entirely unpredictable per the research. It's crazy. Unfortunately, everything carries risk. I was lucky my son only has some gross motor delays and continuing digestive issues and neurological issues from his induction. C-section would not have helped-he was just early due to the u/s being wrong as it so often is.

I also hemorrhaged severely after the birth when they pulled the placenta out and swept their arm in so they could get off work sooner instead of wait for it to come out on it's own. I had seizures and still am traumatized. I just wish someone would have told me there were real risks with inductions. I knew c-section complication and death rates. I had fought a c-section off for years and researched it, but never knew about the induction part. It hadn't been relevant. There are very real risks with c-section, and playing the what if game doesn't help. Something could always happen. Unfortunately with the OPs situation, the research is not entirely clear, though the conclusion of all the research I have seen and posted has said to attempt vaginal birth but that induction does not decrease perinatal morbidity-it's statistically the same, either way. But for suspected macrosomia which can only be proven post-birth, vaginal birth is safer.

OP, found some c-section facts just to consider. I am not anti-csection, I just think it's important for every mother to know the stats and have been researching this anyway just in case I would have to transfer out of my mw's care for any reason.

http://www.americanpregnancy.org/lab...reanrisks.html

http://www.ncbi.nlm.nih.gov/pubmed/14981385

http://www.usatoday.com/news/health/...sections_N.htm

http://cme.medscape.com/viewarticle/512946_4

Vertex presenting macrosomic infants weighing > or = 4500 g should be delivered vaginally
http://www.ncbi.nlm.nih.gov/pubmed/8794545

Induction and/or cesarean section for suspected fetal macrosomia, or "big babies" does not improve outcomes
Sadeh-Mestechkin D, Walfisch A, Shachar R, Shoham-Vardi I, Vardi H, Hallak M. Suspected macrosomia? Better not tell. Arch Gynecol Obstet. 2008 Feb 26; [Epub ahead of print] PMID: 18299867
http://blog.givingbirthnaturally.com...-cesarean.html

"If elective cesarean section for suspected fetal macrosomia is contemplated, the decision analysis discussed previously determined that for an estimated weight of 4,500 g, 443 cesarean deliveries at an estimated cost of $930,000 would be required to prevent one permanent brachial plexus injury.21 Presumably, elective induction for suspected macrosomia in pregnancies complicated by diabetes has the same increased risk of cesarean delivery as it does in pregnancies with no diabetes. In addition, the higher risk of neonatal respiratory distress syndrome in infants of mothers with diabetes should be considered."...

"In addition to these studies, a recent metaanalysis3 concluded that induction did not decrease the rate of cesarean section, instrumental delivery or perinatal morbidity."
http://www.aafp.org/afp/2001/0115/p302.html


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## turnquia (May 26, 2008)

I say trust your gut mama. Do what YOU and your partner/spouse decide is best. Your a smart woman I can tell by reading your posts... you will do what is right for you.

I sense that if you wait for labor and a dystocia happens there is no way you'd ever be able to forgive yourself.

The risks of a C-Section would be too high fo rme to consider. However I'd consider an induction at 38 weeks. 37 would be pushing ... but 38 I'd be ok. Especially if I TRUELY thought baby was in danger in rather than out at that point.

No amount of statistics can help you decide this. Because there is always a chance SOMETHING could happen. You just need to make sure whatever path you decide its because you felt it was the best choice given what information you have. And IF something happens its because you were doing what was best.

No on on here is qualified to attempt to sway you either way.


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## msmiranda (Apr 22, 2009)

I think you've gotten some great advice here, I agree with everyone who said to get as much confirmation of size as possible before intervening ... and I also wanted to say that if it were me, I would consider whether or not I planned to have more children, as risks are lower with a first section and higher with each successive section (and of course higher in a VBAC, if you were able to go that route, than for a woman who has never had a section). Probably not determinitive, but something that might enter into the calculus.

This is a Hobson's choice no matter how you slice it. Hugs to you.


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## Climbergirl (Nov 12, 2007)

For me, I would do everything to make dang sure that baby was really going to be > 11 pounds. If that is a 3D ultrasound, I would get it. Also, I would get a second opinion from someone else. The options you are given suck.

I measured ahead for most of my pregnancy and my DS was 9 pounds. Big, yes. But, I think that most would consider that "doable".

I would not do an induction at 37 weeks. I watched my SIL go through hell when her OBs stopped preventing her premature labor at 37 weeks. Baby and mom were discharged from hospital after 2 days, and baby was in the NICU 2 days after that. He was having a hard time breathing and would not wake up. The NICU nurses told my SIL they see this a lot. OBs says the lungs are developed enough, but they told her that, especially with boys, they sometimes are not ready enough at 37 weeks. Have no idea why being a boy would make a difference, but that is what they said. My nephew was in the NICU for 5 days.

The c-section? Well, honestly, if you are going to do a c-section, I would wait until labor starts. The hormones your baby gets are very helpful to helping the baby (especially being born in not the way nature meant). I honestly think that being in labor really helped my son before the c-section (and he still had breathing issues). You could just do labor for a while and then do a c-section (if you are planning one anyway). But definitely plan on a long recovery time. It is major surgery and recovering from that with an infant can take a while.

I would say though, you need to compare the risks of a c-section (or induction) to the risks of having shoulder dystocia. And if you want more kids, then what those risks are for the 2nd or 3rd c-section. Some women have nice, uncomplicated c-sections even with the 2nd or 3rd. Some women (like me) have horrible unforeseen complications that require an additional hospital stay. The nature of statistics, you never know where you will fall within them.

I think honestly, if it were me, I would try some serious natural induction techniques around 38 weeks. If you do a search, I am sure you will find some. Pumping (or nipple stim), herbs, sex, walking a ton, etc. Only because I find the choice of hospital inductions versus a c-section to not be really a good one. If that didn't work, I would try to go to 40 weeks, get a 3D ultrasound sometime in the 39th week and then, if the baby was looking super big and I did not feel that things were "right" (because your outlook and thoughts will impact things), I would labor for a while and then have a c-section. But I would do everything I could to avoid both.

I am so sorry you are in this situation. You are definitely in the "rock and a hard place" scenario.


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## JBaxter (May 1, 2005)

Baby #4 measured "big" for me from 32 weeks on. I did not have GD and my other boys were 8lbs, 8lb12oz, 9lb 8oz all had 14 1/2 in head.

I fought with one of the OB's in my office because he wanted to schedule a csection at 39wks OR induce at 39wks. The office I go to will not induce before 39 weeks unless they do a amnio ( some OB recommendation)

I declined. I did preschedule an induction at 40wk6days my babies will not come before 40+weeks.
With the under standing if the baby didnt do well with induction we would section him.

We did a slow over night induction was 1-2cm ( I slept) broke my water at 8am Pitocin at 1pm delivered with 3 pushes at 8pm.
Jack was only 10lb 1oz ( they were guessing 10 lb 8oz ) with a 15 1/2 in head but was 23 inches long.

Inducing for me ( in my gut) before 40 weeks would have insured a csection. I know I pushed harder and did not have a working epidural ( they tried and it failed)

I would not just schedule a csection with out trying.

Oh the OB I had issues with tried to give me sholder dystocia lecture. I birthe 3 others granted not quite as big but cousins daughter had a broken collar bone due to shouler dystocia and she was less than 8 lbs.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *2sweetboysmom* 
*StormBride*- I am throwing at least one full on temper tantrum over this daily. I feel like I am in a position of deciding between 3 things which all have genuine risk and weighing in the balance my lil guy and his health and my own ongoing health too as the mom of 4 busy boys. My ability to be an active part of their lives going forward has value too, YK.

Oh, I know that one...all too well.

Quote:

I am having some pretty intense prodromal stuff for weeks now and alternate encourageing it and ignoring it. It really seems to me that he is just not finding a good position. In addition to having followed spinning babies stuff the whole pregnancy (last baby was a late breach) I am continuing to do all of the positioning stuff and my regular chiro.









I'm just sitting here hoping you go into real, spontaneous labour before it comes down to the induction/c-section choice. What a nightmare.


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## kittywitty (Jul 5, 2005)

I agree, Storm Bride. From what you've stated, OP, I'm assuming you'll hit spontaneous labor before it gets to that point. Good luck!


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## 2sweetboysmom (Aug 1, 2006)

Thank you all for your thoughts and research/links.
Pulling out the stops to encourage labor...Except castor oil, really can't wrap my head/stomach around that :yuck
Really hoping/praying I can get labor in full gear by around this time next week. If not, I'm leaning toward a c-section after labor starts on its own. For me the risks of dystocia occuring for a babe in excess of 5,000g (11lbs) is more than I can get my heart and mind around. I'll ask about a 3-d ultrasound to add validity to the suspected macrosomia diagnosis.

Today is coolish for a so-cal July day...maybe I'll take my guys out hiking again.


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## kittywitty (Jul 5, 2005)

Yeah, castor oil is icky. I have heard that a castor oil pack on your back is a less intense way to kick start, as well as EPO internally and vaginally. Lots of walking, sex, and exercise. RRL tea. Facing the options, this is what I would do.


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## AustinMom (Jul 16, 2008)

Yeah, really sucky spot you are in.

I would make sure you do some research on preventing shoulder dystocia (not just by baby weight, which seems like it is out of your hands). Thinks like which positions are better, how to fix SD by changing positions in labor, etc.

I think it's great that if you do decide on a CS, you are going to go into spontaneous labor.

Either way, to make an informed, comfortable decision, it's best to cover all the research on every situation, especially SD, and not just where it is more common, etc. Things like having a mom not push on her back, push with an open pelvis position like squatting, hands and knees, etc, and if you do run into shoulder dystocia, just move positions and such and that usually frees babies.


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## Lineymom (Mar 14, 2009)

I've had 3 big babies vaginally. The U/S was off by 1lb+ with 2 of them. The boys 10lb4 and 11lb1 came with no stuck shoulders. The smallest and last got very stuck. It was a HB. Midwife had me get on hands and knees after her head was out and it was obvious she was stuck. It took a few more pushes to get her out. She pinked immediately.

Would she have come out fine if I have not been able to turn over (like in hospital setting) I don't know, but I thought you may be interested because of the whole bigger baby= more likely to have dystocia issue. Her head and chest circumferences were an inch smaller than my 11lber that didn't have dystocia. I did have to do as extra hard push for his shoulders, though.

I firmly believe that if I had been induced early even by a few days with any of them, it would not have worked. My body was working so hard to loosen those bones to let the babies thru in those last few weeks (I was so sore!!!). Not that I am saying you should do the section either.....


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## MyFillingQuiver (Sep 7, 2009)

Sometimes, all the options are crappy! Ugh!

I am SO hoping you go into labor on your own before you have to make any decisions, LOL!









I have a question here..if a mama has pretty sure dates, and yet her baby is larger than perhaps the others she's delivered, does this ever (or often) play a part into "going into labor early"? Does the size of the baby have a part in signaling mom to go into labor?

Does this mama have a good chance of going into labor prior to the need for decision making, because her baby is (assuming u/s is close) bigger than average term babies?

Oh, and on the macrosomia deal...my 1st pregnancy I was horribly GD. I was on LARGE amounts of prednisone which caused bad insulin resistance. I wore a 24 hr insulin pump. At 34 weeks I had PROM and early delivery. He was 6 lbs 10 oz, but had a chest circumference larger than his head-I believe it was 15 1/4. He looked like a buff little dude..I didn't realize then that his proportions were from being mainlined sugar, despite my best efforts...Now I know this is a GD baby. So, this would be where the dystocia came into play for me if it was going to..thankfully, I delivered without issue.

Blessings to you, and sorry you are faced with these worries...we are pulling for you! KUP!


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## Adamsmama (Oct 24, 2003)

Do what is in your heart to do. With my 2nd baby was right at 10 pounds. He was a huge baby -- fat and long but we did deliver naturally after his due date.

With my 3rd they told me she would be 11 pounds (had an u/s the day before her delivery) she was only 8 pounds, induced after EDD.

U/s can be wrong but I know that would be scary to have GD and know the chance of having a large baby. I think I would choose the induction at 38 weeks.


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## 2sweetboysmom (Aug 1, 2006)

FillingQuiver, that is an interesting thought/question. I am pretty sure this guys rapid weight/size gain is what caused my preterm labor at 31 weeks uterus/cervix thought he was approaching my usual delivery weight. I have never had PTL before, but dilated from very long/closed/firm to 75% effaced/3cm/soft in less than 24 hours, and was + for fFn. Being off my feet and on procardia till 35 weeks helped me to reverse to 25% effaced, 1-2cm and soft....Took the weight stress off??

This is my first GD pregnancy. I have weighed exactly the same each time I have gotten pregnant, but I have gained the least this pregnancy (without any effort on my part) I have not gained any weight at all since 25 weeks.
After two 2nd tri losses last year for unknown causes, we've had many people praying for a big healthy full term babe.....Maybe too many!


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## kittywitty (Jul 5, 2005)

Careful what you wish for, right?

I have not seen any evidence for preterm labor caused by size outside of multiple pregnancies. You sure there's one in there?








http://www.marchofdimes.com/pnhec/24043_24062.asp

http://www.drmomma.org/2008/01/fetal...-triggers.html


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## triscuitsmom (Jan 11, 2007)

Quote:


Originally Posted by *2sweetboysmom* 
After two 2nd tri losses last year for unknown causes, we've had many people praying for a big healthy full term babe.....Maybe too many!









OT: But I had to laugh at this







Being pregnant with Toad after losing five babies before him and everyone (including me!) was doing the same thing as you. The mantra was "stay in baby, stay in baby, stay in baby". He listened







He was born at 43 weeks, 2 days


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## MyFillingQuiver (Sep 7, 2009)

I wasn't even so much wondering about PTL, but more about just the uterus saying, "Alright, this one is HUUUGE...let's get this done now"..you know, like 37/38 weeks, rather than a 40/41 week gestation.

I just wonder if there is anything there to that question, but then I have to think no, because so many mama's deliver 9, 10, 11 lb babies AFTER their dates..so they'd be plenty big by 38/39!

Yes, praying for a big fatty fat fatso after your heart has broken in a loss certainly seems to have been answered big time!









I pray everything goes well for you, and that you are in labor SOON on your own!


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## AustinMom (Jul 16, 2008)

On the question of bigger baby-sooner spontaneous labor....I believe the newest research shows that once the baby's LUNGS (not size of baby as that doesn't really matter as much in thriving as lung development) are developed, the baby and the placenta shoot some sort of hormone to the mom's pituitary gland that signals her to start labor.

i don't think it's about size, I think it's about development, or if there are complications and the body is saying, get this thing out of me, it's killing me, etc, the body will do what it needs to to survive.


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## phathui5 (Jan 8, 2002)

At the postpartum visit I did today, the mom was telling me about someone she knew who just had a baby that the doctors said was going to be 11 pounds. They chose to do a c-section because of the size. The baby was born at 9lbs, 3oz (smaller than my client's vaginally born baby). It was likely an unnecessary surgery.

In your case, if it's something you are really worried about, I would go for a slow induction over a surgical birth. Get your Bishop score, decide about cervical ripening agents before they start pitocin. Do all your research. But remember that a baby measuring huge doesn't mean they will be.


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## Bubblette (Apr 26, 2009)

I haven't ready everything....

While GD does carry a risk of macrosomia and indeed changes in frame leading to higher rates of SD, if your numbers have been well controlled it is unlikely that this is the case for your baby. I did a ton of reading when I was diagnosed with GD- everything I could get my hands on said that diet controlled GD in a mom who is not obese results is similar outcomes to normal low risk pregnancy. Further, your fasting readings are the most important reading of the day. High after mean numbers are not correlated to typical GD problems.

That being said.... If I were in your shoes I'd get a 3D u/s, I would search my soul as to weather or not I thought the baby was BIG, and if I truly thought I was at risk for SD given how my GD had gone. Then, if after that I was scared about SD I would wait for true labour to start and have a Csec. No scheduled Csec, no induction, both cary higher risks.


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## mntnmom (Sep 21, 2006)

Quote:


Originally Posted by *cappuccinosmom* 
What about giving labor a try and having c-section as a backup plan (it is anyway, afterall, in hospital births)?

Personally, I would want to wait to at least 40 wks to induce. Especially if the dates are off, a couple weeks can make so much difference to lung development.


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## lovebeingamomma (Mar 16, 2007)

I thought you were gonna say your babe was 13lbs...9 lbs is not huge, 10 pounds is not huge, yeah it's big but people have those size babies all the time. I would never induce/section for myself, I would always give labor a go.


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## cathicog (May 7, 2005)

I think the ability of the mom to move freely to whatever position she feels comfortable in(and it might not please the staff, oh well) and avoiding being either on her back or semi-sitting, has more of a bearing on dealing with SD than the size of the baby, per se. I have seen 12 lbers birthed fine at home, and know one lady personally in another state who said her 13 lb boy was her easiest birth(also a homebirth). Also nuchal arm/hand can slow things down a little. But if mom has room to move and get on hands/knees, or however she feels comfy, she can birth a really big baby without distocia...and homebirth midwives are trained to help deal with/avoid SD, whereas most docs get a little panicky....a cesarean might cause lung problems further down the road, perhaps?


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## 2sweetboysmom (Aug 1, 2006)

An ultrasound at 6w2d exactly matched my regular 28d cycle, charted (sympto thermal) ovulation date, and the night we ruptured a condom!!







I am VERY sure of the dates for this pregnancy.

I understand, I'm not looking at 13lbs...but possibly over 12lbs by 40 weeks. I was not thinking monsterously huge...My title was more to indicate that I have a high degree of trust in these estimations for weight (for many arguable reasons, which I was not interested in debating) ie. Assuming it is true that he is big...induce, or c-section?

9 1/2 lbs at 36 weeks is very big...off the top of the chart big.
Since my largest babe to date was only 8.5lbs (and I worked HARD for him), 11lbs is as large as I will attempt. My intuition will not stop bugging me when I am considering a weight above 11lbs...But, I really would like to deliver vaginally.
My mother, mother in law, and various sisters in law on both sides have all had babes in the 6-8lb range, at term, spontanious labor. Within the sphere of personal experience and history there is a norm and an outside of norm for an individual.

My question is, what order do the risks of my various options fall into?
Is it better to *A.* induce+deliver earlier, risking induction and lung and liver maturity,or *B.* carry untill I go into active labor, but have no confidence in my ability to physically deliver because of my son's size and opt for a c-section, or *C.* trust that the moon stars and my pelvis will line up in such a way as I'll be able to vaginally deliver him (without injury to him or serious injury to me) no matter what his head and shoulder measurements may be?


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## KaliShanti (Mar 23, 2008)

C.


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## jeminijad (Mar 27, 2009)

I absolutely vote wait for early labor and then get the c-sec.

If you have these kinds of doubts, it will be problematic in your labor. If you _truly_ can't wait for labor to start do to an uncooperative care provider, can you schedule for 39 weeks or so?


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## kittywitty (Jul 5, 2005)

I would say C.


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## sept04mama (Mar 3, 2004)

I haven't seen all the other replies, but I'm sure most of them say neither. As a mom pg. after the loss of a newborn, I know that it's different after a loss. You aren't as willing to accept low odds because you've lived through being that "small" statistic.

That said, if this baby is anywhere near as big as my son who died, I will be considering an induction. I was measuring 40 cm 6-7 weeks before his birth. He was over 10lbs. and NOT fat or squishy. Totally bones/muscles. His shoulders got stuck, his x-rays showed a cracked collarbone that was bad, not just a little fracture, but almost split in half. Knowing he suffered that on top of the rest of his problems is hard. I won't do that to another child.

I say do what you think is best- I personally would go for the induction IF my body was ready to deliver. But I just wanted to say that after a loss or birth injury there is a different perspective.


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## loveneverfails (Feb 20, 2009)

Quote:


Originally Posted by *sept04mama* 
I haven't seen all the other replies, but I'm sure most of them say neither. As a mom pg. after the loss of a newborn, I know that it's different after a loss. You aren't as willing to accept low odds because you've lived through being that "small" statistic.

That said, if this baby is anywhere near as big as my son who died, I will be considering an induction. I was measuring 40 cm 6-7 weeks before his birth. He was over 10lbs. and NOT fat or squishy. Totally bones/muscles. His shoulders got stuck, his x-rays showed a cracked collarbone that was bad, not just a little fracture, but almost split in half. Knowing he suffered that on top of the rest of his problems is hard. I won't do that to another child.

I say do what you think is best- I personally would go for the induction IF my body was ready to deliver. But I just wanted to say that after a loss or birth injury there is a different perspective.









I am so sorry for your loss. I've had the giant framed babies as well, one of whom had a SD that could easily have been fatal. And I know how much my perspective altered from that experience.


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## Adamsmama (Oct 24, 2003)

Quote:


Originally Posted by *sept04mama* 
I haven't seen all the other replies, but I'm sure most of them say neither. As a mom pg. after the loss of a newborn, I know that it's different after a loss. You aren't as willing to accept low odds because you've lived through being that "small" statistic.

That said, if this baby is anywhere near as big as my son who died, I will be considering an induction. I was measuring 40 cm 6-7 weeks before his birth. He was over 10lbs. and NOT fat or squishy. Totally bones/muscles. His shoulders got stuck, his x-rays showed a cracked collarbone that was bad, not just a little fracture, but almost split in half. Knowing he suffered that on top of the rest of his problems is hard. I won't do that to another child.

I say do what you think is best- I personally would go for the induction IF my body was ready to deliver. But I just wanted to say that after a loss or birth injury there is a different perspective.

Totally agree with you. I vote induction as well.


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## 2sweetboysmom (Aug 1, 2006)

Had my weekly ob appointment this afternoon...It appears my placenta is weighing in on the issue too, and may wind up making the decision for me.







Fasting glucose has been dropping (which I know CAN indicate placental deteroration) but I have been ignoring it. BP is up, swelling is WAY worse and I am spilling +2 on the urine dip for protein.
Doing a 24hr urine plus all the misc lab draws, and adding twice weekly NSTs and ob visits to my life!
Will know the results on Monday or Tuesday am.


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## 2sweetboysmom (Aug 1, 2006)

Sept04mama








I am so sorry for your loss...Yes, loss definately colors your perspective and re-frames how you do things and think things through.

I really do feel reasonably confident that I could birth up to 11lbs, but beyond that my intuitition really won't allow me to seriously consider it, and that 'voice' is as important...maybe more so than any dr, or natural birth philosophy. I've been around farm animals all of my life. I know that occasionally things simply don't fit.


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## CookAMH (Jun 2, 2008)

I know you will make the choice that is right for your baby - I look forward to hearing the good news of his birth.


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## mamabearsoblessed (Jan 8, 2003)

Whatever your gut speaks loudest, go with it Mama.
I've been induced with pit 3 times. My 3rd birth, dd #2 was a requested induction if you will, at 39 weeks (after I swore to never be induced again). My gut was telling me something wasn't right, her movements were different, I was smaller and my day and night dreams were filled with visions of cord, knots and absent fluid. My mw knew and I knew that the baby needed to come. Had a nst and they tried tell me all was well, though it took 45 mins and juice and coersion for reactive strip, the fluid check was less than 1.5 and all the tech saw was cord. She couldn't find 1 good pocket for measure.
I went immediately for induction and dd was born safely 14 hours later. I ahd continuous monitoring because I needed to hear her and so did my mw. I would have been in for c/s in an instant given the situation and that was ok by me, my 'voice' was that loud. It's amazing she tolerated the labor and birth as she did.
She was born with an incredibly looong cord. My mw had never seen anything like it and was truly amazed, dd waswrapped and wrapped over and over with neuchal x3 also had 2 true knots, both pulled tight and begining to turn white, 1 snug between her legs, the other under an arm, and very, very little fluid in spite of the IVs for hydration throughout the induction. I don't mean this as a scary birth story, that's not my intention, just that in reality we don't know exactly what is happening in there. We only have our guts and our guesses.
You're right on with your 'voice' and yes, sometimes things just don't fit. A farm girl myself, I've seen that.
All will be well Mama, however baby gets here. It sounds like you are very concious with the reality of your ability and limits.







Mama.
I look forward to his birth story







.


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## umsami (Dec 1, 2003)

:

I'm on my 4th diabetic pregnancy (insulin)... having had three other GD (insulin, glyburide) pregnancies.

I was induced for DS1 and DD1. DS2 came on his own before my scheduled induction. DS2 was 9 lbs. 12 oz. and DD was 9 lbs. 14 oz.

I think based on what you're telling me, I would plan on keeping baby in as long as possible... even if it meant a c-section at 39 weeks. I would talk to my OB about perhaps another u/s at that time, and considering trying to induce if things didn't seem too big.

One thing I would wonder about is if you are going for the c-section anyway... can you wait until labor starts on his own to have it?? In that way, your baby gets all the necessary hormones, etc. to help prepare him to breathe on his own... plus you "know" that he was ready to come out. I don't know if there are issues with c-sections and larger babies, though... or if you are prone to quick labors, etc.

I think your intuition is the most important thing, though. So if you are leaning towards a c-section being safest for you and baby, then go with it. You can find some good c-section birth plans here on MDC that can help make the experience as positive as possible for you and baby.

Good luck... and may you have a healthy baby and good birth experience no matter what his size and how he comes out.


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## shelbean91 (May 11, 2002)

Given that inductions frequently end in csection anyway, I'd keep baby in as long as possible and opt for the csection. (I've had 2 easy vag births and one csection - surgical birth was no fun, not emergency, but medically necessary. I would have LOVED to not have it, but I know it was the right thing to do -this was my 3rd and last baby, so it was very sad for me, but healthy baby is most important. I did all I could to have a 3rd natural birth, but it just didn't work). It sounds like the decision will need to be made sooner rather than later. Good luck!


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## somegirl99 (Aug 22, 2009)

Just an update, 2sweetboysmom had her baby with an induction on July 13.

http://www.mothering.com/discussions....php?t=1244374


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## umsami (Dec 1, 2003)

Thanks for the update. So glad her induction was a success and that she and the little one are doing well.


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## kittywitty (Jul 5, 2005)

Congrats to the OP! Glad they are both fine.


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## Storm Bride (Mar 2, 2005)

Yay!! Thanks for the update!
















Congrats, 2sweetboysmom!


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