Many predictions of childbirth are somewhat reliable — the sex of a baby, for example, and the due date, as well as the presence of certain significant medical problems. But no prediction in childbirth is an exact science — including the seemingly basic question of how big or small a newborn will be.
That final point was made even clearer recently by researchers who found that a significant number of women are being erroneously told that they would be having big babies. And the study, published in Maternal and Child Health Journal in December and based on the data of 1,900 women surveyed by Childbirth Connection, further showed that mothers who believed they were having big babies were nearly five times more likely schedule a C-section — even though the large majority of their babies wound up weighing less than 8 pounds 13 ounces (the medical definition of a large baby).
“Estimating weight is still an imprecise science. But the study is really more about communication than anything else,” one of the researchers, Eugene R. Declercq, a professor at Boston University School of Public Health, tells Yahoo Parenting. Figuring that a baby will be big, rather than too small (and then at greater risk of problems), he notes, “should be conveyed as good news, with no question about it being able to be delivered vaginally.” But based on the study’s findings, that’s not what’s happening, as a doctor telling a mom-to-be that her baby will be big “has a profound effect, and contributes to undermining women’s confidence they can deliver the baby,” Declercq told the New York Times.
That article, published on Monday, told the story of Maryland lawyer Katy Clemens, 37, who wanted to give birth naturally. But when an ultrasound suggested her baby would weigh 11.5 pounds, her doctors “bullied” her into scheduling a C-section — which she agreed to, only to reveal a baby weighing just 7 pounds 13 ounces.
“They said the estimates are never off by more than a pound. … You imagined a baby that was 30 percent bigger,” Clemens told the Times, noting that the surgery was unnecessary and might have caused breathing problems for her son at birth, as it’s a complication more common in C-section babies.
Fewer than 8 percent of babies born in the United States meet the medical definition of a large baby, the story noted, while nearly one in three babies in the United States are born by cesarean section — something that may be influenced by exaggerated estimates of fetal birth weight, Declercq said.
“Assessing fetal size is part of good care — knowing if it’s particularly small or large and whether there might be any issues at birth,” notes Eileen Beard, a nurse-midwife and senior practice adviser at the American College of Nurse-Midwives, a professional organization representing midwives in the U.S. “But,” she tells Yahoo Parenting, “women were made to birth babies, so size generally isn’t a problem.”
Estimating the size of a baby in utero “isn’t like taking a teaspoon and measuring something,” she says, but rather is an assessment, often based on what are called Leopold maneuvers — standard, manual procedures named after gynecologist Christian Gerhard Leopold — which are not exact, because of factors including the size of the mother and her abdominal tone, as well as the baby’s positioning. “Ultrasound is a wonderful tool,” she adds, “but it’s not always accurate.” In the recent study, Declercq says, about two-thirds of the women had relied on ultrasounds for weight estimates.
“I think there’s a lot of casual attitude about surgery, and our society has become very tolerant of it and doesn’t always view C-section as major surgery,” Beard says. “But I think obstetricians are becoming more sensitive to the fact that the cesarean rate is way too high.”
Fetal weight, she adds, “is just one factor I’d look at in making an overall assessment, because midwives have a holistic view of care. … So [weight is] just one little piece of the whole picture. We look at the whole woman and her ability to give birth and her confidence in giving birth, and we stress the importance of informed consent” when discussing C-sections or any other interventions.
That said, “Women have to be informed consumers. And a provider has to take the time to make sure she understands the risks of major surgery,” Beard notes. “I think if more women were informed about the risks, then the cesarean rate would be lower. Women in general have great trust in their providers, but many may not realize the variation in care that’s out there.”
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