Written by By Dr Jonathan Weinstein, MD, FACOG
- Arrives on the labour ward immediately after office hours and says, “I just don’t think this baby is going to fit.”
- Third Trimester, Routine Office Visit, “I think this is going to be a big baby. You should just have a c-section” –
ACOG has very specific guidelines for when it is appropriate to offer a patient an elective C/S for MACROSOMIA (fancy word for large baby). ‘Prophylactic (elective) cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights greater than 5,000 gms (5kgs) in women without diabetes and greater than 4,500 gms (4.5kgs) in women with diabetes.
- “We should induce at 39 weeks because your baby is getting too big” Did you know that, according to ACOG: ‘Induction of labor at least doubles the risk of cesarean delivery without reducing shoulder dystocia (rare situation where baby’s shoulder can get stuck at delivery) or newborn morbidity(complications). Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes.’
- Performs routine ultrasounds at end of pregnancy to see how big your baby is. Did you know that ultrasounds at the end of the pregnancy can be 1-2 pounds off? Ask some VBAC patients who were talked into a C/S for this, then had a vaginal delivery of a bigger baby the next time.
- “You have a positive herpes titer (or history of herpes); the baby will get it if you deliver vaginally.” Try some Valtrex for the last month of the pregnancy that is pretty much standard of care now. It prevents outbreaks and allows for a normal vaginal delivery.
- “Your baby is breech. You need to have a C/S” Ever heard of or performed an External Cephalic Version (process by which a breech baby is turned to the proper position)? It really does work.
- “You have pushed for 2 hours” (with an epidural that prevents you from feeling anything so you are probably not pushing effectively; this is evident on exam because the baby’s head is still perfectly round, but you do not need to know that) “It’s just not going to come out”
- “I scheduled you for an induction at 39 weeks. It is just soooo… much more convenient for you!” (and so much higher risk of ending in a C/S, especially if you are not dilated when you start the induction). At least 80% of my VBAC patients were induced the previous pregnancy. For whose convenience was the induction?
- First Visit (7 weeks), “Congratulations you are having twins. I will go ahead and schedule your C/S at 38 weeks, but don’t worry if you go in to labor early I will cut you right away!” Translation, “I am scared out of my mind for you to deliver your babies vaginally because I am not trained on what to do when the second baby is coming, plus it pays more to cut you open. Oh yeah, I don’t have that great a rapport with you because I only spend 2 minutes (fundal height, heart beat and ‘I’ll see you next time’) with you each visit, so I am afraid I will be sued for trying to do the right thing.”
- First Pelvic Exam in Office (7 weeks), “Hmm, your pelvis is pretty narrow”.