A locum told me my baby was on an "oblique lie" and that I needed an ultrasound because she was not happy with the position at 38 weeks. The next day the ultrasound showed baby in the transverse position and weighing approx 8 pounds. My regular private obstetrician saw me this week (39 weeks) and became visually distressed about the size of the baby, and stated that baby could get to 10.5pounds by the edd as baby has jumped from the 50th percentile to the 90th in one month. He said that we have a good case for an elective caesar next week. I dont want to have a csection but am terrified of the horror stories he told us about big babies, tearing, incontinence and shoulder displacement.
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Dr David
Moderator posted 19 December 2000 06:19 PM
Marie
Many issues here.
Your next post states that your baby is now vertex, or head first, so in the right position.
Macrosomia (big baby)/shoulder dystocia.
There is an excellent review article that your obstetrician could get and discuss with you. Prophylactic cesarean delivery for fetal macrosomia diagnosed by means of ultrasonography - A Faustian bargain? Rouse DJ and Owen J. AmJOG 1999;181(2):332-338.
Basically this discusses the inability of ultrasound to accurately predict birthweights in larger babies, the unpredictability of shoulder dystocia and the fact that shoulder dystocia usually does not cause permanent fetal injury.
Tearing
60% of women in Victoria have a tear or episiotomy at vaginal birth. 3.4% of those tears affect the anal sphincter muscle, 0.1% involve the rectum. (Perinatal data collection unit - 1999) A review of perineal trauma was published in the Lancet 22 Jan 2000 vol355 pp250-1 by Johanson R. The most important factor in perineal trauma is restricted rather than routine use of episiotomy. Antenatal attempts to minimise OP position may be important. (see October post in VBAC discussion forum) Size of baby is a factor, though not quantified in this review. Perineal massage may be helpful. Evidence suggest that "for every ten women doing perineal massage, there will be one additional woman whose perineum remains intact after delivery".
Incontinence
This is currently the source of much debate. A recent study using objective urodynamic testing suggested that "obstetric and neonatal factors were not related to urodynamic variables". That is, neither fetal weight nor mode of delivery correlated with change in urodynamic testing. This does differ from studies describing women's symptoms where there is a correlation between postpartum incontinence and vaginal birth.
Chaliha C et al. BJOG Nov 2000;107:1354-59.
DrDavid
DISCLAIMER:
This advice is of a general nature to help in decision-making. It
does not constitute recommended treatment for an individual. You must
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