A bad first labour and a large baby on the way has led one mother to wonder whether an elective caesarean might be the answer for our second birth. Our midwife offers advice.

Raisingkids member's problem
I am 35 weeks pregnant with my second baby. At 33 weeks when I was measuring 36 my consultant, seemed concerned and sent me for a growth scan. The scan showed that the baby is big, and at 34 was estimated at 3.2kg! I am worried now, as at 35 weeks I am measuring for 38 and baby is obviously getting bigger and bigger.
My first baby was born at 41+1 weighing 8lb 11.5oz and his shoulders got stuck, so I am concerned that this baby will be the same, especially as it is so big already. I'm also suffering with Symphysis Pubis Dysfunction [SPD] this time which makes my concern greater as during my son's birth they had to pull my legs back to enable my son's shoulders to be delivered and having SPD, this won't be very comfortable for me!
I wanted to ask my consultant if it would be possible to be induced two weeks early, in the hope that the baby won't be too big, but I'm scared of asking, and of what to say. I have also thought of having an elective section, to prevent any unnecessary pain and damage to my hips! Do you think I have a good enough reason to ask, or will they say no. Of do you think it would be better to let nature run its course so to speak?

Midwife Genevieve Kingston's Advice
First to reassure you, I know your first baby's shoulders got stuck (did anyone mention the word shoulder dystocia, as that is when the baby's shoulders are truly stuck, sometimes it can seem that the baby is stuck because they try to deliver the shoulders too soon before they have rotated properly, without access to your previous notes I cannot say.), but you did, however, deliver him vaginally. This means that you have a wide (or at least not a small) pelvis and should be able to do it again.

Inducing somebody early tends not to have the greatest success rate. When you are inducing a woman, you are trying to trick the body into thinking it has gone into labour itself. The gels, pessaries and drips are a synthetic version of what your body produces. Breaking the waters works because it brings the baby's head into direct contact with your cervix which stimulates it. The problem is that if you try to do it too early, the body isn't fooled and once they start inducing you, the doctors have to see it through so if the induction fails you will need a caesarian.

Caesarians are a very useful method, but they come with their own risks. Having a caesarian is major abdominal surgey and it takes about 6 months to recover completely. You said you were suffering from SPD, which won't resolve immediately after the baby is born unfortunately. SPD is caused by hormones designed to make your uterus softer so it can grow. The body however, isn't very accurate and all your tendons and ligaments get softer - for some women this results in SPD. The SPD resolves slowly after the baby is born as the hormones disappear from your body, so you could have both a CS wound and SPD.

I am assuming the consultant has asked for more growth scans? They will be keeping an eye on this baby's weight and they will recommend CS or induction if they think your baby is growing too big. There is no reason why you can't ask at an appointment what the plan is. It's your body, your pregnancy and your baby, they are simply helping you. You could say at an appointment that you are nervous about delivering this baby, what were their plans this time regarding how big they are going to let the baby get before they intervene?

If you do have a vaginal delivery, I strongly recommend you look at alternative positions other than lying on your back. When you are laid down, it pushes your coccyx (tailbone) up, and this makes the vaginal outlets smaller - definitely something you don't need. If you are stood up, or squatting, the coccyx is free to move (it is designed to be flexible) which will allow the widest diameters possible).

If you have a vaginal delivery, there will be less recovery time than if you had a caesarian. Even if the baby did suffer shoulder dystocia your hips would be okay. If the baby was simply too big too fit through your pelvis, the head will not descend.

I really do recommend talking to your team, telling them your fears and asking what they are thinking. If you don't understand the answer, or feel you haven't been given what you want to know, ask again and ask the midwives to assist you. We do want you to have a happy (!) delivery, and even if the team seems rushed, you are in their care, and they do want what's best for you.