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Friday
Dec122008

For HoneyBunnyLove

I read this post this morning from a woman named HoneyBunnyLove. In it, she speaks about her baby measuring 2 weeks ahead and the midwife's discussion with her about shoulder dystocia and her need to see the GP to get clearance to have the homebirth she wants. She is in London, England, so their system is a tad different than for those of us in the United States, she needing the approval of all the care providers before being permitted to deliver at home.

She says in part:

I am SO frustrated.
So what if he is 2 weeks ahead in growth?!
Does that mean that I won't be able to give birth naturally on my own terms? :[
My midwife was telling me not to worry, because even if I do have a c-section then it doesn't mean I can't try to give birth naturally with my next child - oh, but I will have to be continuously monitored at the hospital from the moment I go in to labour, by the way! O_o
It took all my strength not to yell and cry..
Somehow I managed.

I sat there, looked right in to her eyes and I said "I will do this naturally if I can, as long as my son is healthy and not distressed. I would never purposefully endanger my sons health. But I want a natural birth at home, I want to try and give birth to him normally, even if he is a little larger than some babies. I want the chance to TRY."..

Because HoneyBunnyLove is on LiveJournal, I am not permitted to comment and really wanted to share a couple of things with her, so decided to write here instead of not saying anything at all.

HBL, I can't imagine how hard this must be! I think you are dealing with it really well. You are a trooper. Some thoughts...

1. If you are measuring larger than weeks just one or two times, it can be the position of the baby. Re-measuring is absolutely called for, if possible, by the same provider each week. It is very odd to me that they would want to send you in for a consult after ONE measurement with large-for-dates (large for gestational age - LGA).

2. If you were my client, I would discuss diet with you and HIGHLY encourage some serious changes in order to keep the baby growing normally, but not too big.

I have my clients with a history of large babies eat a diet with ZERO dairy. Dairy foods are almost pure sugar and can meke babies grow huge. I have seen subsequent babies up to 2 pounds less than a previous cesarean baby that was born surgically because of its size. It can be hard, but if you are already 36 weeks, at the most, it would be for 6 more weeks. You can do it!

I also ask my clients to not eat any meat that isn't organic. Most animals are fed feed with growth hormones to make them fatter faster. Well, humans don't need those hormones - and pregnant women need them least of all! Cutting out beef (especially) and eating only organic meats can also help facilitate keeping babies normally sized.

Keep juices OUT of your diet! Juices are only sugar and sugar can make for really big babies - see babies of not-under-control-diabetics as an example. If you want the juice, eat the fruit. That way you get the fiber as well as the juice and fiber slows down the metabolic processing in your body and it is very hard to eat as many pieces of fruit that would equal the calories of the small glass of juice you might want to drink.

3. Walk! Walking helps the metabolism of glucoses in the body, helping the body with any insulin issues that might be cropping up. Walk for about 15-20 minutes after every meal; this can really help with processing the glucoses in the body.

The midwife is right about shoulder dystocia... it can be gnarly! But, there are things you can do ahead of labor to try and keep that complication from happening (even though SD is a mechanical issue). Keeping your baby a healthy weight helps lots.

I hope some of this helps and I'll keep checking in on you to see how things are going.

If any of you are in LiveJournal, can you let HBL know this is here?

Much good luck, girl... I am rooting for you!

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    - Navelgazing Midwife Blog - For HoneyBunnyLove

Reader Comments (12)

There are a number of inaccuracies in this post.
[1] Any woman in the UK who absolutely wants a home birth, despite all advice to the contrary, can still attempt one. The medical/midwifery professionals are very unhappy, but it is the patient's right.
[2] Two weeks is not usually enough of an issue to worry about, in infant size. I wonder whether the midwife is either overly cautious, or the baby is indeed already very big. I see no mention of GDM status on the mother. Since there is a 4 week "window [38-42 weeks] during which she may give birth quite normally, the baby's size is not going to be exactly according to "average" weight charts anyway.
[3] Your dietary advice is in part not correct. Dairy products are NOT mostly sugar, and unless you want the woman to wind up losing her own calcium, the baby needs the calcium in dairy products. Besides, maternal ingestion of sugar, or calories, really has only a small effect on infant size [unless there is GDM, and even then, dairy products are encouraged.] The effect on humans of growth hormones allegedly fed to animals is minimal. The effect of animal protein in the diet of a pregnant woman is not. Organic food is expensive and mostly a scam anyway. It would be sensible for the woman to see a professional dietician in any case. Exercise is of course a good thing.

Is HBL a primigravida? Sounds like it. She may find the reality of labor and birth rather different than she expects, in any case. UK midwives can give some forms of pain relief in the home, but if she decides she needs an epidural, the woman will have to transfer to hospital in any case.

December 12, 2008 | Unregistered CommenterAntigonos

hey, Barb-

I'm on LJ, if you want I can send her a link to your blog? I didn't know people had problems commenting on LJ! I know my friends complain about it, but I didn't know it was so hard to do. Anyhow, just let me know and I'll do that fer ya.

Alex

p.s. oh, yea, the girls are doing great - 'your' baby is nearly 18 mos. old and talking up a storm!

December 12, 2008 | Unregistered CommenterAlex

Thanks so much for posting this. I have a bit of this anxiety myself for my next child (hopefully HBAC). My son was born 10lbs, I never measured a day over and my last u/s estimated him at 8.5lbs. While I don't think it was at all impossible for me to birth him, given his size, I had the odds stacked against me with a difficult induction/epidural, AROM, and rather asynclitic head down there.

My diet was not terrible during the pregnancy and I didn't have GD. He wasn't even chubby, just broadchested and BIG! Now that I think of it though, I did eat alot of meat (mostly sandwiches) and cheese, and drank quite a bit of milk.

Of course we'll be moving to SD in the next few months (HOPE!fully) and I'm sure if we get pregnant again there (likely) I'll be seeing you. :)

I know you probably won't see this for a while, I hope the surgery went great and you'll be back on your feet soon!

December 12, 2008 | Unregistered CommenterStassja

she needing the approval of all the care providers before being permitted to deliver at home.

+++++++++++

That's not really the case. The midwife and/or GP can recommend delivery in an obstetric unit (though generally, GPs keep out of this). However, the woman can decide to stay at home against this advice, and still have a midwife attend her in labour. Whether that's a wise thing to do is another question.

Estimating fetal weight is notoriously difficult, whether from abdominal palpation or from ultrasound. And while small for gestational age is one of the indications for recommending birth in an obstetric unit, large for gestational age is not - at least not according to national guidelines.

December 13, 2008 | Unregistered CommenterYehudit

55% of the calories in skim milk are from carbohydrates, all from sugar. But that is a far cry from being "pure sugar." 2% or "low-fat" milk is 40% carbohydrates because of the higher fat content. So even if your sugar/carb/calorie restriction advice to mothers of large babies were sound, which I really don't think it is, calling dairy "pure sugar" is just ridiculous. And it should be noted that cheese, which I presume you include in "dairy foods" has next to no carbohydrates and no sugar. If this information can be found in 15 seconds by typing three words ("nutrition information milk") into Google, and clicking the first link that comes up, why are you misinforming your clients this way?

December 13, 2008 | Unregistered CommenterNearly April

Good points. Thanks for clarifying for and correcting me.

Perhaps I shouldn't be so hyperbolic, eh?

Of *course* eating a hunk of cheese isn't like eating spoonfuls of sugar, but is it like eating piles of fat and empty calories? Some would say yes (but that is also being hyperbolic).

I didn't elaborate and say that IF dairy is eaten or drunk, then thinking of them as garnishes instead of a major food group can help keep the calories and carb counts in a reasonable number. Eating cheese and drinking milk according to the food pyramid - in the proper portion sizes - can keep things in order, too.

What I *do* know about women who are either vegetarians or who eat to above-fulfillment is many eat far out of proportion to their caloric needs. Dairy, for the most part, should not be a major food group. Yes, it does provide calcium, but if the caloric intake is far above the calcium benefit, a woman would be better off taking a supplement instead.

And, I also didn't say that I recommend that women not eat dairy or non-organic meats the last 6 weeks of pregnancy, not the entire time. The woman in the post is at that point, so I neglected to state that point.

What I tell my clients is said in context and over a discussion period far longer than a few moments long post. Obviously, I need to be more clear and in-depth. Thanks for the reminder.

December 14, 2008 | Registered CommenterNavelgazing Midwife

Wow Antigonos, you want to talk about innacuracies? First, I don't really even want to know what growth hormones "allegedly" being fed to animals even means. There is really no question that happens (here in the us anyway) and it's been proven that pharmaceuticals that pass through our systems into the water supply show up in our systems in scary amounts. What do you think happens with chemicals in the food you actually ingest? Of course that has an effect on us.
Second, do just a little research on dairy beyond the dairy councils "got milk" ads. The level of proteins in dairy and type is much too hard for our bodies to process. Therefore the calcium in dairy is not actually absorbed by us due to the process of our bodies trying to rid itself of the excess proteins. In addition, when studies are done of countries and the level of dairy consumption in relation to the level of osteoporosis, the countries with the highest dairy intake have the highest level of osteoporosis.
The advise she gave is actually sound advice if you know anything of nutrition other than believing that the standard American diet is healthy and that animal and dairy proteins are necessary and actually good for us. That is so far from the actual truth. I could go on and on.

December 14, 2008 | Unregistered CommenterRedmoon79

Being that you're a midwife and doula, I am curious about your opinion regarding the Brewer Diet. After I had PIH with my last pregnancy, I became well-informed on the Brewer Diet and how it can ward of PIH/pre-eclampsia. I am now pregnant and am going to work carefully to make sure I am getting at least 80 grams of protein/day. I ask this b/c of your comments about dairy. Although, Dr. Brewer's Diet has plans for lacto-ova vegetarians and vegans, too. Plus, I recently read the explanation about the original plan and why it contains so much dairy...since he worked primarily with poor women in the south, dairy and eggs were and inexpensive and easily-accesible forms of protein. Anyway, just curious about your thoughts.

This is my first comment on your blog! I've been reading off and on for a few months and it has been SO informative. I'm currently in training as a CCE (plus pregnant, of course) and I've learned a lot from your wisdom. Wish I lived in CA, b/c I would hire you as my doula in a heartbeat!! :)

December 14, 2008 | Unregistered CommenterSarah B.

HonyBunnyLove has been told of your post and had this to say:
"i also have to mention how grateful i am to "navelgazing midwife" for commenting on my situation and giving me some tips! :D
i must admit, i feel quite starstruck lol"

I was going to let her know about it since I'm on LJ, but 2 people had already commented. She got your message!

December 14, 2008 | Unregistered CommenterLarissa

Hyperbole aside, I'm still looking for, and not finding, any sound rationale for restricting caloric intake or carbohydrate intake (beyond what is normally appropriate which is ~60% of daily calories should be comprised of carbohydrates) outside of a diagnosed diabetes, gestational or otherwise, on the grounds that it would inhibit fetal growth in a good way. It sounds like a crap shoot, if the mother isn't known to have an insulin issue, and this is all to preserve a VBAC when the earlier section was for the medically nebulous dx of big baby, especially if there wasn't a true macrosomia and/or GD in the prior pregnancy.

December 15, 2008 | Unregistered CommenterNearly April

Nearly April: Not ignoring you. You asked great questions. I will get to it as soon as possible. :)

December 17, 2008 | Registered CommenterNavelgazing Midwife

Not sure if this has been mentioned already, but in the UK you can birth at home if you want to, regardless of your situation, and your care providers must attend. (Thanks Labour, ;-) ) They need to give you all the advice and risks etc. but the decision is yours. If it goes against their advice, you need to sign a form to that effect.

If the fundal height measurement is up to 3cm either side, that is not usually considered a problem. I am looking at a HB in 3 weeks time - and my FH is currently measuring 4wks ahead. I've been given the spiel on shoulder dystocia and might have to sign an AMA form, but no one can "make" me give birth in a hospital... I am the only person who decides what I am "allowed" to do with my body.

May 21, 2010 | Unregistered Commentermadasa

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