Pregnant and Told You Have a Large Baby? What You Need to Know

by Brood

CW: This post discusses body sizes for both pregnant/birthing people and babies. The topics of body size, anti-fat bias and pregnancy are nuanced and often harmful, please proceed with caution.

*Anti-fat bias is very prevalent in our medical system and refers to a culture that promotes systemic discrimination and prejudice against fat people. This pervasive belief system promotes thinness as the ideal, equating personal worth with body size and encouraging weight loss as a means of achieving health, happiness and moral superiority. The topic of weight gain is one that birthing parents and families will be faced with navigating when going through pregnancy—in regards to their own body as well as the size of their baby. These conversations and experiences can lead in some instances to huge violations of privacy and personal boundaries. We hope we can dispel some common misconceptions and myths, especially the one about delivering “big babies”, with further reading, research and links below this blog post. Already navigating diet culture’s impact on pregnancy and parenthood? Read more about navigating diet culture’s impact on pregnancy and parenting here.

We’ve all heard the stories about delivering big babies before, and there are understandably some fears around birthing bigger babies. We get it, the thought of delivering a “big baby” is enough to send any birthing parent into a tailspin! Oftentimes, as you get closer to your expected delivery date, families may hear their doctors or midwives say that the baby is “on the larger size” and this statement alone oftentimes causes more harm than good. It would be amazing if care providers could accurately predict the size of your baby (for many reasons!), but at the end of the day the tools that are available to measure, like ultrasounds or physical exams, are about 15-20% off in accuracy. This means that for a baby that is estimated at 9lbs, it could be over or under 1lb, which is a lot! 

And yes, having a larger baby may pose some unique challenges, but not as many as parents might think. As doulas, we get so many questions about big babies and what to expect during labor and delivery, so we thought we’d break it down for you to ease some of your concerns and worries. There’s enough to think about already, right? 

lUp front, some key facts about larger babies:
What is considered a large baby?

Babies significantly “larger than average” for their gestational may be referred to as fetal or newborn macrosomia. Typically, a baby weighing over 9lbs at birth is considered macrosomic. Now, keep in mind that these growth charts and normals weren’t created to be diagnostic tools, but have become them. In preparation for this, take these suggestions with a grain of salt, while getting ready for the first year of doctor visits where they talk about percentiles (being below or above average), will make you more resourced for how tough these conversations and visits can be. 

If my baby is big, will I need an induction or a c-section?

The decision for induction typically depends on various factors beyond just the baby’s size. While a large baby might be a consideration, other factors such as the birthing parent’s health, gestational age, and medical history play significant roles in determining if induction is necessary.

Similar to induction, the need for c-sections aren’t solely determined by a baby’s size. Many big babies are delivered vaginally without any complications at all. However, in certain situations such as concerns for the baby’s or parent’s well-being during labor, a c-section might be recommended by healthcare professionals. Again, this likely won’t have anything to do with the baby’s size.

Part of why we’re writing about this topic is because of the many assumptions that are made about big babies and we want to support safe, effective and joyful birth journeys. When a care provider suspects that a baby may be larger than expected, usually during ultrasounds or your fundal measurements, families will often encounter a shift in how their care providers approach their labor and delivery.  This shift frequently results in an increased cesarean section rate and a greater likelihood of individuals being incorrectly informed that labor is progressing “too slowly” or that the baby is “too large to fit.” Research consistently reveals that the care provider’s perception of a baby’s size can be more detrimental than the actual size of the baby itself. Having an understanding of this and knowing your rights and advocating for yourself may help avoid these circumstances. Even better? Hire a doula who can help you navigate these situations and the medical system, advocating for you and your baby every step of the way!

Do big babies make delivery more challenging?

Contrary to popular opinions, the size of the baby doesn’t always correlate with the ease of delivery. While some big babies are delivered without complications, others may pose challenges during labor, such as shoulder dystocia or prolonged pushing. This is usually more dependent on your baby’s position in the birth journey/birthing canal, as it would with babies of a smaller size.

How do you measure the size of a baby in utero, and how accurate is it?

Ultrasound is commonly used to estimate fetal size during pregnancy. However, it’s important to note that these measurements aren’t always accurate and can have a margin of error of about 15-20%, as we mentioned above. Additionally, other methods such as fundal height measurement and clinical assessment may be used by healthcare providers. These measurements can be most helpful when applied to your individual growth curve, and when looked at based on a pattern over weeks. All of these measurements may give us the estimated width, height and depth of your baby’s size, but cannot accurately predict the density of your baby. Babies also most commonly match parents body composition — meaning some care providers may have concerns that upon reviewing the gestational parents birth stats, are to be expected.

By engaging in an open and thorough discussion with your healthcare provider about the estimated size of your baby, your perinatal history, physical examination findings, and any relevant risk factors, you can better create a birth plan that feels right for you. Working with a doula to help you navigate these conversations and advocate for you can be an incredible support – as these topics can be emotionally difficult and you deserve to understand your options and rights as a birthing person. We’re here to help advocate for you, every step of the way.

Additional Resources:

To support you in better understanding anti-fat bias, we are sharing this list that was created by our friend Victoria Welsby for our Bad Moms: F*ck Diet Culture workshop – where we discussed how diet culture and anti-fat bias shows up in pregnancy to parenting.

*How Anti-fat bias shows up in pregnancy and early parenthood:
  • Being told you cannot get pregnant as your body is inherently incapable due to its size.
  • Losing the ability to get pregnant due to poor care.
  • Being told to lose weight to increase changes of getting pregnant.
  • Being denied IVF and adoption/fostering due to body size.
  • Being routinely weighed.
  • The presumption that you make “poor” food choices.
  • Being told you are a high risk pregnancy solely due to weight.
  • Being booked in to have C-section or induction whereas small bodied parents are more likely to be told they can birth the way they want to.
  • Healthcare providers assume your body “cannot birth”.
  • Being given interventions early or that are not needed.
  • Being told you are a bad parent for being fat.
  • The presumption that you are harming your child because you have a bigger body.
  • The belief you cannot feed your child in a nutritionally balanced way.
  • Having a child removed from home for being fat.

Check out Doula Nicola Salmon’s amazing Fat Positive Fertility Resources for more information and support in navigating these topics. 

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We work and live on the unceded and occupied territories of the Sḵwx̱wú7mesh Úxwumixw (Squamish), səl̓ilw̓ətaʔɬ (Tsleil-Waututh) and xʷməθkʷəy̓əm (Musqueam) Nations. Since time immemorial, the original peoples of these lands have cared for their families and communities. We are committed to honouring their teachings, legacy and their sovereignty.

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