BIG BABIES

These are the stories of some of the big babies that I have delivered over my career. One of these was in India in 1960. Usmana a Muslim woman aged 38 years came into the labour ward and she was well established in labour, she was obese weighing 96 kgs. This was her 7th baby she never had any antenatal care (ANC), never had any problems with any of her pregnancies or childbirth. She came to the hospital as she wanted a tubal ligation so that she can also get a transistor radio which the Indian government was offering to all those couples who had a tubal ligation. This was to promote family planning in India. This was an enormous size baby lying as breech (bottom first). Her blood pressure was mildly elevated 146/90; her urine was loaded with sugar (Probably gestational diabetes). She was well advanced in labour her cervix was 8 cms (almost fully dilated). Luckily the presenting part was well down. I was very worried about the delivery, particularly the after coming head and post partum bleeding. Luckily she delivered so fast, I did not have to do anything. I gave syntocinon for the placenta which followed soon after.  There were no tears or bleeding. A glucose tolerance test which we did within 24 hours of delivery,(as is advised) confirmed gestational Diabetes. It was a male infant weighing 7.2 kgs’, it required care and treatment because of mothers gestational diabetes. I had to start believing in GOD even if I never did before this incidence; there were many situations that happen during obstetric practice that takes your faith to GOD.

The next case that happened was in 1978. This was a normal twin pregnancy which had regular ANC, but the babies were enormously big for twins. It was my practice to rest twin pregnancies in hospital from 28 weeks to 34 weeks in the hope of preventing premature labour which I did in this case as well. The babies were growing bigger every day; I decided to do an elective Caesarian Section (CS) at 38 weeks. Both babies were happily delivered; they were both females and weighed 7.5 pounds each. I felt safer in delivering them by CS, being such big babies the mother was 36 years of age and a primigravida. I followed these girls for many years I was advised that they were growing well and doing well at school.

The next woman I delivered was in Australia in 1986. By now I was an expereriened senior obstetrician. This woman was a recent migrant from Lebanon. She was aged about 37. She was not sure about her age, but this was the age in her passport.

She had had 12 children in Lebanon without any ANC or care during labour. All the children were alive and well. A very lucky family. She arrived in Melbourne about 30 weeks of pregnancy. When I saw her she was about 32 weeks pregnant. All her blood tests were normal. It is a routine in Melbourne to test all pregnant women for diabetes. This was very important in this case as she was obese weighing110 kgs, her B.P was normal. She had had 12 children ( the risk of gestational diabetes was very high in this woman because of her parity, age,obesity and this baby being very large) luckily for her she had a normal glucose test and no gestational diabetes. On Ultrasound it was estimated that the baby’s birth weight will be about 12 lbs. She did not know the weights of her previous babies, she thought they were average. This baby was almost always lying in different positions (Unstable lie) this is a serious complication of later stages of pregnancy. They baby can have a cord prolapse or even a hand prolapse then it can become very difficult to save the baby, and even the mother. I suggested to her and the family that we should deliver this by caesarean section, I had great difficulty in convincing the mother. I finally called her Priest who convinced her. A male baby was delivered by caesarean section and even this was difficult due to the position that the baby was lying in. The baby weighed 13.3 lbs and he did well.

I was greatly delighted when I was invited to his 21 birthday party and his mother was telling me he is the best of her 13 children. He had grown up into a handsome boy who was a charted accountant and played in a band.

The next biggest babies were born to a German couple. They were both about 6 feet tall, well built, very healthy with a good life style and they came to me for their first pregnancy at ten weeks. The pregnancy progressed well. They had told me that they were themselves big babies when they were born and weighed about 8 to 9 lbs. This labour started well, she required an epidural for pain  relief and normal labour progressed. She had a normal vaginal delivery of a male baby weighing nine lbs and two ozs in good condition with a good *apgar, with an episiotomy.

*(APGAR- measures the following in a baby-Activity (Muscle Tone), Pulse, Grimace (Reflex Irritability), Appearance (Skin Colour), Respiration).

No dramas, no Post partum haemorrhage. All went well. Two and half years later she came back to me for her second pregnancy. This time the pregnancy progressed well. She had no Gestational diabetes. This baby was also a big one, the ultrasound estimate of the foetal weight was ten and half lbs, I felt a bit anxious, but I knew that she had a well shaped big pelvis, and we would manage. This time she had a very quick and easy labour, she did not require even pain relief, however I repeated the episiotomy. He was born with good apgar weighing ten lbs four ozs. I felt happy.

Three years later I saw her for her third pregnancy. Now she was 34 years of age still well, she had not put on any weight, her blood pressure was normal, her glucose tolerance test was normal. Towards the end of the pregnancy I realised that this baby was really big. Estimated foetal weight was twelve lbs. I discussed caesarean section with her. Finally we agreed to give a trial of vaginal birth and if at anytime I felt that there was a problem I would do a caesarean section. Luckily she agreed. Labour progressed slowly with the help of an epidural. Towards the end the second stage was slow, that is, that it was longer than average for the baby to be born after full dilatation of the cervix. I delivered the baby by forceps, with a good apgar. Again it was a male baby, weighing 12lbs and 9 oz. There was some excess bleeding but not amounting to Post partum haemorrhage, which is when the bleeding is more than 500 mls.

I was in touch with the family for a long time; all the boys became involved in sports.

This story is of a big mother (Very Obese) who had a very big baby. This also showed me how I would get some sort of sixth sense about my patients .Christine was admitted to the hospital at 38 weeks of pregnancy as she was not feeling well.  At 9 pm I saw her and she was not too bad, her blood pressure was border line high 140/90, the urine was clear foetal heart monitoring was normal. I advised some sedation for her with a view to review her in the morning. In the middle of the night I felt like that I should go and see her now. When I got there the baby was very restless, the foetal heart sounds were non reassuring, I decided to do a caesarean section immediately. It was not an easy task because of the mother’s weight; the baby proved to be very big, with the cord round the neck (I wonder if that caused foetal distress), the baby’s extraction from the uterine cavity was not easy. It weighed 15 lbs and 6 ozs. It was the biggest baby I have ever delivered. The baby’s apgar was 7, it did well. There was a paediatrician present at delivery. The mother did not have gestational diabetes.

I understand that this baby remained big for many years. Maybe this was due to poor life style factors of the family.