Birth + Beginnings Doula Services

Birth + Beginnings Doula Services Birth Doula located in Southeast, TN.

Cycle tracking is something that can be done to avoid or achieve pregnancy. When done precisely and with care, it is ext...
03/05/2026

Cycle tracking is something that can be done to avoid or achieve pregnancy. When done precisely and with care, it is extremely useful and accurate. It’s also an amazing way to get to know your body better.

Is this something you would try? Do you do it now? Would you feel comfortable doing this in place of birth control?

02/28/2026

✨ How amazing is this?! ✨

Breech is simply another way a baby might settle in late pregnancy. Only about 4% remain breech near the end. Although many providers routinely recommend a Cesarean for breech babies, newer evidence shows that some breech presentations can be safely born vaginally.

If you’re looking for reliable guidance on fetal positioning and gentle techniques to help a breech baby rotate, Spinning Babies is an incredible resource.

: 2Life Doula
📸: .doula.birthphoto

Which option did you choose for Vitamin K? Did you know you had 3 options? Let’s discuss in the comments! 🧡
02/12/2026

Which option did you choose for Vitamin K? Did you know you had 3 options?

Let’s discuss in the comments! 🧡

Being educated about labor, birth, and postpartum is very important. Being educated about your hospital of choice is als...
02/07/2026

Being educated about labor, birth, and postpartum is very important. Being educated about your hospital of choice is also important. I compiled the rates of some available information from https://ratings.leapfroggroup.org. Please share these with your family and friends so informed decisions and conversations can happen. 🤍

What makes you feel most supported when you need it the most?
02/05/2026

What makes you feel most supported when you need it the most?

Vaccines and SIDSThe talk and debate of vaccines is highly controversial. My goal is to always share evidence-based fact...
02/03/2026

Vaccines and SIDS
The talk and debate of vaccines is highly controversial. My goal is to always share evidence-based facts and to continue to learn and grow and never assume “the science is settled”.

This is a long summary, but it contains lots of numbers, facts, and details. I added the biggest highlights above the break (~~~~~), in this post. Everything after this is deeper detail with statistics and numbers.

This is my own summary of “Vaccines and sudden infant death: An analysis of the VAERS database 1990–2019 and review of the medical literature”. All of the information is directly quoted or shortened directly from the article itself. The graphic attached to this post has some of, what I thought were, the most important highlighted points from the article.

With that said, let’s get into this research article on Vaccines and SIDS. The highlights of this paper are as follows:
• Additive or synergistic toxicity may occur following multivalent vaccines.
• Of all SIDS reported after vaccination, 75% occurred in the following 7 days.
• Infant deaths post-vaccination are often misclassified as suffocation in bed.
• Inflammatory cytokines in the medulla act as neuromodulators causing prolonged apneas.
• Adjuvants that cross the blood-brain barrier may induce fatal disorganization of respiratory control.

- Summary of Abstract
Even with considerable evidence that a subset of infants has an increased risk of SIDS after vaccination, health authorities eliminated “prophylactic vaccination” as an official cause of death. This resulted in misclassification since medical examiners were forced to use other categories to classify these deaths.

Of 2,605 infant deaths from 1990 to 2019, 58% clustered within 3 days of vaccination and 78.3% within 7 days. This finding is statistically significant.

- Summary of Section 1.1: International Classification of Diseases
When an infant dies, there are 130 categories of death the coroners must choose from. Previously, “prophylactic inoculation and vaccination” was listed separately with subcategories for each vaccine. In 1979, all cause-of-death classifications associated with vaccinations were eliminated. This is odd since permanent disability and death are recognized after vaccines. This is the very reason for the National Childhood Vaccine Injury Act of 1986, which created VAERS and VICP.

-Summary of Section 1.2: Sudden Infant Death Syndrome
Prior to the introduction of organized vaccine programs, “crib death” was so rare it was not mentioned in infant mortality statistics. In the 1960s, several new vaccines were introduced and promoted. Most U.S. infants were required to receive multiple doses of DTP, polio, and measles vaccines. At this time, (1963-1965) measles vaccine was given at 9 months. Mumps and rubella vaccines were also introduced in the 1960s. By 1969, so many unexplained infant deaths were happening, a new term was given — SIDS.

By 1972, SIDS became the leading cause of death in infants occurring between 28 days to 1 year of life in the U.S. In 1973, the National Center for Health Statistics, operated by the CDC, created SIDS as a new cause of death category. An autopsy with SIDS ruled as the cause of death often reveals congestion and edema of the lungs and inflammation in the respiratory system. Throughout the 1980s, SIDS continued to skyrocket.

-Summary of Section 1.3: Back To Sleep Campaign
In 1992, the AAP came up with a plan to reduce SIDS. The AAP initiated the “Back to Sleep” campaign. From 1992-2001, SIDS declined by an average annual rate of 8.6%. It seemed that “Back to Sleep” was successful and SIDS was not related to vaccines. However, a closer inspection revealed a loophole within the ICD. They didn’t have to list the death as SIDS. Postnatal SIDS rate dropped from 1992-2001, but “suffocation in bed” increased by an average annual rate of 11.2%. Unexplained, sudden infant deaths that were classified as SIDS prior to “Back to Sleep” were now classified as “suffocation in bed”. Other causes of death that increased during this time were “suffocation other” and “unknown and unspecified causes”. Although SIDS declined, there was no difference in infant mortality rate backing the inspection that revealed the loophole of categorization.

From 1999 to 2015, the U.S. SIDS rate declined 35.8% while infant death due to suffocation increased 183.8%. As quoted by Lambert et al., “There is evidence of continuing diagnostic shift between SUID subtypes,” but “there have been little changes in the overall SUID rates since 1999.”

As previously described, the true extent of vaccine-related infant mortality has been obscured by:
•The cause-of-death classifications associated with vaccination that were eliminated from the ICD.
•SIDS became a commonly utilized cause-of-death category for at least some vaccine-related deaths (as confirmed by the VCIP awards that were misclassified as SIDS).
•SIDS cases were later reclassified under alternate ICD codes.

-Summary of Section 3: Results
From 1990-2019, there were 2,989 infant deaths reported to VAERS. 2,605 (87.2%) occurred within 60 days of vaccination. Infants less than 6 months compromised 86.5% of all deaths. Of the 2,605 deaths, 58% clustered within 3 days post-vaccination and 78% within 7 days post-vaccination. The deaths between 8-60 days occurred at an average of 11 per day compared to 760 deaths on day 2. Of the 1,048 SIDS cases, 51% were clustered within 3 days post-vaccination and 75.5% within 7 days post-vaccination. The remaining between 8-60 days occurred at an average of 4.8 deaths per day.

-Summary Section 5: of Conclusion
This study found a substantial proportion of infant deaths and SIDS cases that occurred in temporal proximity to vaccine administration.

*The excess of deaths during early post-vaccination periods was statistically significant.*

Several theories behind these events have been proposed, such as:
•Vaccine-induced inflammatory cytokines as neuromodulators in infant medulla preceding abnormal response to accumulations of carbon dioxide.
•Fatal disorganization of respiratory control induced by adjuvants that cross the blood-brain barrier.
•Biochemical or synergistic toxicity due to multiple vaccines administered concurrently.

There are 130 official ways for an infant to die when categorizing using the ICD, and ONE unofficial way: fatal reaction to vaccines. Because of this, the true number of vaccine-related deaths is uncertain. This is why increased transparency is a desirable goal.

Below this is further details, facts, and discussion points that pertain to this article and its findings.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

-Summary of Section 4: Discussion
Infant deaths as a whole and SIDS were not randomly distributed each day. Instead, death and SIDS cases reported to VAERS tended to occur early after vaccination (1-7 days). Theories of pathogenic mechanisms have been proposed, such as:
•Douglas Miller, neuropathologist and SIDS expert witness, suggests that vaccines evoke cytokine production that can produce a fever and inhibit the activity of 5-HT neurons in the medulla, causing prolonged apneas and interference with auto-resuscitation.
•Matturri et al. Hypothesized that luminous adjuvants cross the blood-brain barrier, “inducing neuronal molecular alterations in DNA, RNA, and proteins of the brain stem neurons regulating vital functions, with consequent fatal disorganization of respiratory control in particularly predisposed infants.”
•Miller and Goldman suggested the potential for biochemical or synergistic toxicity due to multiple vaccines administered concurrently.
•Torch (1982) found unvaccinated babies who died from SIDS did so most often in the fall or winter, while vaccinated babies died most often at 2 and 4 months of age — the same age when infants received their initial doses of DPT.

-Summary of Section 4.1: Early Evidence Linking SIDS to Vaccines
The following are documented cases of infants who died after receiving routine vaccinations.
•In 1933, Madsen documented sudden death of 2 infants soon after whole-cell pertussis vaccines. The first child developed cyanosis and convulsions 30 minutes after vaccination and died a few minutes later. The second child developed cyanosis 2 hrs after vaccination and died.
•In 1946, Werne and Garrow documented sudden death of identical twin boys 24 hrs after diphtheria and pertussis vaccinations. The babies had symptoms of shock through the night prior to the fatal reactions.
•Another case of 12-week-old identical twins died “lying on their backs”. Their deaths were labeled as SIDS. Five days prior, they each received multiple vaccines concurrently. These vaccines were DTaP, oral polio, hepatitis B, and Hib. - Mitchell et al.
•Huang et al. published a case of sudden death involving 10-week-old twin boys. Their mother found them on their backs, lifeless just 10 days post-vaccination of DTaP and oral polio.
•Balci et al. reported a case of 15-week-old identical twin girls who died suddenly 2 days after receiving oral polio, hepatitis B, and DPT vaccinations. Both were found by their mother “on their backs”. They were both healthy prior to vaccination.

In the 1960s and 1970s, Australian babies were dying at alarming rates. In some regions, as much as 1 out of every 2 babies. Archie Kalokerinos made the connection between their deaths occurring shortly after their vaccinations. Their deaths corresponded with the recent vaccine program. He also realized these infants were severely malnourished. Their underdeveloped immune systems couldn’t handle the added stress of vaccination. Some would die of vitamin C deficiency precipitated by the vaccine. Others died later of immunological insults such as pneumonia, gastroenteritis, or malnutrition. In response to this, Kalokerinos saved numerous babies by administering vitamin C (100mg per month of age prior to vaccination).

*Immunization leads to destruction of vitamin C. - Linus Pauling (Nobel Prize winner in Chemistry) supported the work of Kalokerinos.

In Japan, from 1970 through 1974, there were 37 documented SIDS deaths following pertussis vaccination. They reacted to this by changing the recommendation of vaccination from 3 months of age to 2 years of age. After doing this, deaths dropped from 37 cases during a 5-year period to 3 in the next 6.5 years. The rate dropped from 1.47 to 0.15 deaths per million — a 90% improvement. From the early 1970s to the mid-1980s, Japanese infant mortality rates dropped from 12.4 to 5.0 — a 60% improvement.

A special task force on Pertussis and Pertussis Immunization investigated the Japanese data and published it in the journal “Pediatrics”. They also made the following observation:
•”It is clear that delaying the initial vaccination until a child is 24 months, regardless of the type of vaccine, reduces most of the temporally associated severe adverse reactions.”

Goldman and Miller investigated more than 38,000 infant reports filed with VAERS. This included non-serious events. The hospitalization rate for infants vaccinated shortly after birth was 20.1%, but decreased to 10.7% for infants vaccinated just prior to their 1st birthdays.

Below are the following details of studies of infants who died due to SIDS following vaccination.
•1978-1979:
•11 babies
•Died 8 days post DTP vaccination from the same lot
•As a response, the manufacturer revealed a new policy of limiting shipment so no geographical location would receive product from the same lot to avoid a cluster of SIDS post-vaccination.
•2005
•Von Kries et al. analyzed the risk of sudden death in children 1-28 days following the hexavalent (6-in-1) vaccine (DTaP, Hep. B, Hib, Polio). In the 2nd year of life, children were significantly more likely to die within 1-2 days following hexavalent vaccination.
•2007
•Soldatenkova and Yazbak examined Hep. B vaccination and unexplained neonatal deaths. Of the 29 deaths reported to VAERS, 24 were attributed to SIDS.
•Of the 29, 13.8% died within 24hrs, 32% died within 3 days, and 44.8% died within 7 days.
•Authors concluded that any death following Hep. B vaccination should undergo a systematic review, and this should happen at an international level.
•Sudden Deaths within 20 days after hexavalent vaccination:
•97% occurred in the first 10 days. (Data obtained from a confidential report by GlaxoSmithKline, 2011).
•2015
•Another confidential report from GSK showed 52.5% of deaths were clustered within 3 days post-vaccination, 82.2% within 7 days, and 97.9% within 10 days.
•2015
•The CDC characterized the main causes of death reported to VAERS from 1997-2013. Among 1,244 child reports with autopsy or death certificates for review, SIDS was the cause. Most SIDS cases were around 2-4 months of age. Among 1,165 infants, 86.2% received multiple vaccines prior to death.

-Summary of Section 4.5: Case Reports
In 2019, Japanese scientists studied autopsy reports associated with SIDS in previously vaccinated children. Three of the children died within 3 days post-vaccination. The following are the case reports of 2 of those children.
•Case 1:
•3-month-old female
•Received: Hib, Pneumococcus, and Rotavirus vaccines. One week earlier, the baby received DTaP and Polio vaccines.
•Infant was found limp in the evening, transported by ambulance. Shallow breathing upon arrival, died 12 hrs with little response to resuscitation.
•Case 2:
•3-month-old male
•Received: 8 vaccines in total being Hib, Pneumococcus, Hep. B, Rotavirus, DTaP, and Polio.
•Baby was experiencing cold-like symptoms continuously from the day of vaccination. Found dead early morning of the third day.

-Summary of Section 4.6: Recent VAERS Reports
SIDS continues to occur shortly after vaccination. Here are 5 recent reports filed with VAERS.
• #860135 - February 1, 2020:
•2 months old
•6 vaccines concurrently being DTaP, Hep. B, Pneumococcal, and Rotavirus
•Cardiac arrest 3 days after vaccination
• #867981 - April 8, 2020
•2-month-old female
•7 vaccines given concurrently in the morning
•”Arrived in ER deceased” by 1:30 p.m. Physician claims the 2-month exam was normal prior to the vaccines.
• #873934 - May 21, 2020
•1-month-old male
•8 vaccines given concurrently being DTaP, Polio, Hep. B, Hib, Pneumococcal, and Rotavirus
•Was taken to the ER with SIDS 5 days later
• #873474 - June 11, 2020
•6-month-old male
•7 vaccines received concurrently
•4 days later, suffered from cardiac arrest at home and died from SIDS.
• #883878 - September 1, 2020
•3 month old male
•7 vaccines received concurrently
•2 days later he “experienced cardiac arrest” and was taken to ER but was unable to be resuscitated. No autopsy available at the time. SIDS suspected.

-Summary of Section 4.7: Sudden Unexplained Death in Childhood (SUDC)
SUDC is now a leading cause of death in toddlers, (1-4yrs of age). Although 100s are certified cases by medical examiners yearly, 392 cases were recorded by the CDC in 2018. In a recent study by Crandall et al., experts disagreed with the original certified cause of death in 40% of cases, including many that were considered accidental or natural but ruled “unexplained”. There is a low rate of consistency and precision in death certification as SUDC; therefore, true SUDC cases are likely higher than reported by the CDC.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8255173/

01/27/2026
BIG BABIESLet’s talk about them. What’s evidence based and what isn’t? There’s a lot that gets discussed when a big baby...
12/28/2025

BIG BABIES

Let’s talk about them. What’s evidence based and what isn’t? There’s a lot that gets discussed when a big baby is expected, but what if all of that’s useless and can cause more harm than benefit? Let’s get into it.

———————————————————————————

This is a long post, so here’s a complete summary that’s also listed at the bottom of the Evidence Based Birth article:
-Non-Diabetic Mothers-
•Ultraounds are only right about 50% of the time. Ultrasound weight results anywhere from 15% above or below baby’s actual weight.
•7-15% of big babies will experience shoulder dystocia.
•Permanent nerve damage risk is as follows:
—> 1 in every 555 babies (0.18%) between 8lbs 13oz - 9lbs 15oz.
—> 1 in every 175 babies (0.57%) 9lbs 15oz or more.
*Regular training for shoulder dystocia is extremely important.
•Providers suspecting big babies are more harmful than the baby actually being big. This is because of the way providers manage labor with a suspected big baby that increases the risk of cesarean and complications.
•Very early induction (37-38w) can prevent some cases of shoulder dystocia, but it doesn’t show to decrease brachial plexus palsy or other risks that come with early induction.
•Elective cesarean likely does more harm than good.

-Diabetic Mothers-
•Ultrasounds are slightly more accurate.
•Providers should follow the standard definition of slow labor.
•There might be some benefit to elective cesarean with babies over 9lbs 15oz, but this is not conclusive.
•Management of diabetes such as diet, exercise, or medication lowers the chance of having a big baby or shoulder dystocia down to normal levels.

Read below for all the details!

———————————————————————————

Macrosomia is the medical term for “big baby”. A big baby is any baby that is 4,000g or 8lbs 13oz or bigger. Some say 4500g+, or 9lbs 15oz. For most, when a big baby is referred to, they’re referring to a baby larger than 8lbs 13oz. An extremely large baby would be a baby 5,000g or more, or 11+ lbs. Large for gestation age is referring to any baby larger than the 90th percentile at birth. This means that there are only 10% of babies that are larger.

Risk factors that can contribute to a big baby are:
•Big babies in families (genetics)
•Male baby
•Higher BMI before pregnancy
•Older age
•Post term
•Previous big baby
*Exercise has been shown to decrease the risk of a large baby.

-Routine Care For Suspected Big Baby-
Only 1 in 10 babies are born large, but in one study 2 out of 3 families were told they could expect a large baby. In the end, the average weight was only 7lbs 13oz. Two of three mothers had discussions with their provider about induction, and one of three had discussed a planned cesarean simply due to suspicions of a large baby. 67% were induced and 37% tried self-induction. One in five were not even offered a choice when it came to induction. One in three went with a planned cesarean, and two of five respondents said their discussion was framed that cesarean was the only option. Not only is this incorrect, but it majorly lacks informed consent.

“Big baby” concerns were the 4th most common reason for induction, and the 5th most common reason for cesarean.

Is cesarean or induction even evidence based for suspected large babies? This approach is based off these 5 assumptions:
•Higher risk of shoulder dystocia
•Higher risk of birth problems
•Providers can accurately tell baby’s size
•Induction keeps baby from getting bigger; therefore, decreasing risks.
•Elective cesareans are only beneficial IF they don’t have major risks that could outweigh the benefits

-ASSUMPTION #1: SHOULDER DYSTOCIA-
Truth: 7-15% of large babies will have issues with birth of their shoulders. Most are handled without harm. Permanent nerve damage happens in 1 out of every 555 babies, (0.18%), between 8lbs 13oz and 9lbs 15oz, and 1 out of 175 in babies, (0.57%), over 9lbs 15oz or larger.

Providers get nervous of large babies because the possible risk of nerve damage. Brachial plexus palsy is the most common cause of litigation.

A combination of multiple studies found that shoulder dystocia happened to 6% of babies over 8lbs 13oz, and 0.6% who were not “big”. The risk raised to 14% for those 9lbs 15oz or larger.

Rates were higher in those with Type I or II diabetes. 2.2% that were less than 8lbs 13oz, 13.9% that were 8lbs 13oz - 9lbs 15oz, and 52.5% that were over 9lbs 15oz. Treatment and management of gestational diabetes drastically reduced the chance of having a large baby with dystocia. Mothers with high blood sugars during pregnancy are at an increased risk for shoulder dystocia even when baby is not big because weight can be distributed differently on baby. Problems are mostly likely to occur when baby’s head is smaller in comparison to their shoulders and abdomen. Half of all dystocias occur in a baby who is NOT big. Shoulder dystocia can NOT be predicted. This is why ALL providers must know how to accurately diagnose dystocia and quickly and effectively manage it.

-Brachial Plexus Palsy-
Brachial plexus palsy refers to weakness or paralysis of an arm, shoulder, or hand. This happens to 1.3 out of every 1,000 (0.13%) of all vaginal births. This can occur with or without dystocia being present. 48-72% of BPP cases happen without dystocia. Rarely, this can happen during a cesarean. In a study with 387 children who experienced BPP, 92% were born vaginally and 8% by cesarean. Other researched have found it occurs in 3 per 10,000 cesareans, (0.03%). About 10-18% end up with permanent injury, defined as arm or shoulder weakness after 1 year.

After combing 5 studies, babies over 8lbs 13oz vs babies who were not born big had significantly more brachial plexus palsy injury, (0.74% vs 0.06%). The rate increased to 1.9% for babies over 9lbs 15oz. In a recent study, extremely large babies (over 11lbs), 17 out of 120, (14.2%) experienced shoulder dystocia. 3 out of 17, (17.6%) had temporary brachial plexus palsy, but were healed within 6 months. The overall rate was about 1 BPP cases happen per 40 vaginal births, (2.5%), when baby is 11lbs or larger.

-Can A Baby Die From Shoulder Dystocia?-
Yes, it’s possible, but it’s rare. Out of 15 studies, there were 0 deaths to of 1,100 cases. Two other studies showed 1%* and 2.5%**.
—>*One baby out of 101 “died at delivery”, possibly due to shoulder dystocia, but not clear.
—>**One baby out of 40 cases of shoulder dystocia.

In a 2011 study, 132,098 women gave birth. 1.5% had shoulder dystocia, and of those 101 were injured, (brachial plexus palsy or collar bone fracture). There were 0 deaths and 6 cases of brain damage due to an average time of 11 minutes between birth of babies head and body.

-ASSUMPTION #2: BIG BABY LEADS TO AN INCRASED RISK OF HEALTH PROBLEMS AND COMPLICATIONS-
Truth: Risk of complications with a big baby are higher along a spectrum. So babies lower on the big baby scale have less risk and those higher have a higher risk. The same risk doesn’t apply to a 8lbs 13oz baby like it does a baby larger than 11lbs. A providers suspicion of a big baby also carries its own risks.

-Unplanned Cesareans-
In a meta-analysis, babies larger than 8lbs 13oz are more likley to end in a cesarean. The average rate was 19.3% compared to 11.2% when a baby that was not suspected to be big. With babies suspected to be over 9lbs 15oz, the unplanned cesarean rate rose to 27%. A providers suspicion can also lead to an increased risk of unplanned cesarean.

-Perineal Tears-
The largest study showed that a 3rd degree tear had a rate of 0.87% with a big baby, and 0.45% without a big baby. Forceps and vacuums were more likely to be used with big babies, and both of these increase the risk of severe tears.

-Postpartum Hemorrhage-
Mothers with babies over 8lbs 13oz had a rate of 4.7% of hemorrhage compared to 2.3% when mothers didn’t have big babies. With a baby over 9lbs 15oz, the rate was 6%. It is not clear whether the higher rate is due to the big baby or induction or cesarean that was recommended by the provider.

-Newborn Complications-
One study found that large babies had a higher rate of low blood sugar, 1.2%, compared to 0.5% when baby was not large. Larger babies had higher rates of temporary breathing issues, (1.5%), compared to those who were not large, (0.5%). Higher temp was also seen more in large babies than average sized babies, (0.6% vs 0.1%). Birth trauma was experienced at a rate of 2% for large babies rather than 0.7% of average sized babies. Lastly, there were more large babies born via cesarean (33% vs 15%). The cesarean births for larger babies could also explain the temporary breathing issues since that is a side effect to cesarean births.

A combined 5 studies shows that birth fractures occurs in 0.54% in larger babies versus 0.08% in average sized babies. This rate increases to 1.01% in babies 9lbs 15oz or larger.

-Stillbirth-
Some doctors will recommend cesareans for suspected big babies because they believe there is a higher risk of stillbirth in larger babies. A study grouped babies together in this fashion:
•4th-10th percentile
•11th-20th percentile
•21st-80th percentile
•81st-90th percentile
•91st-97th percentile
•98th-100th percentile

The group with the highest stillbirths was the smallest group. The third highest risk group for stillbirth was the 98th-100th percentile group.
—>This could be partially explained by mom being diabetic, but also a higher risk of unexplained stillbirths happen in this group as well. The group with the lowest risk of stillbirth was the 91st-97th percentile.

Another study showed several other risk factors for stillbirth, such as:
•High BMI in mom
•Smoking during pregnancy
•Older age
•High blood pressure and gestational diabetes
•Small for gestational age
*Being large for gestational age looked to be protective against stillbirth unless it was due to gestational diabetes or mom with type I or II diabetes. Remember, though, diabetes can be improved with diet and exercise which showed a drastic decrease in bad outcomes. The largest study on gestational diabetes showed NO increased risk for stillbirth. The Canadian study showed a link to stillbirth IF gestation diabetes and baby was large for gestational age were both factors.

In the largest study of more than 100 million babies, about 10% were large. There were 1.2 per 1,000, (0.12%) stillbirths for large babies compared to 1.1 per 1,000, (0.11%) for average sized babies.

Because stillbirth has many factors and varies so much from situation to situation, each pregnancy should always be individualized.

-Is It Harmful to Suspect a Big Baby?-
Suspecting a big baby leads to a higher rate of cesareans. Research consistently shows perception of a big baby is more harmful than a big baby itself. NINE different studies showed suspicion of a big baby leads to higher cesarean rates and higher diagnoses of stalled labors. Suspicion of big baby, and those who actually had one, had triple the inductions, more than triple the cesareans, and quadruple the amount of maternal complications compared to those who weren’t suspected to have a large baby but actually did. Researchers suggested a weigh cut-off of 9lbs 15oz, or larger, to trigger counseling to avoid unnecessary interventions and maternal complications.

-ASSUMPTION #3: WE CAN TELL WHICH BABIES WILL BE BIG-
Truth: Physcial exams and ultrasounds are equally bad at predicting a large baby. 14 studies looked at ultrasound reliability to predict a baby larger than 8lbs 13oz. It was accurate 15-79% of the time. Most studies showed the accuracy was less than 50%.
—> In other words, for every 10 babies, 5 will weigh more than 8lbs 13oz and 5 will weigh less.

Ultrasound was less accurate at predicting babies over 9lbs 15oz. Accuracy of extremely large babies was 22-37%.
—> In other words, for every 10 babies, 2-4 weighed more than 9lbs 15oz and 6-8 weighed less.

In women with diabetes, ultrasounds were more accurate at 44-81% accuracy.
—> In other words, for every 10 babies of mothers with diabetes, 6 will weigh more than 8lbs 13oz and 4 will weigh less.

Over all, when there is a suspicion of a large baby, there is only a 40-53% accuracy.
—> In other words, half will weigh more than 8lbs 13oz and half will weigh less.

A systematic review concluded: “No clear consensus with regard to prenatal identification, prediction, and management of macrosomia”. The authors also stated that macrosomia can only be diagnosed AFTER birth.

The Warsof2 formula, which goes by abdominal measurements, came within 15% of baby’s true weight.

-ASSUMPTION #4: INDUCTION ALLOWS BABY TO BE BORN AT A SMALLER WEIGHT, WHICH HELPS AVOID DYSTOCIA AND LOWERS RISK OF CESAREAN-
Truth: There is conflicting evidence about whether induction for suspected big babies can improve outcomes.

A Cochrane review split mothers into two groups. One was induced at 37-40w and the other would wait for labor to begin. The induction group had a decrease in dystocia (4.1% vs 6.8%), a decrease in fractures (0.4% vs 2%), an increase in perineal tears (2.6% vs 0.7%), and an increase in jaundice (1.1% vs 0.7%). There was no difference in cesarean, instrumental delivery or NICU admissions, brachial plexus palsy, or low APGAR. There were also 0 deaths.

The second largest study included women who were at least 38 weeks, suspected to have a big baby, (over 8lbs 13oz), no gestational diabetes, and no previous cesarean. Those results showed that women who waited for labor had babies about 5 days later, had slightly larger babies (3.5oz heavier), no dystocia difference, no nerve damage, no cesarean rate difference. Ultrasound overestimated the weight 70% of the time and under-estimated 28% of the time.

In summary, ultrasound estimates of weight was inaccurate, shoulder dystocia and nerve damage is unpredictable, and induction did not decrease cesarean or shoulder dystocia risks.

-ASSUMPTION #5: ELECTIVE CESAREAN FOR BIG BABY HAS BENEFITS THAT OUTWEIGH POTENTIAL HARMS-
Truth: Researchers have never carried out a study to determine the effects of elective cesarean for suspected big babies.

Evidence did NOT support elective cesarean as a way to prevent bad outcomes due to big babies. Some known cesarean risks are serious infections, blood clotting disorders, postpartum hemorrhage requiring transfusion, and newborn breathing problems.

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For those who have read my personal summary, thank you! You can find the entire article at: https://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/

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