Labor and Delivery Experiences of Mothers with Suspected Large Babies

OBJECTIVE: To characterize the prevalence of and factors associated with clinicians’ prenatal suspicion of a large baby; and to determine whether communicating fetal size concerns to patients was associated with labor and delivery interventions and outcomes. METHODS: We examined data from women without a prior cesarean who responded to Listening to Mothers III, a nationally representative survey of women who had given birth between July 2011 and June 2012 (n=1,960). We estimated the effect of having a suspected large baby (SLB) on the odds of six labor and delivery outcomes. RESULTS: Nearly one-third (31.2%) of women were told by their maternity care providers that their babies might be getting “quite large”; however, only 9.9% delivered a baby weighing ≥4,000 grams (19.7% among mothers with SLBs, 5.5% without). Women with SLBs had increased adjusted odds of medically-induced labor (AOR 1.9; 95% CI: 1.4–2.6), attempted self-induced labor (AOR 1.9; 95% CI: 1.4–2.7), and use of epidural analgesics (AOR 2.0; 95% CI: 1.4–2.9). No differences were noted for overall cesarean rates, although women with SLBs were more likely to ask for (AOR 4.6; 95% CI: 2.8–7.6) and have planned (AOR 1.8; 95% CI: 1.0–4.5) cesarean deliveries. These associations were not affected by adjustment for gestational age and birthweight. CONCLUSION: Only one in five US women who were told that their babies might be getting quite large actually delivered infants weighing ≥4,000 grams. However, the suspicion of a large baby was associated with an increase in perinatal interventions, regardless of actual fetal size