Labor and Delivery Experiences of Mothers with Suspected Large Babies
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Labor and Delivery Experiences of Mothers with Suspected Large Babies Erika R. Cheng1 • Eugene R. Declercq2 • Candice Belanoff3 Naomi E. Stotland4 • Ronald E. Iverson5
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Ó Springer Science+Business Media New York 2015
Abstract 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 = 1960). 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 C4000 g (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 & Ronald E. Iverson [email protected] Erika R. Cheng [email protected]
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. Conclusions for Practice Only one in five US women who were told that their babies might be getting quite large actually delivered infants weighing C4000 g. However, the suspicion of a large baby was associated with an increase in perinatal interventions, regardless of actual fetal size. Keywords Suspected macrosomia Mode of delivery Labor induction
Significance The suspicion of a large baby is independently associated with greater use of perinatal interventions that are not currently indicated for fetal macrosomia and may 2
Department of Community Health Sciences, Boston University School of Public Health, 810 Massachusetts Avenue, CT430, Boston, MA 02118, USA
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Department of Community Health Sciences, Boston University School of Public Health, 810 Massachusetts Avenue, CT429, Boston, MA 02118, USA
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Department of Obstetrics, Gynecology, and Reproductive Science, San Francisco General Hospital, University of California, San Francisco, 3333 California Street, San Francisco, CA 94118, USA
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Department of Obstetrics and Gynecology, Boston University School of Medicine, 10 Grove Street, East Boston, MA 02128, USA
Eugene R. Declercq [email protected] Candice Belanoff [email protected] Naomi E. Stotland [email protected] 1
Division of General Academic Pediatrics, Harvard Medical School and Massachusetts General Hospital for Children, 100 Cambridge Street, 1570-B5, Boston, MA 02114, USA
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