I am currently pregnant with my second baby. DS born at 4kg, 38w5d, vaginally. I did have a large PPH immediately following this birth, which really wiped me out for some time (borderline blood infusion, I ended up on iron tablets).

Ever since finding out my first was 4kg at birth (public system first time around) my ob has been saying things like 'oh that is a very hefty baby for your first, considering he was born at 38 weeks' and 'I don't think we would like you to go over 38 weeks with this one either, as it's likely to be large'. I believe her concern lies around having another PPH.

I am quite disappointed in her attitude, as so far my scans have indicated average size for dates and I've been cleared of GD so there is really no reason for this baby to end up ginormous at term. I am quite comfortable with the idea of pushing out another 4kg baby.

Of course at my next appointment I am going to get her to explain the risks of birthing another large baby naturally vs the risks of induction.

Has anybody else out there been pressured by your ob and induced for a perceived 'large' baby? What are your experiences?

No personal experience, however never let a doctor do anything you are not comfortable with. You are employing them.

I'm not 100% certain, but I don't think the size of the baby has any bearing on having a PPH. I had one after my first and she was only 3.05kg.
If you feel comfortable pushing out another POSSIBLY large baby, then go for it!

Can't speak to your experiences but I think you are right to be concerned. 4kg is not off the charts and 38 weeks is full term. I had an induction and it's not ideal. Could be worth making an appointment with another OB just to see.

My first was 4.75kg at 42 weeks and I had a 600ml PPH. Second time around I was again in the public system and did not have any of the pressure you have experienced - I had extra testing for GD (didn't have it either pregnancy) and had a growth scan at 36 weeks which estimated a 4kg baby. The OB I saw for my final appointments was happy for me to go over again as I had a spontaneous labour first time - he wasn't concerned about size. I also had to have a drip put in while I was in labour in case of another PPH - every doctor I saw told me this and wrote it on my notes at each meeting, one even giving me the whole lecture because he thought my asking questions meant I was going to refuse it. It was never mentioned that I would need induction because of a big first baby or PPH.

DS2 arrived at 40+9, 4.1kg and no PPH.

I agree with the above post... find out everything you can so you feel comfortable making the decision.

I would have to agree with the above post, I had my twins at 23 weeks , they weighed just 560grams and 620grams and I had a major PPH, 2 blood transfusions were required, I then had a secondary PPH 7 weeks later (due to a large amount of retained placenta), so nothing to do with size here (more trauma I think).

My second baby was 5kg at 6 days over and there was a huge range of complications with birthing a baby that large and I would much prefer to be induced than have to do that again. For me the risks of birthing a big baby far outweigh the risks of an induction. BUT if you are making an informed decision to go to term knowing that you may have a larger baby and you are happy with that choice and comfortable in your abilities to birth a big baby, then there is nothing wrong with that. They can't 'force' you to have an induction, you can always say no. The most they will do is write up that they had advised an induction and you had declined, they still owe you a duty of care and need to provide adequate attention for the duration of your pregnancy.

I think it's odd to refer to a 4kg baby as being 'hefty'. It is on the larger side, yes, but not off the scales. I understand that, being born at 38w it would have grown larger if you had gone to 40w but I still don't think that's cause for concern.

I had a 4.5kg baby the first time, and then agreed with my ob to induce one week early when my second looked like being bigger than that. He was born at 4.4kg so would certainly have been bigger if let go. Both times, it was an event-free birth with no tearing and no issues. My ob left it up to me to choose the induction and I was happy to go with it. I am now expecting my third and will go with it again if heading down the same track.

I have no experience or knowledge of PPH so I won't pretend to offer advice there - it must have been very scary for you. If what others say is true, though, and PPH is unrelated to baby size, then I don't think inducing two weeks early is called for.

Good luck.

Whilst I don't think there is any indication for the Obstetrician to be talking Induction for the OP just at the moment, having as baby over 4 kgs does double the risk of PPH.

An atonic uterus is the major cause of PPH so anything that has over extended the uterus is a risk factor plus large babies usually have a larger placenta and therefore a larger placental site.

Having said that lots of mums with smaller babies have PPH too.

STBG, you say that it doubles the risk of pph, but what is the actual rate at which pph occurs? I ask because I once made a choice when my risk of something doubled, it wasn't until after the event, I found out my actual risk had doubled.....from 1% to 2%. I don't think I would have chosen to go the way I did if I had of been informed of the actual rate of risk iykwim.

I had a traumatic first labour, and will be induced at 4kg for this bub. Ill be having weekly ultrasounds from 36 weeks for sizing.
my PPH wasnt an issue (I actually was resuscitated and had 5 transfusions due to the blood loss) , but I had a complete uterine inversion, and have a 40% chance of it happening again (especially if its another long labour and large baby which gets stuck)

It is quite surprising but moderate PPH occurs in roughly 10% of all births, sometimes it is quoted as even higher.

I understand that in some cases just doubling a risk of complication will still not put it into a high risk category but with PPH I think that anything that can help reduce the risks is advisable. PPH and it's resultant complications remains the highest cause of maternal death.


Edited to add a link

http://www.pphprevention.org/pph.php

Thanks for your informative responses everyone. I had a growth and wellbeing scan on Thursday and turns out baby is completely average for dates and shouldn't be as big as her brother.

Too bad for my ob, I think she was hoping to schedule my induction between her golf and day appointments

Baby will be choosing her own birthday - hurrah!