Saturday, July 24, 2010

Bigger is...better?

Or at least, not bad. I should give a disclaimer, I suppose. I am not a medical professional. Still, after the recent birth of our beautiful daughter, who happened to weigh 9 pounds and 6 ounces, I've been rethinking our view of appropriate sizes for babies in this culture, and I am wondering if perhaps it is just that: cultural.

The OB who assisted my midwife made several comments about potential size, which in retrospect were probably leading up to a warning about her being too big to be born vaginally. At the time, however, I was too focused on giving birth to read anything into it. She is our fourth, and in my experience, subsequent babies tend to be larger. She had measured on target, and I didn't have GD, so I wasn't going to waste energy worrying. Also, I had read so many accounts of home births where healthy babies were born weighing nine or ten pounds or more that I didn't see a large baby as being a problem.

Our society expects babies to weight around seven pounds. Of course, a couple of generations ago, we expected them to be around six pounds. I think there were a lot of things that influenced that: many women were still smoking and drinking during pregnancy, and they were limiting total weight gain to 15 pounds or so during pregnancy. The mothers themselves were smaller, not just in weight but also in height.

Now there are still many women who restrict their weight gain in pregnancy, not by following healthy diets, but by limiting food intake. The high number of false positives in standard glucose testing causes many women to go on diets in pregnancy, and there are still plenty of OBs out there who warn women against gaining much weight or who automatically schedule C-sections based on their best guess of the baby's size. Add to this the fact that most hospital births take place with the woman flat on her back, which causes her pelvic opening to be 30% smaller than in other positions, which likely contributes to the myths about women being unable to deliver larger babies.

In reading numerous accounts of homebirths where women followed healthy eating guidelines, but didn't otherwise restrict their caloric intake, and gave birth in whatever position they wished (almost never on their backs), I have been struck by the significant number of babies that were well over nine pounds. They were healthy babies, their mothers did not have diabetes, they were birthed naturally without complications, but they were generally larger than babies born under standard OB care.

What if that is actually normal, perhaps even optimal? What if smaller babies are more a result of our attempts to restrict birth weight rather than a reflection of what is most healthy for the babies and mothers? Anecdotally, I can say that the larger babies I've known of (including my own) tend to be more content, sleep better, are healthier and are easier babies than those who are born smaller.

It would be very interesting to see research comparing both models of pregnancy care, birth weights and outcomes.


Heather said...

First of all, this:

"The OB who assisted my midwife..."

Makes me feel all giddy and bubbly inside. :) It still all feels so surreal.

And as a midwife chiming in I couldn't agree with you more. Clients are usually shocked when they comment about not wanting a big baby and we reply, "Oh, but 8-9lb babies ARE healthy!!"

Another note about these 8-9lb babies, they also nurse VERY well.

Theresa said...

My last pregnancy in which I had several illnesses that I had trouble getting over resulted in my smallest baby and I'm sure that had something to do with it.

My 9lb 8oz baby was by far the healthiest and happiest out of my 3.

Amy said...

I didn't have any babies over 9lbs, in fact my largest was my 1st @ 7lbs 13ozs. I would say Lindsay who weighed in at 5lbs 14ozs was my healthiest. And possibly happiest since she was held almost constantly to protect her from her well meaning brothers! So I don't have any insight into larger babies, but just wanted to say I didn't smoke, drink, or restrict my diet in any way. But I was sick the entire pregnancy.

So not contridicting, just giving another perspective. : )