Big Baby Webinar

Rebecca Dekker, PhD, RN, APRNFounder, Evidence Based Birth®

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Is “big baby” a big problem in your

community?

1) Cochrane Review

2) New RCT

3) Most pressing questions

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Disclaimer

▪ Watching this webinar does not mean that we have entered into a patient-care provider relationship

▪ Nothing in this course shall be construed as medical advice

▪ Talk with a care provider before putting this information into practice

▪ Content is not guaranteed to be 100% accurate or up to date

One of my big babies…

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We will cover:

▪ The new Cochrane review

▪ The new RCT

▪ EBB resources for learning more

▪ Your questions

▪ Your handout

Sound good? Type “Yes” in the chat!

Free Printer Friendly PDF!

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Cochrane Review

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Why do you think the results changed?

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▪ In 2012, 1 in 3 U.S. women had their labor induced

▪ Most common reasons?

Declercq et al. Listening to Mothers SM III. New York: Childbirth Connection, May 2013.

1. Baby was full term or it was close to the due date 44%

2. Mother wanted to get pregnancy over with 19%

3. Care giver concerned that mom was overdue 18%

4. Mother had a health problem that required quick delivery 18%

5. Care provider concern about the size of the baby 16%

6. Water had broken and there was concern about infection 12%

Problems with estimating size..

▪ 98% of ultrasounds will be within 15% +/- of the baby’s actual birth weight

▪ If an ultrasound says your baby is going to weigh 8 lbs 15 oz or larger, 50% of the time it is right and 50% of the time it is wrong

▪ Haave to induce a lot of women early… and some of those women will NOT have had big babies!

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Cochrane Review: Induction▪ Cochrane review of 4 RCTs

▪ 1,190 women with suspected big babies

▪ Randomly assigned to induction at 37-40 wks or not

▪ Results?▪ No difference in Cesarean rates, vacuum, or forceps

▪ Decrease in shoulder dystocia (absolute risk went from 6.8% to 4.1%)

▪ Decrease in collarbone fractures (2% down to 0.4%)

▪ Increase in severe perineal tears (0.7% vs 2.6%)Boulvain et al. (2016).

Cochrane Database Syst Rev(5): CD000938.

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What about brachial plexus palsy?▪ No differences between groups in actual brachial plexus

injury rates▪ Such a rare event, would need a huge study to show a difference

▪ Also no corresponding decrease in NICU admissions or low Apgar scores

▪ Increased use of phototherapy for jaundice (11% vs 7%)

Boulvain et al. (2016). Cochrane Database Syst Rev(5): CD000938.

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In Summary▪ Cochrane review was based heavily on two trials;

one of them just recently published

▪ Found a trade-off– lower rates of shoulder dystocia, higher rates of perineal tears

▪ Shoulder dystocia in itself is not a bad outcome, it’s considered a “surrogate” outcome

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Questions about Cochrane Review?

New Randomized

Trial

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What problems do you think researchers might run into when doing a study about induction for

suspected big babies?

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▪ Women must weigh pros and cons of early induction with suspected big babies

▪ The risk/benefit profile may look different for different women!

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▪ Careful when applying research from one population to another population (ex. VBAC moms)

▪ Coercion and bullying have no place in maternity care!

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New Randomized Trial (2015)

▪ 818 women with singleton babies who were estimated to weigh in the 95th% at 36-38 weeks

▪ Randomly assigned to a) inducing labor at 37-38 weeks or b) waiting until 41 weeks

▪ Cross-over between groups▪ 11% of induction group had spontaneous labor

▪ 28% of waiting group were induced

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Results from New Trial▪ Fewer cases of shoulder dystocia in induction group

(1% vs. 4%)

▪ No brachial plexus injuries in either group

▪ More jaundice in induction group (9% vs. 3%)

▪ No differences in NICU admission rates or any other newborn outcomes

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Why did this RCT have different results from previous RCT?▪ New study: ▪ Larger study

▪ Researchers claimed better at predicting big babies

▪ Induced earlier (37-38 weeks)

▪ Some have said the diagnosis of shoulder dystocia is too subjective (and not blinded)

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Questions about Randomized Trial?

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Any other pressing questions?

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In Summary…

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Resources for You

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Signature Article on Big Babies

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Ebbirth.com/BigBaby

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Where can Parents learn more?

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Where can Professionals learn more?

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EBB Professional Membership

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▪ Professionals who want to change the world!

▪ Earn relevant CEUs in an inter-professional environment

▪ Support the work of EBB

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What is included in your membership?

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▪ All our continuing education courses

▪ Live monthly trainings (+ recordings!)

▪ Private community▪ Library ▪ Access to Rebecca

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Continuing Education for…

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▪ Nurses

▪ Doulas

▪ Childbirth educators

▪ CPMs, CNMs, CMs

▪ Midwifery Bridge Certificate (17 hours)

▪ Physicians

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Available Courses

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▪ Help Families get Evidence Based Care (8 hours, 0.7 ACNM CEUs, 8 AAFP credits)

▪ Big Babies & Gestational Diabetes (3 hours, 0.3 ACNM CEUs, 3 AAFP credits)

▪ Due Dates & Advanced Maternal Age (3 hours, 0.3 ACNM CEUs, 3 AAFP credits)

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Available Courses

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▪ Failure to Progress (2 hours, 0.2 ACNM CEUs, 2 AAFP credits)

▪ Vitamin K & Eye Ointment (2 hours, 0.2 ACNM Pharm CEUs, 2 AAFP credits)

▪ Overturning Hospital Bans (3 hours)

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How to Join?

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Membership Options

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How to Join?

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Scholarships

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▪ Scholarships for midwifery, nursing, and medical students

▪ University subscriptions ($30/student per semester)

▪ Scholarships for persons of color

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Question & Answer

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Handout

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Thank You!

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