Do you need a cesarean for a big baby?




Question of the day: Is it true that you need a c-section if a baby is "too big"? Ahhh this seems to be a question I hear over and over again. I want to start out this blog by reminding you I am NOT an obstetrician or midwife and this article is not meant as medical advice or to substitute for individual medical care. Every mother, baby and pregnancy is unique with unique needs, so please just use the information you learn hear as a conversation starter. All information shared here is in consideration of an average, healthy dyad. Many mothers-to-be are nervous about labor for so many reasons… two of them being 1.) the potential of a gigantic baby fitting out of a not so gigantic place and 2.) the potential of having an unwanted cesarean… This often results in a worry of “if my baby is too big I will need a cesarean”. In this article we’re going to explore what “too big” means, and if you need a cesarean. I’ll mix a little personal experience with some hard facts and you will walk away with ammunition to make your own decisions!

What is “a big baby”? According to large cohort studies cited by the American College of Obstetrics and Gynecology (ACOG) an infant born at a weight of 9lb 4oz is considered “macrosomic” or large for gestation age… a “big baby”. How do I know if my baby will be a big baby? Many providers will estimate a baby’s size with palpation or ultrasound measurements. It is important to note that this measurement is not considered scientifically reliable and can be “off” up to 2 pounds in either direction. Therefore, it is discouraged to induce or schedule a cesarean based off of size predictions alone, in the absence of other risk factors.





What are the risks of birthing a “big baby”? Big babies are associated with an increased risk of clavicle fracture, shoulder dystocia, and cesarean section. Is there a way to mitigate or reduce these risks? YES! As always, laboring and birthing in an upright position that supports physiological birth and the natural widening of the pelvis, increases the likelihood of having a smooth, healthy birth. Even if an emergency like shoulder dystocia occurs, a skilled provider and some quick position changes should be able to resolve the situation without needing a cesarean in most cases. It is also important to note that shoulder dystocia can occur in infants of all sizes. Having a “big baby” doesn’t guarantee this risk, and having a “small” or “normal” baby doesn’t eliminate the risk.


As far as increased chance of cesarean goes, it is important to consider a few variables not related to size of your infant: your facility, your provider, your birthing positions. If your provider practices in a manner that supports and encourages physiological birth, it is much less likely that you will be at risk for a cesarean. However, many physicians in hospitals practice in ways that inhibit physiological birth and this could play a role to skew the statistics of vaginal births with a “large baby”.



Woman labors in an upright position to facilitate physiological birth

Do you know anyone who has had a large baby vaginally?

OH HECK YES. I personally know of quite a few people who have had “large” babies vaginally with no complications. I “know of” even more. But I can’t tell you their stories. I can, however, share mine with you. My first baby was born via cesarean due to breech position. He was born 8lb 4oz. Two years later I gave birth via VBAC (Vaginal Birth After Cesarean) to my second baby at 9lb 4oz…. The only complication was a second degree tear due to his compound presentation (his fist came out with his head). But then, almost 2 years after that I gave birth to my third baby… there was a running joke that she would be 10lb 4oz… but no one actually thought this to be true. I didn’t show til late second trimester and only really “popped” mid third trimester. By all accounts, this baby was anticipated to be around the same size as her brothers. I gave birth to her 100% unmedicated at home in my bedroom. When she was born were shocked to see a giant fat baby who weighed in at…………TEN POUNDS FOUR OUNCES. I kid you not. Another complication free birth… HOWEVER, I must share with you, that I attempted to give birth to her in my tub in a semi sitting/reclined position and it felt like torture. My body screamed at me to get upright. I jumped out of the tub and gave birth to her in a standing position which I firmly believe is why she was able to be born so easily without complication. I do believe if I had been in a hospital and not able to move in response to my body’s cues we may have had a different story to tell. And ps… I’m a pretty small girl 5’ 3’’, 135lbs pre pregnancy with a small frame, one doctor even told me I could *only* have a successful VBAC if I had a small baby…



Look how chunky she was!!

So…. Does a big baby mean you need a Cesarean? The answer is no. You do not automatically need a surgical birth in order to bring a “big baby” into this world. It is absolutely possible to do so vaginally and safely. I think the stronger determinant of your birth outcome is not your baby’s size, but rather your preparedness for birth - physically and mentally. If you have a solid understanding of the birth process and a supportive team, you can be confident that your body is capable of birthing a big baby. I want to hear your stories? Did you have a large baby vaginally? Share your story below to encourage other Mama Bears to birth with confidence!




Jaimie Zaki, owner of Little Bear Services, LLC is a Birth Photographer, Labor Doula, & IBCLC serving families in South Jersey and Central New Jersey. Mother of three, military wife, and lover of coffee, Jaimie enthusiastically supports hospital and home births in Burlington County, Camden County, Mercer County, Atlantic County, Ocean County in New Jersey. If you reside outside of this service area, there are online courses and virtual support packages available! Jaimie is excited to serve your family! Learn more about Jaimie and the services she offers now!


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