San Francisco Injury Lawyer Blog

Delivery of a large baby can lead to shoulder dystocia that may result in an Erbs Palsy or even brain damage under certain circumstances. For this reason, a treating physician must carefully consider and evaluate fetal size before delivery. This is one area of obstetrical litigation in the medical malpractice arena that is seen repeatedly. It is important for a treating OB or primary treating doctor to assess the potential for this problem (macrosomia), especially in mothers that have certain risk factors. These include prior deliveries of infants approaching 4000 (8lb/13oz)-4500 (9lbs/15oz) grams, diabetes of any kind and/or that the mother is 'post dates' at the time of labor.

Estimating fetal weight (EFW) requires some highly technical interventional medicine. It requires the physician to ask the mother, 'Does this feel like a very big baby to you,' or 'Do you think this baby is larger than your others,' and if so 'How much larger than the others does it feel to you?' This is called the 'maternal guess' method of estimating fetal weight. Catchy name. We have come such a long way in medicine, haven't we. Surprisingly enough, this method is just as effective as its counterpart, Leopold's maneuver where the physician places hands on the mother's abdomen and in his or her infinite wisdom and experience, predicts the weight. Maternal guess and Leopold's are statistically similar in their accuracy.

Probably the most accurate method of estimating fetal weight is by ultrasound although ACOG does not agree. Ultrasonography offers hard information that if interpreted by well trained doctors familiar with the techniques of interpreting fetal ultrasounds, can predict a large baby by comparing certain bone lengths and head diameters. With any question of macrosomia due to one or more of the following risk factors an ultrasound should be done although it too has a significant margin of error. ACOG, one of many conservative physician groups, (American College of Gynecologists Obstetricians) recommends currently that women with diabetes and an estimated baby size of 4500 grams or larger be considered for C section. This is bumped to 5000 grams for women without diabetes. Different articles offer different statistics. For example, one article notes: "When birth weight is more than 4,500 g, however, the risk [of dystocia] is increased to 9.2 to 24 percent in pregnant women without diabetes and to 19.9 to 50 percent in pregnancies complicated by diabetes." (American College of Obstetricians and Gynecologists issues Guidelines on Fetal Macrosomia).

There may be many reasons why ACOG now has such liberal parameters but my speculation is that it is just another way to attempt to insulate physicians from medical malpractice liability--at the expense of their patients.

Statistics can be applied or interpreted in many ways and the general argument floated in the literature is that many children are born without dystocia at high birth weights and we would have to perform many more C sections to save one child. I suppose that argument depends a lot on whose 'ox is being gored', so to say. If it's your baby that is unable to use his arm from birth--and all of the very serious repercussions that go with that, the argument is not compelling, particularly if it was known that the baby was going to be large but the EFW did not quite meet ACOG criteria.