58. The Fear of Big Babies During Childbirth with Bloom Physical Therapy and Wellness

Are you worried about having a big baby and it leading to an induction of labor or perineal tearing?

As a mom of big babies, I was fear mongered in my second pregnancy to do extra testing early on, leading to further intervention… instead of being educated, empowered, and supported to do what was right for me. You won’t want to miss this episode with Bloom Physical Therapy and Wellness!

In this episode we talk about:

• The myths and truths about big babies during pregnancy and childbirth…
• Expert insights from physical therapists in supporting women during pregnancy and postpartum…
• How to navigate common fears and misconceptions around big babies and tearing during childbirth…
• Practical ways to prepare for childbirth that includes more mindset work than controversial perineal massage…
• The importance of supporting and informing women throughout their pregnancy to feel confident birthing their baby…
• …and so much more!

Thank you for tuning into this episode today! To connect with Mary and Amanda at Bloom Physical Therapy and Wellness in Hartland, WI, please see links below.

Instagram: @bloomptandwellness
Website: www.bloomptandwellness.com
In-home services and office availability in Hartland, WI

🌸 Connect with Beth

Website - www.familyfocusedmidwifery.com
Instagram - @family.focused.midwifery
Pinterest - bethconnors_cnm
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👋 WHO AM I?

Welcome, friends! I am Beth, a certified nurse midwife, doula, and childbirth educator. My philosophy is rooted in autonomy, informed decision making, and positive mindset to help expecting parents plan for a beautiful, stress-free birth. I am here to provide value to YOU through tips and practical advice, either to guide you through pregnancy or to help you prepare for childbirth, postpartum and beyond. There’s no fluff here - only info that adds to your positive experience and saves you stress and uncertainty.

Transcript

 The stress and the fear that they  instill,  literally the second that you walk through the door, that you're going to have this ginormous baby and this really terrible, difficult birth. And it's going to be better with an induction or better with medical intervention. I think it's sometimes hard for moms to look past that because they think earlier labor induction,  smaller baby, easier labor, but induction always comes with other things too.

So I think preparing moms for. All of the options and then allowing them to choose. I think it's a huge part of just the whole big baby thing. That's  Hey there. I'm Beth Connors, a midwife and mom of two, but also your birth bestie. In this podcast, we'll dive deep into everything you need to feel confident, prepared, and in control from baby bump to delivery room, from practical tips to personal stories, we'll cover it all.

So you know exactly what to expect every step of the way. Let's get into it.  Hello everyone and welcome back to episode 58 of Your Birth Bestie podcast. Today we are going to be talking all about big babies in pregnancy and childbirth, which I know is a big topic that comes up a lot. Moms come to me all the time asking about growth ultrasounds, specifically in that third trimester, if they should induce for a suspected big baby, how to prevent tearing in general, but especially moms who think that they're going to have a big baby Or maybe have had a big baby in the past.

And there is a lot of misinformation out there and also fear instilled in women that their bodies are going to grow a baby that is just too big for their pelvis. And this is just usually not the case, which we are going to talk about with two very special guests, Amanda and Mary. Both are physical therapists with Bloom Physical Therapy and Wellness, which is very close to me in Heartland, Wisconsin.

They support women in pregnancy and postpartum, specializing in pelvic floor health, and are just a great resource for women throughout their journey, whether it's pregnancy discomforts,  preparing for childbirth, postpartum pain or leakage. bladder or bowel concerns. There is really just so much that they can do to help. 

Unfortunately, the beginning of our interview cut out a little bit, but Amanda started sharing her personal experience with her three kids. Her first girl born at 40 and two at seven pounds, six ounces, and her second was born at 40 and one. almost two pounds bigger at nine pounds, nine ounces. But she said that that was a smoother labor and delivery experience.

And she birthed with a midwife in a hospital. They did not know that he was going to be big. It kind of just happened. And then with her third baby, based on an ultrasound that she had. She was suspected to be carrying a 10 pound baby, but then her baby was born at 39 weeks at 8 pounds, 12 ounces. So this is a good example of every pregnancy and every baby being so different.

And we talk about a lot how in this work, there are a lot of women that are afraid of big babies and of tearing. And ultrasounds are also inaccurate the later that you go in pregnancy.  And just in general, there's a lot of fear around this topic, but also not a lot of support or encouragement for moms to really trust the process and be informed and trust that their baby is going to be the best for their body and that they're going to have the best experience.

possible. With my first baby as well, she was also very big without anyone suspecting it. My belly measurements were normal during my prenatal visits. My growth ultrasound was normal, you know, within a normal range, and there was just nothing out of the ordinary. But when she was born at 39 and six, she was 10 pounds, 12 ounces.

And the issue is that because of her size, When I was pregnant with my second daughter, literally every intervention early on to try to find a problem was thrown at me. I was told I needed extra gestational diabetes screenings from the very first appointment. I was told I needed to be induced around 38 weeks.

Also from the very first appointment, because I was considered high risk or, you know, very high probability of having another big baby.  Also that I should start around 30 weeks doing chiropractic care, natural induction methods to prepare my body to go into labor early. All of these early interventions that I felt  I Was going to have so many extra things to kind of check off my list and do in pregnancy, just to have a safe delivery. 

It really started at the beginning and I had a lot of stress and fear that my baby was only going to be bigger than my first, you know, the second time around. So that was very unfortunate part of my story. And I have learned a lot since then too, especially about big babies, but this should not be the way that we view it.

normal, uncomplicated pregnancy. So let's get into the interview with Mary and Amanda. 

When you guys do have your patients that come in  nervous or fearful about the size of their baby or just in birth in general with tearing, I mean, some people  think a big baby is eight pounds. Some people think a big baby is 11 pounds, everyone's idea of a big baby is different for their body size and everything.

Does that change  your approach to how you care for them or certain exercises or different ways to. I guess help them through that.  I  in general, for me,  my treatments don't really change. It's more of just educating at that point to , just kind of calm them down a little bit.

Because in the end of the day,  we're still preparing our body for birth. So it's not going to change kind of how we're going to prepare. It's just more of . Trying to educate them saying, , you're again, your body was made to do this. And so we do a lot of, , hands on treatment, but also we go over labor and delivery positions about, , hip positioning and stuff.

And  also the pros and cons of, , different positions and stuff. So, for example, . Some people I've heard love being on their back, but okay, what can we do if you are on your back and you find that comfortable? How can we do that? So we create room for the sacrum. So that way baby can clear through.

And so just kind of giving those them those tips and tricks. So that way when it comes down to  game day, they're, they're feeling good to go. And that way there's, right. Not as much intervention or as much of that fear and  coercion from doctors or midwives or nurses because it can kind of come from all places.

So I don't know. I mean, it doesn't really change my practice. What would you say? Yeah, I think similar. It doesn't necessarily change it. I probably focus more on , just instilling confidence in them every time we see them. Because I think.  The traditional medical model. We don't,  you know, put a lot of trust into moms and the choices that they make.

And you have to do that as a parent. , you figure that out. , you just have to make the best choices for your little family and for your baby. So just instilling confidence in mom and then providing education as much as possible. If they want to. So we love evidence-based birth. Oh, they're so good.

Their podcast and website. So a lot of times we'll steer them. They just have   nice one page handouts. Mm-Hmm. . And I know they have one on Big Davies, so Mm-Hmm. just kind of giving them all the research and statistics on that.  So, and I think too,  if they're afraid of tearing,  educating them on other things  Mm-Hmm.

That will help reduce their risk of tearing. Yeah. So laboring at home as long as possible, position changes.  Trying to remain as intervention free as possible. And also to , when we're doing  hands on treatment, we're doing   our own form of  perineal massage and soft tissue release, but we're also  working on addressing  the thoracic spine abdominals  doctors,  the inner thigh muscles,  hitting kind of all the different parts that impact  pelvic floor and everything and just  hip positioning.

So that way,  there won't be restrictions from other places that will impede  their ability to position or a baby to get into the right position. Because I always told moms  takes two to tango. You can be doing everything humanly possible, but if baby isn't doing their job either, then things will be a little bit different.

So we want to set everybody up for success, even including baby. So, yeah. Yeah, I think that's actually, , a really good answer that you don't change it because, , I mean, standardized, well, not standardized care, but,  everybody needs to prepare to have their baby no matter how they decide to come that, , we're just supporting moms to have their babies and it's, , not a big deal.

, it's not, , something we need to add extra exercises to or add all this other stuff. It's just supporting your body the same way as everybody else does and trusting that it's going to all work out the right way. Yeah, that it, , include, , the Kind of be in addition to the fear mongering that's already happening.

If we're like, yeah, let's, this is a specific exercise for  big baby mamas. ,  that's just  adding to the narrative. I feel like, so just doing more, there's nothing to it. Yeah. And that's how it was too. When they were telling me with my second baby that I needed to to do all these things.

Like my midwife was  very adamant that at 30 weeks I needed to start chiropractic care. And for me it was like this out of pocket expense that I wasn't able to afford to go every single week. So I didn't go at all. And I mean, she, my labor with her was 45 minutes long. So , I mean, she was just so, and I let it, Pretty much happened.

It was, I was 42. So yeah, it was just , but I was so nervous going up to that point of , it's going to be so hard, harder than my first, bigger than my bigger babies come  each time. Okay. So how much bigger can you get than 10, 12? That was a little bit  nerve wracking, but in  hospital practices, you see different midwives every time.

I did see a few of the same, the same ones. But there's always a couple that would  lean on the more. Induction side,  we're going to schedule this already and you're only 30 weeks out. Let's just have a date in the calendar. And then the other ones that are like, no, it'll all be fine. Like, we don't have to think about that.

So, which is nice to have those different perspectives, but some people don't have those different perspectives. And then they're kind of , you know, maybe cornered into one person's way of thinking that they don't always agree with. And then it's hard to navigate it without having the Yeah.

background too. Yeah.  With this topic too,  big babies, like, okay, you get that whatever diagnosis or that thing on your chart that's like, put it suspected macrosomic macrosomia. And all of a sudden it's , okay, now what can I add to my checklist to , make sure that that doesn't cause problems.

And then , another thing to think about and more ultrasounds, but. For me, they already offered me my  36 week ultrasound. I'm like, I know that it was so inaccurate the last time. Unless there was something else going on. I'm, I'm personally not interested in doing that just because I don't want that on my chart to be like, this is what we think it's going to be.

And then it's two different  directions.  Right.  Yeah. I don't want to give myself   that thing that's already in your mind, the back of your head that you're like, I can't do it because my baby's big or like self fulfilling prophecy or something like that. Yeah. My next question for you guys is about  preventative measures.

We kind of talked about  the different things that you kind of already educate patients about, is there anything  specifically with the pelvic floor like supporting the pelvic floor to make, I guess, labor more effective or you know, make it just  a smoother transition, whether that's.

In pregnancy, like planning ahead or during labor. So we focus a lot on relaxation of the pelvic floor, which I feel like is counterintuitive to  a lot of advice that pregnant women just get is like, do a bunch of kegels.  I have a list to ask you about. I'm a physical therapist. We're happy to see you during pregnancy.

But a lot of times we'll see that pregnant women more have tightness in their pelvic floor. And that's just because those muscles are working over time with growing baby uterus, all the extra fluid and just weight. So those. Muscles are just hanging on for dear life,  working all the time, extra tired.

And so when we think about during labor and delivery, the uterus is really doing the job. So we talk about this a lot with patients too, because they think  they're the ones pushing their baby out and. It's like just your uterus, it's doing its job. And we want those public floor muscles to be relaxed and get out of the way.

So that's our focus more during, especially during the third trimester. And then, so doing like stretches at home and some other things at home to work on that just overall calming the nervous system, we work a lot on that. Cause we know the pelvic floor is an area that we can carry a lot of tension.

So if you feel like you're, a lot of times people are like. They grip their jaw or their teeth, quenchers, pelvic floor. A lot of times goes hand in hand with that of just  an area we hold tension. And then we do, yeah, more  manual hands on things during physical therapy too, to work on. Just the relaxation of those deeper pelvic floor muscles and then the more  superficial perineal muscles too.

Also too,  we  try to release  different ligaments and  longus sacrum or  the pelvis and stuff because if also ligaments are kind of holding things a little too tight then  how do we expect the pelvic bones to kind of do their job  Being mobile during birth and everything.

So we're not only hitting the muscles, we're also hitting the ligaments and just hitting muscles to up and down the public floor chain. So  going up, like kind of in the torso and down in little legs. So that way things up and down the chain, aren't impacting public floor negatively. So kind of  what Amanda was saying with You know, clenching the jaw, clenching the toes.

 We talked about, like  getting those relaxed. And if you have a nurse or  a doula or anybody in there, when you're laboring, they're going to tell you, , relax your toes, relax your job. He is, yeah. If you're keeping everything clenched, when you're having a contraction, then yeah, that's going to negatively affect the pelvic floor.

So we just want to keep the body nice and loose and goose and kind of  have people feel good when they're laboring or as good as you can. Yeah.  So.  Yeah, I feel like the one thing I tell  doula clients right now a lot when they're  laboring is  just to release their hands because I feel like, you know, for me too, it's like, I was always gripping onto something when I was in labor,  I didn't, I just went too fast.

I literally had no coping mechanisms to  use, but that's something that I could think if labor is a little bit more, a little bit longer and , you're trying to really . Go through all those waves of contractions. It's  just focusing on  your shoulders and your jaw and your hands opening and then  everything kind of else will  melt away and follow.

But  you do have to practice it too.  It can't just be something you say you're going to do in labor. I feel like you have to kind of. You have to practice it for sure. Yeah. Yeah. It's nice to be able to educate different patients. Be like, go take a bath at the end of the night, like, and do, do your app and it's just nice.

And you can just relax and and then you can want to kind of find the flow, like, when you're pregnant, then you can utilize that when you're laboring and stuff. So yeah, kind of going into that practice and stuff. Yeah. Cause it's, I think sometimes when people think about like physical therapy or  pelvic floor physical therapy, it's always , what's my exercise program going to be?

Or what's, you know, all the things that I need to be doing on a daily basis. And it's going to take all of my time. It's like, it's actually kind of like self care and   bonding and breathing and mindset work too, that you're  just connecting with your body and practicing. Cause  for me even when I took your class, Mary,  like trying to calm my brain down.

 It's always going places. I don't do it often. So something that you have to   train your brain to  shut off and  just experience what you're feeling in the moment. That's literally what birth is like to get through, especially if you want them to have  an unmedicated delivery. 

It's something that is out of body. It's  grounding yourself in something else and kind of surrendering while you're still in control is like a very weird thing that you don't do every day. So as  far as  perineal massage, I know many patients ask about that around  34 weeks or so. Is that something that you guys recommend to your clients is  doing that kind of just talk.

We were just talking about this.  So I've heard both ways and I'm like, I don't know.  So the research isn't great, especially if you're not a first time mom. I think the research is  best if you're a first time mom, but I think it's something we don't necessarily recommend to our clients to do. I don't feel like the research is strong enough to  add it on as  something else you have to do during pregnancy.

Honestly, I think it's more, but I feel  more beneficial,  when we're doing  our internal releases and stuff versus  somebody at home, you're either  super pregnant and it's just  really awkward angles and you're not able to relax into it. Or it's  your partner who's doing it and they're making weird comments and you're not relaxing because they're just being awkward about it.

So , I don't know. I, part of me is like, is it, is the research not behind it because of  those reasons, or is it  just not beneficial, but But I would feel like from a pelvic floor,  therapist standpoint,  massage is still beneficial, but the research is  still. Yeah. Jury's out on it.

I mean, I think if people want to do it, it's not going to harm anything, but I can't say that it's necessarily going to prevent tearing. I think , honestly,  making sure that we're not  having a,  we're hoping for open glottis or kind of breathing while we're pushing,  kind of having that not super forceful pushing time,  where you're just kind of rushing everything and trying to speed it along,  letting your body do what it feels like it needs to do is better off like preventing tears.

Yeah. Yeah, I think there's other things that are more beneficial. Yes. And positioning too, I think is way better,  to prevent tears. Also we do warm compress. We, I encourage  my, my patients to  do work compresses in between pushing, because then that just  makes the tissues a little bit more pliable.

It's kind of like warming up for  exercise, you know, you want to keep everything nice and  limber or warm.  It's like, that's me. That's going to make or break that you're tearing. There's so many other things that there's other, there's other risks.  So many other risk factors that are  outside of your control to that, you know, long pushing page, short pushing phrase,  that kind of thing.

And I like to educate patients to like, if you do tear,  we know how to work on your scar,  we know how to rehab from a perineal tear. It's they're pretty common. So I feel like there is a lot of fear mongering now coming. With tearing,  the tearing conversation, , obviously we want to prevent as much trauma to the body as humanly possible, but I have  first time moms be like, Oh shoot.

I had a grade one tear and  grade one tear is  a little more than like a rug burn kind of thing. Like it's like, and I feel like just the conversation with tearing there,  if you're, if somebody understood kind of what a grade one tear is,  they would be like, Oh. Not as big of a deal as I thought, but they're envisioning almost like a grade four.

It's like, mm-Hmm. all the way to  the, you know, you know, the rectum where they're just like, oh my gosh.  So I feel like that's also too, kind of what you were saying, Amanda, like  we, we can, we can work on that. Like that, we can rehab that and obviously we wanna like. Prevent as much trauma to the body as humanly possible, but it's also being realistic about  not catastrophizing pairing either.

Yeah, I guess is kind of   natural. , I remember too, when I was , in my midwifery training, , we would  suture, pretty much any, any tear for the most part. Even if it's just  one stitch, but then I was learning more too,  in different continuing education things and just learning from different home birth midwives, and they don't always even repair those things if they're not necessary.

So. There's some  more conservative approaches where we just repair everything and then other different research says that , it is very it's an area that heals very well on its own,  just naturally, because it makes sense that that does it that way. So yeah, there's like, it's not the worst thing to happen.

Like you don't have to.  You know, have on your, like, to do list, like, don't tear because, I mean, a whole baby is going to come out of you, and the chances of tearing are very high but also the chance, if you do some of these other things to help prevent, like, the severity of it, like, you can have a really good postpartum healing experience that helps you, , like, care for it, yes. And I think that starts to with you mentioned like the pushing part of it to me personally, if I would have even known I had a choice to push other than on my back without them counting and yelling at me with my breath held as hard as I could, if I would have known that cause I didn't even want to push when I was 10 centimeters.

I was.  Over the edge of the bed. And I'm just like, I don't want to yet. And they're like, yeah, 10 centimeters. We need to start right now. Your first time, mom, it's going to take you a long time. And I was like, how long is long? 30 minutes. And four hours later, they're like, you ran out of time. So yeah,  looking back, it's like all these things.

I wish I would have just been like, wish I would have known. Or , even like, if you do know, I like, at least for me, when. But like, and again,  things feel a little bit fresher just because I had my kiddo not that long ago,  even when it, when I was  laboring and people would ask me questions and I do this for my job, I was like, I don't, I don't know.

, , that's where I feel like having a doula, especially for your first time,  being a first time mom is so helpful because your birth partner has no idea what's going on. They're terrified. You, you're just trying to survive and so like having a doula to kind of like be able to kind of like one keep everybody steady and calm  and also to just kind of being  that bridge of information a little bit for you.

I feel  it's just way more beneficial and just kind of keeps things.  I don't know, makes you feel clear minded a little bit more. That's a huge part too of  the reassurance aspect is just having  a third party there as  a facilitator of like, you've been to birth before,  you kind of know how things are going to play out.

Even if you take , a childbirth course or you do whatever research on your own on social media or YouTube or watching that kind of stuff. You don't actually know everything from start to finish that's going to happen or what the, even just  what the room's going to look like, where people are going to be standing,  how all that kind of happens that to have somebody else there to be like, Here's a recommendation or like, go stand over here or go try this.

Or what do you think of this? Or this doesn't look very comfortable for you. How about we move? Cause in the moment,  I have no idea sometimes like what you're actually doing and your partners wants to help, but sometimes they don't know how to help. So I think that's, yeah, it's helpful to have more support people.

I think if people are up for having an extra person in their, in their birth room to help.  Facilitate that and just have the ideas and the education beforehand, whether that's like meeting with a doula or meeting with like somebody like you guys, the pelvic floor, physical therapists, like there is so much education and coaching that's part of it.

It's not just, we're going to come in for a visit and do like an adjustment or exercises. And then like, that's going to be the part that it changes your birth. It's like all of it combined with. Yes, the mindset work and the education and the body work and all that, like it all goes hand in hand. And I wish I would have known that much sooner, but yes, loving spreading the word about it. 

Yeah. Especially pelvic floor physical therapy, like during pregnancy is going to be a lot of education, hands on, like. We're probably going to give you a max of three things to work on at home. Like what's not going to be like, here's 15 exercises to do. And we just want patients to feel empowered and like as knowledgeable as they can about their choices and what they want.

And no matter, no matter what type of birth you're planning on to have, like we've worked with moms who are  giving birth in a birth center, they want to go on medicated all the way to, as soon as I walk through the hospital door, I'm going to get an epidural. We're like, dope. How do we make that like, as close to the dream birth as humanly possible and just kind of giving everybody the tools.

and things to set them up for success going into that.  Yeah. I love that too, because it's like, it doesn't matter what interventions you have or don't have, or like the actual like unfolding of your birth. It's going to go how it's meant to go with the right information that you have. Like, you know, Mary, you said that you had a C section that you didn't plan for, or well, you planned for it eventually, but it wasn't in the original plan.

Yeah. And it took a lot of , Again, mental work to be come out of that delivery and be like, my body did a really hard thing and I'm really freaking proud of myself. And so I think the just mental mindset and just kind of that, like  mental work going into a delivery is just huge because I don't know, everybody should be proud of their birth.

They like, it's a really cool thing that your body is doing. So. Thank you so much for tuning in to your birth bestie podcast today. You can find Mary and Amanda on Instagram at bloom PT and wellness, or on their website at bloom PT and wellness. com. They offer both in person physical therapy sessions, as well as in their office in Hartland, Wisconsin.

If you are expecting or have had a baby before, it doesn't matter how far out postpartum, definitely two great providers to reach out to if you're interested who will also provide education and encouragement and lots of amazing support. Thank you again for being here and I will be back next Tuesday.

Bye everyone!