Episode 151 - Big Babies, Small Babies: Understanding Size, Scan Accuracy, and Your Choices at the End of Pregnancy

In this episode, I unpack one of the most common concerns at the end of pregnancy: baby size. Whether you’ve been told your baby is “big” or “small,” this conversation can quickly lead to discussions about induction, monitoring, or caesarean birth.

This episode breaks down what those labels actually mean, how accurate growth scans really are, and how these predictions can influence decision-making.

References

1.American College of Obstetricians and Gynecologists. (2020). ACOG Practice Bulletin No. 222: Fetal Macrosomia. Obstetrics & Gynecology, 135(3), e18–e35. https://doi.org/10.1097/AOG.0000000000003770

2.Royal College of Obstetricians and Gynaecologists (RCOG). (2017). Management of Suspected Fetal Growth Restriction. Green-top Guideline No. 31. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/fetal-growth-restriction/

3.Melamed, N., Yogev, Y., Glezerman, M., et al. (2009). Inaccuracies in ultrasound estimation of fetal weight: implications for clinical management. Obstetrics & Gynecology, 114(5), 1077–1084. https://doi.org/10.1097/AOG.0b013e3181bb3b43

4.Deter, R. L., et al. (2018). Ultrasound estimated fetal weight: Accuracy and implications for clinical practice. Ultrasound in Obstetrics & Gynecology, 51(2), 154–161. https://doi.org/10.1002/uog.18994

5.Ehrenberg, H. M., Mercer, B. M., et al. (2004). The influence of birth weight on cesarean delivery rates. Obstetrics & Gynecology, 104(4), 671–677. https://doi.org/10.1097/01.AOG.0000133326.19052.8c

6.Sovio, U., White, I. R., Dacey, A., et al. (2015). Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women: A prospective cohort study. The Lancet, 386(10008), 2089–2097. https://doi.org/10.1016/S0140-6736(15)00221-9

7.NICE (National Institute for Health and Care Excellence). (2019). Intrapartum care for healthy women and babies. https://www.nice.org.uk/guidance/cg190

8.Jolly, M., Sebire, N., Harris, J., et al. (2003). The risks associated with small for gestational age infants. BJOG, 110(3), 201–207. https://doi.org/10.1111/j.1471-0528.2003.02090.x

9.Hiersch, L., Yogev, Y., et al. (2016). Impact of estimated fetal weight on labor management and birth outcomes. American Journal of Obstetrics & Gynecology, 214(3), 385.e1–385.e7. https://doi.org/10.1016/j.ajog.2015.09.081

10.Buck Louis, G. M., et al. (2013). Predictive value of ultrasound-estimated fetal weight for delivery outcomes: a systematic review. Maternal and Child Health Journal, 17(3), 540–550. https://doi.org/10.1007/s10995-012-1067-5

11.American College of Obstetricians and Gynecologists (ACOG) (2017, reaffirmed 2024) Practice Bulletin No. 178: Shoulder dystocia. Obstetrics & Gynecology, 129(5), pp. e123–e133. Available at: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/05/shoulder-dystocia (Accessed: 20 April 2026).

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