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Birthing Instincts

#431: "Hold Your Beer" It's Fetal Macrosomia Guidelines

Birthing Instincts

Dr. Stuart Fischbein + Midwife Blyss Young

Alternative Health, Kids & Family, Health & Fitness, Parenting

4.8 • 691 Ratings

🗓️ 17 September 2025

⏱️ 90 minutes

🧾️ Download transcript

Summary

This week Blyss and Stu go on a deep dive into macrosomia, also known as a large baby. They review extensive data from multiple sources, including ACOG, NICE guidelines, and the Big Baby Study, and discuss the implications of predicted and actual macrosomia. They discuss risk factors, maternal and fetal morbidity, ultrasound accuracy, the pros and cons of induction of labor, and the impact of the standard of care. As always, Blyss balances the conversation with discussing the stark contrast between the way macrosomic babies are cared for in the hospital v at home under the care of midwives. She shares tips on how to reduce the risks of macrosomia, especially when a mom is diabetic or has gestational diabetes. 


Mentioned in This Episode

Homeopathy for Community Midwives

Birth Outside the Box

Midwifery Over Medicine: Leaving The Medical Model Of Delivering Babies To The Midwifery Model With OBGYN Dr. Stuart Fischbein Part One

Apollo the Original Podcast: Home Birth, Feminism and Hospital Misogyny | Midwife Tells it All, with Midwife Aleks 

Birthing Instincts Episode 252: Inducing Naturally & Letting Fear Control Us


Studies Referenced

NICE Study: National Institute for Health and Care Excellence. “Induction of Labour for Suspected Fetal Macrosomia: Evidence Review A.” NICE Guideline NG207, [2021]. PDF.

Big Baby Study: Gardosi, Jason, et al. “Induction of Labour versus Standard Care to Prevent Shoulder Dystocia in Fetuses Suspected to Be Large for Gestational Age in the UK (the Big Baby Trial): A Multicentre, Open-Label, Randomised Controlled Trial.” The Lancet, vol. 405, no. 10491, 17 May 2025, pp. 1743–1756. DOI: 10.1016/S0140-6736(25)00162-X.

ACOG Practice Guidelines: American College of Obstetricians and Gynecologists. “Macrosomia.” Practice Bulletin: Obstetrics, Committee on Practice Bulletins—Obstetrics, William H. Barth Jr, MD, and Rebecca Jackson, MD, [2016] PDF.

Preyer, Oliver, et al. “Fetal Weight Estimation at Term—Ultrasound versus Clinical Examination with Leopold’s Manoeuvres: A Prospective Blinded Observational Study.” BMC Pregnancy and Childbirth, vol. 19, 2019, article 122.

In This Episode

Macrosomia: Definitions and Risk Factors

Understanding Shoulder Dystocia and Its Risks

Clinical Estimated Weights and Palpation Skills

Induction of Labor and Macrosomia

VBAC and Macrosomia Considerations


Podcast Produced by: Raquel Hernandez, Pride and Joy Doula Care 


This show is supported by

Connect with Dr. Stu and Blyss



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Transcript

Click on a timestamp to play from that location

0:00.0

Welcome to the Burling Instincts Podcast.

0:05.0

I'm Dr. Stewart Fishbein, community-based practicing obstetrician and long-time advocate for birth choices.

0:10.0

And I'm Bliss Young, a licensed midwife.

0:13.0

Join us in our conversational style podcast where we talk about everything birth.

0:17.0

Sometimes we laugh, sometimes we cry, but we're happy that you're here. So here we go.

0:21.6

Oh my God.

0:22.6

Well, it truly is good morning from here in Utah.

0:27.6

The sun is up and the construction going on to Bach away as loud as ever.

0:33.6

And good afternoon, good evening, and good middle of night and everybody else.

0:38.0

I was thinking that I would talk really fast today.

0:40.5

Like, you know how people put out of their podcast on one and a half speed or two speed?

0:45.4

Because I probably need to talk because I got a lot of data today because we're going to talk about macrosomia.

0:51.1

And I'll get into that minute, but first we have to do our traditional stuff.

0:55.7

Okay. So where are you now? Bring us up to date. And then I'll get into my stuff. And then we'll get into macrosomia.

1:02.7

I'm right on the border of Tennessee and Virginia. I had an elder that I was scheduled for yesterday, but she had to go to a birth.

1:12.7

So I'm kind of in a holding pattern right now until she's ready.

1:16.8

I think when that happens. It happens. And they apologize. And I'm like, are you kidding me?

1:20.9

We're we understand how it is. It's fine. Of course. It's raining here. And I haven't had any rain.

1:27.3

And it's been raining for hours and I looked

1:29.4

around at the math and literally it's only raining here.

1:33.8

Everywhere else around, it's not raining, but it's fine.

1:36.0

It's lovely and I'm near Bristol, which I guess is the home of country music.

...

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