ACOG Takes a Stand on Elective Cesareans and Induction for “Big Baby”

Yesterday, the largest voluntary membership organization for ObGyns in the U.S., the American Congress of Obstetricians and Gynecologists (ACOG), released statements about two subjects near and dear to us:

Early Deliveries Without Medical Indication: Just Say No

Vaginal Delivery Recommended Over Maternal Request Cesarean

We spoke with Dr. Nikolas Capetanakis, an Ob/Gyn in Encinitas, California about these statements.  What do they mean?  How do they impact our care as pregnant women?

Dr. Capetanakis told us that “this information is not ground-breaking; however, it is a good reminder about the parameters in which we should practice.”  For one, induction or surgery for “suspected big baby” (macrosomia) is not medically indicated.  This is one myth we hear about all the time, even though ACOG has been talking about the “imprecise” nature of diagnosing macrosomia for at least ten years.  Bottom line: induction for big babies is NOT medically indicated.

Elective inductions prior to 39 weeks gestation is, again, not recommended.  Studies have shown that babies do better when they are able to remain in utero until 39 weeks.  In the article above, ACOG says, “Early-term infants have higher rates of respiratory distress, respiratory failure, pneumonia, and admission to neonatal intensive care units compared with infants born at 39 to 40 weeks gestation. Infants born at 37 to 38 weeks also have a higher mortality rate than those born later.” The March of Dimes’ “39 Week Initiative” has covered the subject intensely and created a protocol for all hospitals to follow.

In this new age of information, Dr. Capetanakis wanted to mention that women should not feel tied to a provider they are not comfortable with.  It is never too late to transfer to a physician who is more in line with your philosophy and willing to communicate openly and honestly about what is and what is not evidence based medicine.

Consulting on this article: Nikolas G. Capetanakis, D.O., FACOG is a board certified obstetrician and gynecologist with a private practice in Encinitas, California.  He completed his residency at Loma Linda University Medical Center and specializes in VBAC and unmedicated deliveries, minimally invasive surgery, and fertility treatments.


  1. Lynn Allison

    It has been shown that the exposure to the microorganisms that occurs in vaginal births stimulate the immune system making our babies healthier. When did mothers start determining when a caesarian was needed? My mom vaginally delivered 4 babies over 9 lbs safely. The MD just had to be patient.

  2. nancy mercier

    37 years ago, I delivered a baby boy 10 lb 8 oz at home with a mid-wife present. It was a wonderful delivery and we lived 2 hours from the nearest hospital. My daughter delivered three babies at home with a mid-wife: 10 lb, 10 lb 8 oz and 10 lb 5 oz.

  3. I wish there were bigger pictures for pinterest.

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