Small Babies 2

So I think I may have uncovered at least 1 underlying belief that causes many pregnant Filipinas to want to inhibit the growth of their babies in utero so it's not "too" big, meaning anything approaching 7 pounds...
Yesterday, I went to visit one of the obstetricians that partners with the clinic where I work. We refer those patients of ours to her that need something beyond our scope of practice - for example: prescriptions, hospital care, consulting for a complication, etc...
A few friends and I visited her at the hospital because she gave birth to her first child 2 days ago. We dropped off some flowers and congratulated her on her new baby. We asked how much he weighed and she replied, "5 pounds 15 ounces. I'm sooooo luckyyyyyy! I just knew if he was 7 pounds I'd need a C/S (cesarean section)!"
Let me explain that this is a very educated, upper-class Filipina who is also an obstetrician! If she believes it's impossible to give birth vaginally to a 7 pound baby, then it doesn't surprise me that many ignorant, poor people believe that too! I wonder what she did, if anything to keep her baby small. Don't get me wrong, I don't think she starved her baby or anything, as the size of her baby is just on the low end of normal. I just know that she hoped, really hoped her baby would be small.
I just wish that all the women in my life (including my own mother and mother-in-law) who have given birth naturally to healthy babies weighing 7, 8 or even 9 pounds could come and share their birth stories. While I am sure it was hard work to push those babies out, let it be said that it is possible people! I know I'm preaching to the choir here...
For the record, according to the newest growth charts from the World Health Organization, a normal, healthy birth weight range (between 3rd to 97th percentiles) are 5 lb 5 oz to 9 lb 4 oz (girls) and 5 lb 8 oz to 9 lb 8 oz (boys). That means birth weight under 5 lb 5 oz and 5 lb 8 oz for girls and boys respectively is considered underweight and this indicates that the health of that baby may be compromised.
Let me just explain why the newest WHO growth charts which launched in 2006 are a much more reliable indicator of normal growth compared to the ones used in the past put out by the National Center for Health Statistics, or NCHS in the US. The following is an excerpt from WHO regarding how these growth charts are different from the ones previously used:
"For the first time they describe “how children should grow,” which is a prescriptive approach, not just descriptive. These charts show that all children across all regions can attain a similar standard of height and weight and development with correct feeding practices, good healthcare and a healthy environment. It is, then, a more proactive way of measuring and evaluating child growth, setting out normative conditions and evaluating children and populations against that standard.
As such, a key characteristic of the new standard is that it establishes breastfeeding as the biological “norm” and the breastfed infant as the standard for measuring healthy growth. Previous reference charts were based on the growth of a random mixture of breastfed and artificially-fed children.
Furthermore, the pooled sample from the six participating countries allows the development of a truly international standard, which is in contrast to the previous international reference based on children from a single country."
I used to think that it was normal for smaller people to have really small babies. But now I realize that while smaller people will likely give birth to healthy babies that happen to be on the smaller end of normal, there is still a limit to how small a healthy baby can be. The women who I've known to limit their intake of food in the 3rd trimester have had babies that are just too small! The 4 pound 13 ounce baby I delivered earlier this month was too small!
So when I ask these women why they aren't eating much and they tell me they're not hungry - I'm not going to believe them right away. I'm going try to address what they just might be afraid to tell me - their fear of a "big" baby and a complicated birth - and do my best to convince them that their choice to limit their intake may very well have long-term damaging consequences on the health of their baby and that they can, in fact give birth naturally to a baby that weighs more than 6 pounds. Most of our patients do actually give birth to babies over 6 pounds so it can be done. I now personally like to see babies born at at least 6 pounds (15th percentile). So in addition to addressing this underlying belief, I will do my best to educate them and prepare them for the hard work of labor. I will also do my best to provide labor support when these women are in the middle of it and hope that they begin to believe they can do it!