For years on True Birth and in their OB/GYN practice, Dr. Abdelhak & Kristin Mallon have made an unpopular argument: when a baby is measuring big, the safest move is usually to induce, not to wait. The conventional literature did not back them up, and plenty of academics pushed back with the same line every time, that induction does not lower the risk of a cesarean or a shoulder dystocia. In this episode they walk through two pieces of high level evidence that land squarely on their side, and they explain why this was common sense all along.

They start with the bigger cultural point. We do not have natural pregnancies anymore, so it is unrealistic to expect a uniformly natural birth. Electricity, processed food, far fewer daily steps, and later maternal age all push birth weights up, which means more babies are simply too big to deliver without help. Kristin brings the midwife lens to this, including a frank look at the Ina May Gaskin farm numbers and what they actually showed. From there they get into the data, share a real shoulder dystocia save from the floor, and detour into the things that genuinely scare them in delivery, like postpartum hemorrhage, plus Dr. Abdelic's running theory that growth problems are usually about the cord, not the placenta.

The take home is blunt. If your provider tells you the baby is measuring large, the right question is not whether to induce. It is when.

What we cover

Why "natural birth" is a moving target in a non natural world
The Ina May Gaskin farm numbers and what they really tell us
The landmark randomized trial on inducing large for date babies
The brand new 2026 meta analysis on induction at 38 weeks
How estimated fetal weight, the 90th and 95th percentiles, and hospital induction rules actually play out in practice
A real time shoulder dystocia at the bedside, handled without the fanfare
Why hemorrhage, not shoulder dystocia, is the emergency that worries them most
"It is all about the cord," and why placental insufficiency is the wrong framing
The difference between cervical insufficiency and true preterm labor
How to filter real clinical advice from social media noise

The research referenced

The randomized controlled trial (the Lancet study): Boulvain M, Senat MV, Perrotin F, et al. Induction of labour versus expectant management for large for date fetuses: a randomised controlled trial. Lancet. 2015;385(9987):2600 to 2605. A pragmatic trial across 19 centers in France, Switzerland, and Belgium. Women with singleton fetuses above the 95th percentile were randomized to induction between 37 0/7 and 38 6/7 weeks or to expectant management. Induction significantly reduced the composite of shoulder dystocia and associated morbidity, relative risk 0.32, 95% CI 0.15 to 0.71, p equals 0.004, without raising the cesarean rate and with more spontaneous vaginal deliveries.

The 2026 meta analysis (the AJOG MFM study): Paladino, et al. Induction at 38 weeks for large for gestational age or macrosomic fetuses decreases the incidence of cesarean delivery: meta analysis of randomized controlled trials. Am J Obstet Gynecol MFM. 2026. Five randomized trials, 4,083 pregnant individuals, most induced at 38 0/7 to 38 4/7 weeks for an estimated weight above the 90th percentile. Induction lowered the cesarean rate and cut macrosomia (relative risk 0.53 for 4,000 grams or more, and 0.22 for 4,500 grams or more). Shoulder dystocia and fetal fracture both trended down but did not reach significance, which is expected for outcomes this rare. Roughly 25 inductions in this window prevent one cesarean.

Key takeaways

A big baby is the single biggest risk factor for shoulder dystocia, and a baby does not get smaller between 38 and 40 weeks. The evidence now shows that inducing for a large for date baby reduces shoulder dystocia and cesarean delivery and increases the odds of a vaginal birth. If you are told your baby is measuring large, come prepared to ask for induction rather than waiting to be offered it. And take advice from clinicians who have actually cared for patients with your condition recently, not from a single viral story.

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