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Q. My daughter is 28 weeks and measures 32 cm. Her doctor says she is 4 cm. larger than she should be at this time and is concerned that the baby is growing more rapidly than it should. This week, she tested negative for gestational diabetes. She is very overweight. She is 5' 9 3/4" and is weighing about 370. Her diet seems to be nutritional. She is on 2200 calories and is measuring her foods. She is not adding extra fat in the form of oil or butter, etc. She also has brothers who are 6' 6" and 6' 8" and wear a size 17 shoe. The father's family is also tall. So, she is not diabetic, possibly overnourished, and definitely has a heredity factor.

The doctor said he feels she will need a cesarean. She is very concerned and her husband is near panic. Should she seek a second opinion? Are there questions she needs to ask? Can she avoid a cesarean? Are 2200 calories more than she needs? How much chance is there that he has misgauged the size of the baby?

Thank you for your help.

A. Your concerns for your daughter are very valid. It probably is too soon to be worried about the baby being "too fat" at this stage but from the family history you gave it will most likely be a large baby at term. Does her doctor agree with her 2200 calorie diet? It sounds like she is being very careful to have a healthy diet without overeating non-nutritional foods. I hope that she is also getting some fresh air and exercise every day. If your daughter is in good physical shape she will feel better and have more chance for a normal labor and birth. It might help to get a second opinion if her doctor continues to insist on a C-section as that would have its own set of risks, especially for a mother who is very overweight. Please advise her also to keep careful track of the baby's movements as the pregnancy progresses. This will help keep track of the baby's wellbeing as well.

Cyndi Klausing, RN, ACCE, has been a childbirth educator and breastfeeding counselor for over 18 years. She currently works as a newborn nursery nurse and is the mother of four sons.

Cyndi will answer your questions on fertility, pregnancy, birth, breastfeeding and babies. Her advice does not take the place of your practitioner. Personal answers will not always be possible.