Worried about bump measurements, growth scan and over-medicalisation

[kingfisher657]

My last 3 bump measurements were:
-34+5 = 35 cm
-36+1 = 38 cm and no sign of engagement, 5/5 palpable
-38+1 = 36 cm and suddenly engaged, 3/5 palpable

So my measurements have gone down in the last 2 weeks. My midwife is not concerned, she's almost positive it's because his head descended during that time. I'm also a little suspicious that the 38 cm measurement was maybe not accurate. But she has referred me for a growth scan in the next few days just to rule out any problems - apparently they are checking for intrauterine growth restriction, and she says "I've felt a lot of growth-restricted babies and they don't feel like this." She also thinks my bump has visually grown since last time.

I am very worried, not about anything being wrong with the baby - I really think he's fine and I trust her judgement. Instead I am worried about unnecessary over-medicalisation. What if there is some false positive at the scan - too small, too big, low fluid levels, etc - and they recommend an induction or close monitoring that turns out to be unnecessary? I know a friend this happened to, and she had a really bad experience with induction ending in a cesarean, and the baby was an absolutely normal size - if she'd never had any scans at all, it might have been different.

I'm also really keen to give birth on the alongside midwife-led unit, which sounds so much nicer than the proper hospital unit. But if there is anything wrong on the scan they might not let me. On the other hand, if I go into labour before the scan, they might not admit me to the midwife-led unit because they haven't yet ruled out growth restriction, and would want continuous monitoring.

I realise the most important thing is the health of the baby, and of course if anything was actually wrong I would want as much medicalisation as necessary - but I really don't think anything is wrong and I just want a straightforward birth with minimal intervention.

Just looking for a bit of reassurance really and crossing all my fingers the scan is normal, and I don't go into labour in the next few days.

[DinoHat]

My bump is measuring at 5th centile, my growth scan showed my baby is on the 50th centile.

I was 24cm at 28 weeks
29cm at 32 weeks.

[Narwhalsh]

Not related to the growth concerns but I’ve birthed twice in a labour unit (should have been the alongside midwife unit but it was closed both times-what are the chances?!) and have had positive experiences both times. Hands off midwives who listened to my requests. Took in own birthing ball, turned down (off!) main lights, own music etc. Just to say birthing in the consultant led unit doesn’t necessarily mean interventions are thrown at you

[anniebu]

Don't worry, your bump measurement is totally fine. It can vary by a couple of cm due to how much you ate, whether you had a bowel movement or not, wind etc. To say nothing if the baby position and the accuracy of the person doing the measurement.

[JustineTimee]

I can really understand where you're coming from but are you maybe overthinking it a little bit? In all likelihood the scan will just confirm everything looks fine and it will be reassuring and no change of plan will be recommended. I know how it feels, though, OP, it's such a nerve wrecking time as it is- sometimes we forget that things can also go just fine x

[JemimaTiggywinkle]

I had lots of scans because my bump measurements kept coming up small (and the scans kept showing the baby was on the larger side).

Don’t worry, as long as the scan shows the size is within the normal range you’ll be fine.

I understand your concern about flagging up a false positive, but it’s possible it could also flag up something worth knowing.

I started labour in a midwife led unit and was transferred to the labour ward half way through. It was fine, and by that time I really didn’t care where I was giving birth.

[Flittingaboutagain]

I understand OP. Just remember that the decision about what to do based on the scan will involve some choices. Keep asking for specifics and do not accept vague statements of risk. Ask are there any alternative options and why wouldn't we do them first etc? You can also ask for ambulatory monitoring, to be kept upright etc even if some level of intervention turns out to be necessary. Do you have a birth partner you trust to advocate for you when the time comes?

[Peacefulspirit]

You can also decline the growth scan. You make the decisions around your pregnancy and your care. This is something that has been emphasised in all the most recent maternity care reports.

[AutumnVibes]

Just wanted to echo Narwalsh and say that I was induced and gave birth on a consultant led ward and it was a really positive experience with minimal intervention and really kind and sensitive midwives. I also know someone who had a still birth at 41 weeks. So if it was me, I would just let myself be led by the medical professionals and not fear the medicalised route. I hope things go smoothly for you and your baby.

[MindyStClaire]

I think you're really overthinking things here. By far the most likely scenario is that the scan shows everything is fine. I also would've thought a true positive is more likely than a false positive.

Also, I think you're overthinking and over planning in general. I'd hoped for the midwife led unit but ended up with an induction and emergency c section. It was a very positive experience and we were all very well cared for. But I do think if I'd had my heart set on the midwife led unit I might have found it all a bit hard to accept.

[Aozora13]

The tape measure test is just a screening mechanism and not especially scientific - the way I carried in both my pregnancies meant I routinely measured small and was untimely referred for growth scans. I was happy to be scanned though in case something was wrong. Was fine both times and went on to have very straightforward births in the MLU. The way I see it is that the chances of something being wrong are low but the stakes are so high I’d rather they were over-cautious.

It’s quite a leap from measuring a couple of cm behind to emergency c-section though! You do have the option to discuss things further or even refuse interventions at various steps of the way. But I’d definitely recommend keeping an open mind when it comes to the birth - the MLU is great but it’s not suitable for everyone and the priority is getting the baby out safely.

[kingfisher657]

Thank you everyone. I'm sure I am overthinking things, it's a particular talent of mine

I have no idea of the rate of false positives versus true positives for problems flagged up by growth scans. I don't want to refuse the scan, though, otherwise the anomalous measurement will be unexplained on my notes.

Just about everyone I know who's had a baby in the last 5 years has had an induction or a cesarean or both (one as a result of growth concerns which she maintains were a false positive from inaccurate scans!) Based on this sample it feels a bit like spontaneous labour and straightforward birth doesn't exist. At 38 weeks with everything looking good, I was starting to feel like I might be the exception to that - but now I feel like surely something must go wrong - and maybe this is the start of things going wrong...

The most likely outcome, though, is that everything is fine on the scan, I suppose I just have to remember that while I wait...

[Aozora13]

*oops that should say ultimately not untimely, the scans were well timed

[Aozora13]

So according to the NHS statistics for 2019-20 49% of births were spontaneous, 33% inductions and 17% c-section. Not sure about the other 1%! Obviously in that you have to account for things like induction at 40 weeks for women over 40 or when overdue for younger women, people with health conditions eg diabetes or high blood pressure, ELCS etc. So if you’re all good at 38 weeks things are looking good! I think those stats probably reflect my own personal anecdata quite well FWIW.

[HopeValley]

I also do the over thinking! I had 2 births in a midwife led unit - they were positive experiences but honestly I really don't think it would have made a difference where I was. It was a big room with weird and wonderful things in it but I just crouched on or against the bed with my eyes shut. It's not really like on One Born Every Minute when women seem to be in for hours in the very early stages of labour and busy having a chat with their birth partner - they don't want you there til you're pretty far along and by that time it doesn't really matter where you are. Hope all goes well for you.

[kingfisher657]

Thank you @Aozora13 those are really interesting stats! And I agree that many inductions and cesareans will be known well in advance, so my raw chances are better than 50%. Most of my friends are in other countries where I suspect things are a lot more medicalised, so that might be skewing my perceptions as well. (The 1% is probably just a rounding error?)

[MathsyUsernameGoesHere]

At 38 weeks with everything looking good, I was starting to feel like I might be the exception to that - but now I feel like surely something must go wrong - and maybe this is the start of things going wrong...

An induction or section isn't things going wrong though.

I've seen so many women on my birth month groups making birth plans, doing hypnobirthing, really focusing on a natural delivery with no painkillers etc. Then a few months later they're the ones discussing birth trauma because for whatever reason things didn't go as planned. There's a bit of a cult built around natural childbirth and it she's women a disservice IMO - these things just can't be planned for, especially on a first baby, and we need to bear that in mind.

The odds are very much in your favour for spontaneous labour and natural delivery. If that doesn't happen, that doesn't mean anything has gone wrong or should've been done differently, or that it would necessarily be an unpleasant experience at all.

Best of luck

[AutumnVibes]

Couldn’t agree more with previous poster. Definitely not ‘going wrong’ to be induced etc. And the mindset can cause lots of anguish and heartache unnecessarily. Good luck.

[Mammyofasuperbaby]

I went into my first pregnancy with no expectations or birth plan and I just went with the flow which was just as well as I had an emcs at 33 weeks due to pre eclampsia and severe iugr. The events surrounding my sons birth were traumatic but the birth itself was very relaxed (all things considered).
I had increased monitoring with my second with extra appointments and growth scans. These flagged up that baby wasn't growing properly and i had an elcs at 36 weeks. Again this was a lovely experience.
I agree with pps that expectations of natural births and a fear of deviating from that is likely leading to the increase in birth trauma and women's feelings of failure.
Induction, c sections and a medical environment aren't failures or mean that something has gone horribly wrong - it's just the best and safest option sometimes and for others, like myself it's preferable

[awaketoosoon]

If it reassures you I was induced (concerns re blood flow). I searched the internet for positive stories & could only find long labours, intervention etc. I had the pessary & gave birth 12 hours later with 1.5hrs of active labour.

[kingfisher657]

Thank you all for your support, and especially for helping me to think about medicalisation a bit differently. I've just had the scan and everything looks completely fine. 75th percentile weight so definitely not growth restricted - luckily that's from a big tummy rather than a big head! Full steam ahead to the birth centre now...

[awaketoosoon]

good luck!