To decline growth scans

[Orangepen13]

First child born slightly below 5lb 5oz so I have been offered three extra growth scans (28,32,36 weeks) in my current pregnancy

Ive heard so many inaccuracies with growth scans that can sometimes result in lots of panic, so I’m inclined to decline them. AIBU? And what are others experience of growth scans?

for context, I’m petite and my partner is also fairly lean, and first was born at 37+6 so we’re not surprised at all that she was small

I was offered and accepted growth scans and they told me things were wrong which absolutely were not, and I was encouraged to induce. Luckily I went into labour the night after my last scan while I was weighing up whether or not to be induced! My baby with the “tiny stomach and short legs but giant head” was born at 39 weeks, 10lbs and on the 99.6% for height, perfectly in proportion.

I think people are being incredibly naive when they say the NHS wouldn’t waste time and money offering a medical procedure unless they felt it was necessary. Really people?? The NHS is not the well oiled, efficient machine you think it is! & the benefits of having women induced or in for scheduled C-sections are huge. Especially at certain times of the year.

I highly recommend looking at the NICE guidelines and following them. People are saying the scans are just “information” and you don’t have to act on that information, but if that information is routinely entirely false, never mind a little inaccurate, then it isn’t information worth having. I think people would be stunned if they researched the stats behind medicalised birth procedures and how little is actually known about pregnancy and birth in modern medicine. It involves so much guess work and “let’s just whip this baby out and be done with it” kind of thinking.

I loved having extra scans. I found them really reassuring. I would 100 percent attend.

I was completely anti induction so I understand where you are coming from but that's a separate conversation to the growth scans.
I'd take the scans and then make an informed decision about any additional treatment or interventions.

As an aside I had one growth scan with another booked for 2 weeks later but I actually went in to spontaneous labour the day after my scan (at 36 weeks). The weight was exactly correct. I couldn't believe how accurate it had been.

@Lily124 I'm sorry but my dh is medical and has sadly seen dead babies so I just skim read your reply as I didn't need any information. Let's just agree to disagree!

I had growth scans with my second due to my first, perfectly normal weight, being apparently small for the 41+1 they were born at and my height, on their plotting charts.

It was a bit of a slight annoyance having to go into hospital lots more and faff on with samples/checks (and ended up having a GD test I didn’t need because a sample had some sugar in - don’t eat leftover Chinese before doing a sample!) but in the end all that mattered was my baby was okay and the tiny annoyance was far outweighed by getting to see them lots and knowing they were okay. Baby born at 41+3 at the exact same weight as our first, despite the scans plotting her as much bigger.

They’re not typically accurate but they’re absolutely worth having as they can pick up far more pressing things and I’d rather be inconvenienced than risk the worst.

I honestly don't know how women cope having a scan at 20 weeks and then nothing. Take the scans, weight up the findings.

With the above said however, taking into account inductions - mine was automatically booked for 41 weeks; it wasn’t even a conversation with me, more a, this is what I’m doing, from the midwife. There was no medical reason to, just that I was ‘over’ and I was very anti induction.

I had faith I’d go later due to previous birth so declined the induction but they did send a whole team of Dr’s to me, to try and convince me to do it. I compromised on a few days later where it turned out I didn’t need the induction process, just water breaking and she was born that day after 8 hours and 6 mins of pushing. Made it clear they weren’t coming near me with a drip and I trusted my body; do what feels right for you, just make sure you have evidence to back you up and feel comfortable with your decisions.

I took every scan I was offered for the reassurance that everything was well. I found the growth ones to be very inaccurate but that might have changed in 15 years. I kept being told that ds 2 was huge because I was huge (with a small frame) but he was just over 7lb.

If the baby is small for age then I would have thought induction less favourable as they'd want them inside as long as possible? But anyway my approach to this is always discuss discuss discuss and get as much info as possible. Please please do not hide away from medical professionals out of a fear that they just want to push induction/unnecessary intervention. It is not true.

I was told the acronym BRAIN when I was pregnant with my first and it's been invaluable for all health related discussions ever. I think sometimes the "natural birth crowd" can be overly focused on avoiding intervention, the cases where intervention was unnecessarily recommended etc and almost present it like if you have interventions, then your birth is going to be awful but if you can avoid them all then you'll have the magical perfect mythical birth - and that's not realistically the case.

All interventions have their place. For a really clear example, if you were suffering from pre-eclampsia, you've already had the blood pressure medication and that hasn't worked, and you're being offered induction, you shouldn't at this point be comparing induction (and the whole scary cascade of interventions thing) to a nice calm natural perfect birth. Because that calm natural perfect birth is already out of the window. Your choices at that point of pre-e are basically to take an induction, which might turn out to be a really easy nice tipping point induction which goes smoothly and you can otherwise still have many elements of the birth that you'd thought of, such as using water for pain relief or remaining active. Or it might be to take the induction and it turns out to be a harder induction than planned, but you still get the vaginal birth, with all the benefits of the smoother recovery etc. Or it might end up in an emergency c-section. Or you could opt for a planned c-section (which most people find calmer and less stressful than an emergency one.) Or you could say no and lose the race and end up with both you and baby in an extreme medical emergency. The point is that the induction in this case might actually be the best option. That's much more clear cut than a scan showing slow growth. But it's an example to show that the idea of refusing induction because you're fixated on "induction = bad" is not a helpful mindset. Induction is a tool, yes, not one that we want to use unnecessarily, but remember that there are cases where it will be the best option. (And for example, if you're worried particularly about the difficult induction or needing to be monitored, so on the bed, or not being allowed to use the birth pool then you could discuss alternative options like - OK - would I prefer a planned c-section? Would I think about an epidural because I'm worried about not being able to use the tools like active birthing and water that I had planned to use?)

So - back to BRAIN - it stands for

Benefits
Risks
Alternatives
Instinct / Immediate
Nothing

So you could use this right now. Next time you see your midwife, ask her the following questions:

What are the benefits of doing the growth scan? What information would you be hoping to get from that? How accurate is it? What would happen if you found what you're looking for? What would be recommended next?

Are there any risks from doing the growth scan? (e.g. Is it harmful for my baby to be exposed to the ultrasound waves? I've heard that measurements can be inaccurate, is it possible that this could cause undue alarm? My daughter was small but there was nothing wrong with her, is it likely this will be the case again?)

Is there any other way to identify this specific risk?

(Instinct is: What does your instinct tell you? But I prefer immediate personally)
Do I have to decide now? Can I think about it for a while? When do you need to know by? (For things like induction you can use immediately as in: Does this need to happen now? Can we wait a little?)

What happens if we do nothing? (This has always been the most interesting question).

Always always open up a discussion. Understanding why certain things are being suggested puts you in a much better position compared to guessing and worrying about why they are suggested. It also gives you chance to understand what the realistic outcomes are for each scenario, and compare the real situations rather than comparing to an imaginary one which might not be on the table any more. It opens up a discussion with the midwife where you can share your fears and she can explain what her perspective is on this.

More information is always useful.

Take the scans
As well as checking the baby they check the placental position and efficiency which is important
They won't offer them without good reason

I'd take the scans while being mindful of the high level of inaccuracies (scans are useful for lots of other reasons).
I was induced early both times with my "huge" babies. DS was born 8lbs 3 at 39wks and DD 6lbs 6 at 39wks. They were literally miles off.

5lb 5oz is small for a full term baby.

Some babies are just constitutionally small and it’s normal for them. However, some babies are growth restricted due to issues with placental function and are therefore at greater risk. Without growth scans during pregnancy it’s impossible to determine which of these is the case. Reduced fluid or problems with the blood flow in the umbilical artery can also indicate problems with placental function.

If following growth scans your baby is identified as growth restricted you will be offered induction of labour and it’s up to you if you accept that offer but it’s only offered when the risk of remaining in utero is greater than the risk of induction so why would you?

For a previous poster, if a baby is small for dates, they may have to induce rather than leaving them there with a failing placenta. There is usually a reason they are small for dates so no, leaving them there may not be the best course if they aren't getting proper nutrients to grow unless of course they are just a smaller baby as the child of smaller parents.

I was told that scans are generally accurate but for a very small percentage of babies the scan is wildly out and seems to bear no relation to the baby. I was supposedly small for dates and the scan showed a strapping 10 pounder. The specialist was adamant that there was no strapping 10 pounder there and he was right. A month later, a more modest 8 1/2 pounder showed up. I was a 10 pounder of course myself so I thought it would be unusual to have a smaller than average baby so I just thought my stomach muscles were good enough to hold everything in a bit. Of course, I did have the scan just to make sure.

Recently in my country, there was a case where a midwife did not pursue the issue of a small for dates woman. She did not advise scans. The baby died and it could have been saved if she had had scans and an induction. The midwife was censured of course but the baby was still dead. I'd take the scans.

If your not ready to put the child's needs above your own should you even be having one?

Have the scans to have another glimpse at baby but don't let them push you into an induction a smal baby isn't a reason for induction. If movement, placenta positioning and blood flow to the cord it all good then you having a small baby is going to be 'normal ' for you from what you've said above

I was having growth scans with dd. I was told she was just over 5lb and safe to be born at 37 weeks. The next day she was born at 3lb13. (I’m 4ft11 and pre pregnancy a size 6)

fue to this I was offered growth scans with DS. I took them because even though they didn’t seem reliable on weight I know scans can pick up a whole host of other issues that stand a better chance when caught in utero. Plus was nice to see my DC regularly on the scans.

Growth scans are not really to see how big your baby is going to be. If that was the case you would only need one just before your due date.
What they sssess is whether your baby is growing.
I had pregnancy induced hypertension which can cause growth to slow down or even stop as it interferes with placental function. Fortunately I didn’t follow the rules and DS was born at 36 wks weighing 7lbs1oz. He would have been monster at full term.
The extra scans monitored the placental blood flow and confirmed he was growing. It was a bonus that he was a good size.
Despite this he still had a few days in NICU.
I remember the scan at 35 weeks was magical. Up to then scans always make them look like aliens, big head with skinny limbs. At 35 weeks they are beautifully curled up in faetal position with newborn proportions, they actually look like a baby.

I had the 3 extra scans just in case, but they kept telling me she was too big, too small, etc and it was stressful.

I declined further test that they suggested based on a scan.

My first was 6.3lb. (It was twenty years ago no one was concerned) My second was 9lb. Thirteen years later I got pregnant again. Because my first was under 7lb they recommended the extra scans. On the third the baby had pooed inside and they kick started labour. If I hadn't had the third scan we would have only known if the baby was in distress or I naturally went into labour. I'd take the scans

I'd take the scans too. I had growth scans as my son was measuring small they stopped doing them when I was 36 weeks because he was measuring 6lb something. He was born at 41 + 6 and weighed 6lb 4oz! I don't know how they work it out and I agree they are not an exact science. Anyway years later we've found out my son is missing a kidney and one of the indicators of that is measuring below weight during scans. They never spotted it with him but it's worth having incase they do flag something up

I've had 5 growth scans. None of them in line 😅. Yes, the option of induction was bought up. However, they don't just measure growth. They also look at fluid volume, blood flow through the placenta, check your urine and blood pressure.

Though the scans were a bit zig-zagging, they were usually all within the 20-60% centile region. More variation than they would like, but all other measurements were good. I also had good CTGs. So they decided that sincs everything else was perfect and with the margin of error in growth scans that there was no reason to induce before 39 weeks. I was given the option at 39 weeks of induction or being allowed to go into labour naturally. I'm now 40+3 and hoping he comes soon 😅.

Had growth dropped off below 10th centile or my other measurements such as blood flow through the cord started to change I'd have had him out instantly. Because he would have been in danger.

Growth scans aren't taken in isolation and they are a really useful tool for getting the information to decide what you want to do. You don't have to accept induction, you could ask about continuing a bit further with extra monitoring for example. But these scans can tell them if baby is in danger and that should be listened to.

Thanks everyone for to our thoughts! It’s really made me think about my options and I’m feeling much better about accepting them!

(except for the person who questioned whether I should be a parent because I considered my choices, you don’t get any thanks)