VBA2C - Complications with fetal growth, help!

[lindsey077]

Hi everyone,
I'm not a regular here but I really need some advice and I'm really hoping someone knowledgeable will be able to help, I'm so worried. it might be long but II'll try not to leave anything out.

1st birth in 2005 - Emergency c/s after a long back to back labour due to fetal distress. 11lb 5 baby(!!) but healthy.
2nd birth in 2007 - felt cornered into an elective c/s after being told that this baby was going to be big after growth scans. 8lbs 14, healthy baby.

This is our third and will be our last baby. I've fought for a VBAC and my midwife is in full support, and so was a member of my consultant's team when I spoke to him at my 20 week scan.
At around 30 weeks I was measuring 4 weeks ahead and this continued for around a month. I had a GTT which came back negative so was referred for a growth scan at 34 weeks - this picked up low fluid and large abdominal measurement - pretty much on the 90th centile. The head was measuring just under the 50th centile so not a cause for concern. I was booked in for a further scan at 36 weeks (today).
I went in today and the head is measuring in line with the last scan, ie. growing steadily. The abdomen has grown but not by a lot, almost remaining the same as last time.
We met with a doctor after the scan who came in with a load of c/s consent forms and cornered me into booking an elective c/s at 41 weeks due to my first babies size and the fact that this one was measuring big. I wasn't happy with this, and unwarned about it prior to the meeting. Then she proceeded to say I had to have two further scans to measure the size of the baby. I argued this as we were told that if the baby fell back within normal centile lines it would be a good thing. I asked if we could combine the two scans at least so I wouldn't need to keep coming into hospital and finding childcare for the school run. She couldn't tell me and went to get my consultant.
My consultant came in to speak with us and in a very abrupt manner explained the reasons for the two further scans. He said I needed to come in as the babies abdominal growth had slowed he is now concerned my placenta has stopped working properly and that the baby has stunted growth - we did say that the midwife on my first visit measured in a totally different way to the midwife today but he disregarded this. I asked what would happen if next time it was mis-measured and I ended up with a c/s for no reason and he said this wasn't a possibility. He said in one week I had to come back for a doppler test to check the flow of blood through the cord. And then in two weeks for another growth scan. He said he was considering bringing me in every other day for doppler scans and that I should be thankful I'm not going to do that. He also said that I can't combine the scans as I wouldn't want a fetal death on my hands(!!) He and all of his staff seem to be really pushing for another c/s which I absolutely do not want. They keep mentioning stillbirth and things which is frankly terrifying but I feel they are basing this on the merit of one scan carried out by one person which may have been as a result of human error.
So now I am having to go in again tomorrow as I had to leave today to pick up my children from school for a fetal heart trace, the midwife has written I refused it in my notes which was not the case at all. And then again next week for the doppler test and then again the following week for another growth scan after which they will discuss with me about bringing the c/s forward to 38-39 weeks. When I asked if I could be induces/have my waters broken if we needed to get the baby out sooner I was told absolutely not.
I just feel utterly miserable, I have been asking all along for as non medicalised a birth as possible but I get the impression that all the staff on my consultants team are eager for me to have a c/s. I struggle to stand up for myself and question their views as I keep being told that I don't want my baby to die. Of course I don't, but I just can not see that their evidence points to this being a strong possibility.

I think that's everything - I hope it's readable! I'm a bit emotional today and I apologise if it's a bit garbled. I'd love to hear any advice.

Oh dear you sound like you are being a bit railroaded! Having said this what are your reasons for being so adamant ref c/s? I think it's quite unusual for docs to be so pushy FOR c/s...maybe you should just accept their advice?

My reasons for wanting a VBAC are the usual really: faster healing time, no major surgery, ability to care for all my children quickly after birth, less risk of damage to bladder, bowel etc, breastfeeding easier to establish, I want to deliver naturally. Plus I haven't been given a real reason for why a c/s is needed - this panic is all over two growth scans, one or both of which could be a mis-measure and the baby has grown, just not as much as the consultant would like. I feel my wishes are being ignored and not even taken into consideration. My doctors were pushy last time for c/s just on the size of my first, no other reasons for repeat c/s at all and she ended up being normal size. Same consultant this time round.

Forgot to thank you for your reply, sorry! Thank you so much.

Perhaps suggest a compromise? Say that if after another scan at 38 weeks things still don't seem right from their eyes then do a c/s? Or go for further monitoring and if you havent gone into labour by your due date maybe book a c/s then? Poor you!

I've already compromised and booked an elective at 41 weeks. I've told them that of course I won't risk hurting the baby so if the scans show there genuinely is a growth problem then I will consent to a c/s but even the consultant says it's likely to be an error in the way it was measured. I just feel as though they're looking for reasons to push me into a repeat c/s.
In the past I've gone in well informed on VBAC problems etc but I can't find any info on growth slowing to tell me how much of an issue it is. I just want to make an informed decision and feel that the information I'm being given from the hospital is very one sided.
Thanks again for your advice.

I had a baby whose growth slowed due to the placenta not working properly. The would have induced me at 37 weeks had I not gone into spontaneous labour at 34 weeks. (Premature labour is very likely when the placenta isnt working well. Nature's way of giving the baby it's best odds of survival) I don't understand why they aren't considering induction for you tbh. It's worth bearing in mind though that something like half of all induced labours result in emergency CS anyway. At least a planned one is calmer!

Like you, I was adamant throughout my pregnancy, knowing the complications and how closely I was being monitored, that I wanted as natural a birth as possible. In the event they tried to hook me up to monitors, which would've left me on my back - I didn't want this and said so, loudly. Thankfully I laboured very quickly and did give birth naturally, in my preferred position. But I had to 'fight' all the way not to be overwhelmed by the pressure to just get on the bed, stirrups, straps, monitors etc.

Ultimately, how you labour is your choice. With consultants it's worth remembering that they are experts in complications. They don't see 'normal' pregnancies and births therefore they don't quite consider normal birth as a possibility.

Best of luck with it all.

Certain methods of induction are not recommended for VBAC because the increased strength of contractions can put more pressure on the existing scar and increase the risk of uterine rupture, apparently.

I'm hoping for an intervention free HBAC in a few weeks - no complications so far this pregnancy - but I suspect they will push for a Csection if I end up overdue rather than induction.

If you have low amniotic fluid, they want to do much more monitoring to check everything is ok with the placenta and with baby. I was on daily monitoring until my fluid levels crept back up last week. They are super super cautious about it, which I was reassured by tbh.

Hope all is fine and you get the delivery you want, but if you do have to have another cs, at least you know it's for the safety of the baby.

Just wanted to follow up, with another thought. One of the only things that sometimes helps combat low amniotic fluid is maternal overhydration. I've drunk as close to 5litres a day as I can get for the past few weeks, suffered the consequences by peeing for Britain, but it seems to have helped as my levels are slowly but surely rising. Might be worth a try...

I understand your thinking. But have to say, if my consultant thought there was any risk at all to the baby and thought I should have a section, then that's what I would do. No question.

Apologies for the late reply, I've been at the hospital again for a CTG. All is fine with the baby and the midwife said the trace was perfect.
It does help to remember that the consultant is an expert in complications, I hadn't really thought of it like that at all.
I am in full agreement of not being artificially induced, I don't want to put the baby in any danger whatsoever, but I was told that if my cervix was favourable then my waters could be broken as a way to start labour naturally. This is what I was hoping for if the baby needs to be delivered after the 38 week scan but my consultant is reluctant to do this prior to 40 weeks.
With regards to the amniotic fluid, this had increased yesterday at my scan (sorry I forgot to mention). They don't seem concerned now but I will take the advice of drinking loads as it can't hurt to try and improve things a bit more.
The problem I have with the section advice is that it's all based on one abdominal measurement that in my opinion was taken in a different way to the first. The first one was really cautious and plotted points all the way around the abdomen and then joined them up, the one yesterday used a rollerball and was very quick, I remember thinking that it wasn't as carefully done as the previous. I don't want a section unless there is genuine medical need and currently I don't believe there is. If I go for the next scan in two weeks and the ab measurement has still remained the same then I will be concerned. I just felt yesterday it was a bit premature to be talking about fetal deaths and how I was likely to need a c/s. The femur length and head circumference had grown in line with their centile charts.
Thank you all so much for your comments, it has really helped to talk through what's going on and get a different perspective. I am feeling a bit better after the trace today showing no problems.