Being advised to be induced at 37 weeks due to "small" baby, but predicted to be over 7lb at 40 weeks

[Belleende]

Hello all, I am 43 pregnant with DD number 2. I am being scanned regularly and she is coming up growing beautifully just below the 10th centile, according to my personalized growth curve ( based on my height and weight, I am a bit taller and heavier than the average mum). No issues detected. Lots of fluid, moving well, placenta seems to be functioning perfectly.

As she is just the wrong side of the 10th centile, I am being advised to be induced at 37 weeks, even though there is a chance that at that point she will be under 2500g, which is classed as v low birth weight, and likely to have to be in incubator for a few days, may be jaundiced etc.

However, looking at the projections they have given me, if she stayed in there until 40weeks, she is predicted to be over 7lb. Hardly a tiddler. They seem to be saying that I should be having monster babies.

My instinct (and the data tbf) are telling me that the best thing for me and baby is to refuse the induction. Does anyone have any experience of anything similar? Do I need to prepare to put up a fight?

I didn’t understand why you are advised early induction. Is there a problem other than weight? Or a suspected reason why baby isn’t putting on weight?

I thought below 10th centile was about 5.5lb at term?
DD was just over 7lb and was on the 50th at birth from memory.

I think you need to check the birth weight they are predicting and reasons they are advising early birth with your consultant as 7lb isn't below 10th.

10th centile At 40weeks is Just over 6lb.. 2.8kg. That is small for gestational age

You have all hit on exactly the dilemma I am having. When I had dd1 2 years ago, they viewed the size of a baby as relative to the population. So if the average size baby was say 7lb, your baby would be viewed as smaller than average if below this benchmark.

Since then, they have introduced a new system. Instead of measuring your baby against a population average (e.g.7lb), they calculate what size they think your baby should be based largely on your height, your weight, the sex of the baby.

So I am a bit taller than average and a bit heavier than average, so they think I should be having a baby closer to 8lbs at 40 weeks.

Her being on the 10th centile is relative to this 8lb benchmark personal to me, rather than the benchmark relative to population average, which is closer to 7lb.

Judging her predicted size at 40 weeks against the population average, she is bang on 50th centile. Judging her predicted size at 40 weeks against my calculated average, she is 10th centile.

I have been scanned and monitored every two weeks for 8 weeks. Baby growing well and completely in proportion, no issues with placenta identified, lots of fluid, movement good, all my observations normal.

I hope I have explained that a bit better. Do you get my dilemma now?

To be clear her predicted weight at 40 weeks is just over 7lbs.

I had the exact same dilemma. In the end I was induced at 39+2 and gave birth to a 2.76kg baby boy, so got to go to the post natal ward on the midwife led unit as there was nothing wrong with him. My first son was 2.8kg and born naturally, back when the charts weren't personalised, so I think I just have babies that are on the small side. I argued that if the baby was following their growth curve, there wasn't a problem. They agreed with me until 39 weeks when they started saying I wasn't doing what was best for my baby and guilt-tripped me into it.

I think I’d ask to see the evidence favouring induction in cases like yours and maybe ask to speak to a different consultant. I wouldn’t be convinced either.

Ok so not just me. What is concerning me is that they are pushing for 37 weeks, when there would be a good chance she would be under 2500g. It seems bonkers to me that they would advise this.

Also, they don't seem to understand the new model. They told me it was heavily influenced by the weight of your previous children. I have gone back to the original research, and this is not a factor at all, it is all based on my measurements. Based on this new model, my first daughter, who came in at 7.5lbs bang on population average in every measurement would have been viewed as small!

So I need to prepare to dig out in.

Is there any reason to suggest your baby would need to stay in SCBU?

Yes she would be on the smaller side but a 'term' baby. My baby was born at 35 weeks and only stayed in SCBU for a couple of weeks as she had unexpected breathing problems related to an infection but if she had she of been born healthy we could have gone home straight away.

There isn't a "going home" weight like there used to be, if she is healthy, feeding well, no infections etc. she is likely to go straight home, most babies after the 35 week mark do.

Puzzled too op. I was 43 when I had ds, regular scans due to age. . He was born by emcs at 35 weeks after a bleed and scan showed a clot near the placenta (not seen at previous scans) he was 5.7 and went home without SC at 4.12. No mention of being induced ever.

I was 43 and they wanted to induce me at 40 weeks just because he was my first and the consultant disagreed with the sonographer... I refused, signed a sheet and left hospital. Went back to be induced at 40wks plus 12 days. He was born at 42 weeks and was a whopper. Just under 10lb, slim but very long. Male rude Consultant assumed he would be too wide despite sonographer arguing he wasn't. I think 42 weeks is considered a perfectly normal gestational period in some countries. He's still a tall skinny boy.

Namechange makes a good point. My 35 weeker also was on the postnatal ward and no SCBU. We were in a week for the usual stuff that comes with late pre term - jaundice and feeding issues but no special care needed.
If your consultant has mentioned an incubator that's also something to ask about as to why.
Has IUGR been mentioned?

Is birth weight actually linked to parent size though? I can think of a huge number of anecdotal cases of there being no correlation.

Would be interesting to read the science behind this. (Does everyone get these personalised predictions? Are they in your notes? Just curious as I’m due next month!)

Over the 9 years of my having babies my weight increased significantly- I was 3.5 stone heavier when I conceived ds3 than when I conceived ds1- yet each baby was slightly smaller at birth. Biggest 7lb 11oz, smallest 7lb 3oz. I'm a decidedly average 5'4" in height. Always go past the EDD. I'd be intrigued to know what weight of baby this new method would advise I should have.

How odd. I’m taller than average (5’10”) and consequently heavier than average and had two low-7lb babies. Totally healthy, normal birthweight. But under this system, I guess they’d have suggested inducing me too?

I was induced with DC2 due to low weight concerns. I had regular growth scans from 32 weeks, and was at the hospital twice a week from 36 weeks for scans, before they decided to induce as she dropped below the 10th centile and was estimated to weigh 5lbs 4oz.

The concern was that there could be an issue with my placenta (although there was no evidence of this on the scans). I also had low PAP-A.

DD was born 12 hours into the induction weighing 5lbs 12oz and perfectly healthy. We were home the same day.

It's a difficult one I know. I questioned why they wouldn't just leave DD in for longer, but they felt she was better out, so they could intervene if necessary, rather than take a chance by leaving her in for another 2 weeks.

How far along are you? Is there an option of a 38 week induction so DD has another weeks growth? My friend negotiated this when she had fluid issues. She just had to go for almost daily scans that last week of her pregnancy.

I was induced at 40 weeks, DS measured small and DD was 6lb 2 so he was expected to be small. I was having fortnightly growth scans.
Being induced, for me, was incredibly painful and felt totally unnatural. Ds was born 56 hours later weighing 9lb11oz.
The hospital was being over cautious as they had a spell of very small babies being still born and were delivering early as it is safer.

37 weeks does sound very early! I've been reading a lot about induction guidelines and it's quite rare to suggest one so early, I would definitely question it and please remember that you do not have to consent and can also ask about monitoring if you or they are worried. If there is a very specific reason for them wanting her to come out at 37 weeks then these reasons should be made very clear to you.

I know what you mean about the new growth charts; I've been booked an urgent scan this afternoon and will discuss results to make a decision on potential induction/c section. I was frustrated at the consultant because even though DD was quite small and this baby is measuring huge by population standards, he is not quite big enough to be worrisome according my personalised growth chart. Even though I clearly don't normally make huge babies as DD was under 8lbs! So he could be huge but because they have calculated that as normal for me, might not do anything

Definitely have a word with them to express your concerns :)

Even if your baby is smaller than they think he should be in your womb, how do they plan to grow him quicker once he is out? In other words, what good is it going to do to take him out quicker than the natural term of his gestation?

There is some really good research behind this. It came out of the west Midlands. They had a rate of still birth much higher than national average. they looked carefully at why that might be. The strongest predictive factor were babies estimated to have a low gestational birth weight, in relation to the size of the mother.

They basically recommend close monitoring for all below the 10th centile on the personalized growth curve. If baby drops in centiles, is not in proportion or any issues are identified with placenta, fluids or movement, then they advise induction or c section. The rationale being that if something is restricting the babies growth in the womb, then they are more likely to do better outside the womb.

This new protocol has reduced still births by 40% in places, but I think the unseen cost of this has been some women having unnecessary inductions and c sections. I suspect I could be one of them.

I got some steer from the group that carried out the research. Their take is that the protocol is designed to flag the women who need to be monitored most closely, but that the clinician should make decisions based on all the info they have, not just follow it slavishly.

So next scan in a week. I think unless baby has dropped in centiles and/or there is an issue with the placenta or fluids then I am going to hold out to 40weeks.

Good luck op.

PS DD is now on the 50th centile at 10 months and is thriving.

i don’t understand the logic of removing the baby from it’s safe place unless eg there was a problem with your placenta or something i’d refuse under those circumstances

Have you seen the RCOG Green top Guidelines? They haven’t been revised since 2014 so probably pre-date the research you refer to, but like the research do suggest following a customised growth curve. However they don’t suggest automatic induction after a >10 centile reading, just further follow-up screenings if this the case:

’Where the fetal AC or EFW is < 10th centile or there is evidence of reduced growth velocity, women should be offered serial assessment of fetal size and umbilical artery Doppler.’

The push for induction before these steps have been taken seem heavy handed to me (if all else is normal.)

Where the fetal AC or EFW is < 10th centile or there is evidence of reduced growth velocity, women should be offered serial assessment of fetal size and umbilical artery Doppler.

Whoops sorry, didn’t mean to quote twice.

Thanks gunpowder, I will add that to my arsenal.