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?

My Ds was induced at 37 weeks due to low birth weight

He suddenly stopped growing at 35 weeks and I had to go in everyday for 2 weeks to be on the fetal monitor for half an hour at a time.

He was born weighing 5lb 3oz but didn't need an incubator. He was allowed home 2 days later (he was kept in with me due to low blood sugar but he stayed with me all the time)

My biggest baby was 6lb6 and smallest 5lb 2oz

Ok so you know that this technique has reduced stillbirth (and you are over forty so slightly higher risk for stillbirth) but it sounds like you just don't think stillbirth will happen to you? I would suggest you think very carefully about that. In your shoes I think I would want daily monitoring and an induction at 39 weeks.
We still don't know why most stillbirths happen and midwives and doctors get a pounding on here for 'shroud waving' but.....our stillbirth rate is way too high in this country. You know your baby is growing on a curve which is good but she is smaller than you might expect, it may all lead to an unnecessary induction it to a lifesaving procedure, there's no way to know but I know which side of the fence I would go for. I admit I am very much influenced by a friends stillbirth, no risk factors at all but it still happened to them.

Or to a lifesaving procedure that should be

Tbf to OP it doesn’t sound like she wants to flagrantly disregard research in favour of waiting for 40 weeks, more that she needs further counselling of the absolute/relative risks of expectant management given her situation vs. induction at 37 weeks.

Totally agree we need to do more to lower stillbirth rates but daily monitoring and then planned induction at 39 or 40 weeks is very different to automatic induction at 37 weeks (and its associated risks) when the only indicator (as far as OP knows) is that the baby is small.

I'd be inclined to make the same decision as you, but to request expectant management (e.g. weekly scans) to see if growth slows down or if there's any cause for concern. If not then, like you, I'd push for 40 weeks.

While stillbirth is a serious concern, so is pre-term delivery before the baby is ready to come out. It would also mean either c-section or induction, both of which come with additional risks.

I'm not sure why they are saying that. I had a growth scan at 37 weeks, I measured 30 weeks at 37 weeks gestation and my baby weighed 6lb. DC was born at 40+6, and weighed 6lb 7oz.
Have they said why!

I think I would want daily monitoring post 37 weeks and induction at 39. Although everything is looking good at this stage, that can be said for lots of pg that later end in stillbirth. We don't know why that happens but this new approach is reducing that figure.
39 weeks would give your baby time to grow, if everything is looking good but would still get the baby out before the full 40 weeks.

I will ask what the options are for more regular monitoring, maybe not daily, but at least weekly.

Northern I have taken a really thorough approach to assessing the research for myself. I understand the potential risks and benefits. Just because a procedure reduces the risk of the worst happening on a population level doesn't mean it is right on an individual level.

For example, if all we cared about in breast screening was reduction of incidence, then we would advise lots of women to have mastectomies. this would drastically reduce the rates of breast cancer, but only a very few women would actually benefit and many many more would be harmed.

I expect my consultant to understand the model she is basing her advice on (she doesn't), and to look at all the data and help decide what is best for me, not what is best for their figures.

Sorry Northern I just saw the bit about your friend and her still birth. Absolutely horrific, and if I had that personal experience I may well take a different position, but my gut and my detailed research is telling me that holding out is the right decision for me.

I understand entirely what you mean about risk on a population and individual level but my experience is the other way round from yours. My dd has a heart murmur, nice guidance says that prophylactic antibiotics will only prevent a very small number of endocarditis cases following dental work, therefore that is no longer part of the standard of care. ThAts in the context of antibiotic overuse in the population generally of course.

In the context of my particular child though, there is no risk of antibiotic overuse. She hadn't actually ever had any before. The risk of endocarditis oth seemed far more significant for her. So I asked the dentist to prescribe, which they did.

I guess that the root of my concern is that we really know relatively little about the placenta, what causes it to stop working and when. It plays in to the whole debate about when to induce post term too and of course personal experience plays a part too. I was induced at term plus 14 with dd1. With dd2 they booked for term plus 10 and I refused to consider that because, like you feel, it felt wrong for me and my pregnancy personally. As it happened she arrived at term plus 7 so not an issue. My friends lost their child after I'd finished having babies and I know now that experience has skewed my risk assessment in totally the other direction. I wouldn't make the same choice now because I sadly know that disaster can happen to people like me. As long as you have all the information then you can make the choices for you. It's just hard when the risk is so hard to quantify on an individual level.

Haven't RTFT but if your baby is predicted less than 10% of your personalised growth chart, that means they are predicted to be small for gestational age.
Small for gestational age babies are at increased risk of stillbirth as the placenta is often not working properly, this is why induction is offered as soon as the baby is term.
I was offered induction due to sluggish growth and pre-eclampsia. My baby was on the 6th centile, and apparently, my placenta was 'gritty' (don't smoke, healthy lifestyle).My daughter is healthy, clever and wonderful! Who knows what would have happened if I hadn't been induced.
Doctors and midwives don't offer induction at 37 weeks for the laugh, or to be arseholes. They are making a calculation based on risk.
You're within your rights to refuse, but make sure you understand the reasons they are advising this, and the implications of refusing (i.e. increased risk of sb)

Also a bit shocked by some people on here advising someone to turn down an induction their medical recommendation based on 'I was induced early and my baby was fine'.
If you don't know why you were induced early, educate yourself on the reasons why, don't advise others who may be vulnerable to disregard medical advice because everything turned out OK for you

Quite frankly I think that you should respect the opinion of your consultants who are making this decision for the health of your baby. Research is only helpful if it is taken into context and unless you are a doctor I'm not convinced you'll have enough background knowledge to make your reading useful. Doctors don't induce at 37 weeks for no good reason.

I agree with those advising you to heed the medical opinion. I'd also say as well that the research shows that an unacceptably high number of babies with the same profile as yours will have poor outcomes unless induced early. Our technology though doesn't tell us WHICH babies will definitely be affected and which will be perfectly fine without induction. the only way to know for sure which inductions would have been unnecessary is to leave all the babies and see which survived. I wouldn't be willing to take that chance. Your age is a very serious risk factor, your baby's percentile is another pointer that your placenta isn't functioning as well as it could.

If it helps, I had a baby with suspected IUGR diagnosed at 36 weeks, I was admitted and monitored several times a day. The minute he reached 37 weeks 0 days, I was induced and had a beautiful 5 pound 13 ounce baby. He was half a pound heavier than they predicted and had zero breathing problems thankfully. You could say my induction wasn't necessary as the baby was just fine - I say it was a miracle and I am grateful for it every single day.

For me, the prematurity-related risks of a 37 week birth are nothing in comparison to the stillbirth or placental malfunction risks of continuing a pregnancy beyond term.

My sister in law had the same issue although she went ahead with the induction at 37 weeks as they said her baby would be small , it took 4 days to give birth from
Day of induction and her little girl was 6lb 7 hardly tiny imo. Her previous babies were 7lb2 and 8lb1
I had a little girl at 40+1 and she was 5lb 1 at no point did anyone raise concerns even when I had no proper bump, my previous ranged from 9.6 to 7.13 with a few in between.

I normally do listen to medical advice, I am quite risk averse, but in this case, I don't believe my docs actually understand the basis on which they are advising me, and as such I think they are over estimating the risk of there being a growth restriction. I also think that advising me to be induced at a point when there is a risk that the baby will be under 2500g is bonkers.
Age is actually not a strong independent risk factor for birth complications. It can put you at higher risk of things like problems with the placenta in later stages (why i will have an induction at 40weeks if she isn't here), but if you are being monitored then this risk can be managed. My baby is on the 50th centile when compared to the general population and has a perfect growth curve. There is zero evidence that there is an issue with my placenta. If there was I would be first in line for the induction.

Sorry if you have posted this already, but how big was your first baby. There is research to support that number 2 is usually bigger than number 1, so if on track to be smaller that can be a flag to the consultants. My first was 7ib 10, second 6 12 & induced for reasons which included growth concerns. Due to him being smaller, during pregnancy with number 3 I had scans every couple of weeks towards the end.
Ask them what else they are concerned about...but growth is a factor they look at in combination or age, first child etc. In my opinion they don’t offer induction lightly so I would take it, but you want to be harmed with more facts that make you feel happy with the plan & if you are not confident they may offer daily monitoring etc...

I don't understand why the weight and height of only the mother is taken into consideration when guesstimating the size baby she should have? Surely the fathers should be taken too?

Also like to add that growth scans aren't always reliable. I was expected to have a 7lb + twin and a under 5lb one but they were 6'2 and 6'9. Worth bearing in mind.

@doubletrouble - because there is no guarantee that the person the woman says is the father, is actually the father. A stuffy into the genetics of cystic fibrosis found that 10 per cent of children had a different father than the one named on the birth certificate. Women who are rhesus negative get anti-d injections without taking into account the fathers blood type for this reason.
If the centile as calculated on incorrect information it could be very dangerous.

Ds was predicted to be small (I was extremely neat thanks to good stomach muscles, GP made my day when he told me that ).

Ds was 8lb 15oz!

As both dh and I are not tall, he then spent 7 weeks "catching down" to his "correct" centile. (ie massive initial drop and then minimal/flat line growth).

Now a health, small to average height, slim 17 year old

I was having growth scans from 28 weeks, until I was advised to be induced at 37 weeks, as DS was measuring below the 10th centile. He was growing, but a lot slower than they would have liked. They said there was a risk that my placenta could stop working, or slow down and this would affect DS. Being my first baby, I agreed. He was born at a weight of 5lb 8oz. However, he was perfectly healthy, no jaundice or feeding issues, just very petite!

Looking back, even though being induced is not a particularly nice way to go into labour, I’m glad I chose to.

You’ve probably already looked at this but essentially they are following the royal college of obstetricians guidance which recommends delivery by 37 weeks of babies estimated less than 10th centile.

It isn’t an elegant approach as we know that most of these babies are entirely appropriately grown but in the absence of any better test that will pick out those who are struggling it is a balanced population risk. And obstetricians are risk averse.

Induction is always an offer, not a demand so you are entirely entitled to decline, if you understand the admittedly very small but devastating worst case scenario.

www.rcog.org.uk/globalassets/documents/guidelines/gtg_31.pdf

Oh and I forgot to mention - since changing to the customised growth charts anecdotally this problem comes up time & again but they are recommended as more specific to individual babies and supposedly more accurate (can’t say I’m a fan tho)