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?

They are offering this to you because stillbirths are quite common over 40. It’s standard practice in my area for women over 40 to be induced at 37 and 38 weeks. Please, please ask your gaenecologist more questions - it seems you are not getting the reasons behind the request.

The research is still developing, I think the model as it stands is quite crude. It does account for the expectation that second babies are generally larger (an extra 180g). But nothing from the father's side and nothing based on previous babies. Also, I have a very similar build to my mum, her babies were all 5to6 lbs.

Good point about daddy perhaps not being daddy. I did a summer project many years ago in a human genetics clinic, it was quite interesting...

I'm not in exactly the same position but thought I'd share my experience. I've now got my 6 day old son and am processing my last few weeks of pregnancy. I really wanted a low-intervention MLU birth with access to a birthing pool, however my due date came and went and so people started talking about induction. At 41+6 there was still no sign of baby, and despite me saying repeatedly I didn't think I wanted an induction I was booked in for one anyway and told I "needed to think of my baby"- I was quoted horror stories about the placenta deteriorating and the increased risk of stillbirth and felt very unsupported in my desire to avoid induction and wait it out.

In the end I caved and went for induction. I spent a night on a shared ward listening to other women around me screaming and shouting all night as their labours began, which for a first time mum was terrifying, then when my own first stage of labour kicked in rather than being in my own home and being able to manage it in my own way the only escape I had from my hospital bed was to walk around the hospital grounds, hardly relaxing! As I was over 42 weeks I had to give birth on the consultant unit despite being no higher risk at 42 weeks than I had been at 41+6, they didn't have wireless monitors and it's policy to do continuous monitoring there so I couldn't be active, food is banned on the cons unit and they kept asking to take my blood pressure and blood samples (which I refused as there was no medical reason for me being on the cons unit), which they didn't like! Personally my experience has led me to the decision that in future I'd refuse induction- they said my baby would be huge and the placenta wouldn't work... my baby was 7lb 11 and my notes state placenta was healthy with no signs of deterioration.

You've been really smart with this OP in doing your research so you can make an informed decision, I'd just add don't be afraid to stick to your decision, I wish I had!

So, I have a plan. Baby still growing beautifully along 10th centile. Consultant still wanted to induce me this week, but accepted that this was very cautious management.

We have gone for induction at 39 weeks, with additional monitoring and sweeps in between. I think this little one might justly make an early appearance of her own accord.

Just posting for solidarity as I'm in a similar position. Baby on my personal 10th centile but 50th overall, having a fortnightly growth scan and have just now been advised to attend twice-weekly monitoring. Might be delivered at 37 or 38 weeks (currently 32+6). It's given me the scares a bit... I'm 34 so don't have the age factor, but previous baby was on my personal 80th centile and weighed in at 9lb 12oz (but at 42+1). Feeling quite anxious about it all especially as I still have a fortnight left at (unsympathetic) work...

I can never understand all this measuring small / large business.

I admit this is anecdotal but I don’t think I have EVER known them get it right abd all it seems to do is worry women that they’re going to have a tiny / freakishly large baby.

I’m sure there’s loads of science to back this stuff up but in general it seems pretty inaccurate in real life situations a lot of the time

Yes there is real life science to back it up, the point is that each woman has a personal growth arc and you're looking for deviation from that. As the op noted it's an approach which has delivered a reduction in stillbirths.

Glad all is going ok and you have a plan you are happy with op.

I understand the theory is real science, I just find that the actual RL measuring often doesn't seem very accurate

“I don’t think I have EVER known them get it right... in general it seems pretty inaccurate in real life situations a lot of the time”

Depends on the equipment & skill of the ultrasound specialist. I was lucky to be followed by one of the top 5 specialists in the world, using top-quality equipment that GE etc loaned him to test for bugs & give his feedback. He was scarily accurate in every measurement.

I think scan accuracy has massively improved. I have been scanned over two months, 3 different sonographers and all their measurements are 10th centile, so I am happy to be guided by that. They say measurements are +/_ 15%, with accuracy decreasing as the baby gets bigger. I think when the size at birth differs massively from estimated, this is probably based on a single late scan rather than a series.

First monitoring all good, although they have written all over my notes that i have refused early induction.

Lux you can only do what feels right for you. I would say that if I had a single measurement that suggested growth was slowing, or not in proportion, or any issues with placenta or fluid, I would have agreed to an induction asap. Still would. I feel much closer to giving birth at this stage than I did with my first. I have a sneaky feeling she will come out sooner of her own accord. I am so done being pregnant.

I find it werid that they would induce a baby early when there is nothing wrong with mum or baby.

Why not let nature take its course.

I was advised to induce at 36 weeks as I had too much fluid and if my waters broke I was at risk of prolapse.

I was induced, baby was tiny weak and had to be pulled out with forceps.

I've since been told early induction was not the correct advice.

Also they told me he would be a healthy weight based on the scans and he wasn't.

I had something similar.

I had already had 4 babies weighing between 8lbs and 11lbs at birth. All easy straightforward pregnancies and births. The heaviest was born at home. There was no indication that he would be so big! A scan at 34 weeks didn't pick it up.

I had wanted dc5 to be born at home too but a midwife decided at 36 weeks that I was measuring small for dates and referred me to a consultant.

The consultant scanned me and said although the baby was well within average and was predicted to be over 7lbs at birth, he felt that her growth was a concern when compared to my other pregnancies. He said that he felt that her size could be an indicator of my placenta not working as well as it should and at that point she was better off out than in.

I agreed and I was booked for induction at 38 weeks. She was born weighing 6.15.

It sounds like you've reached a good course of action. Well done.

I find it worrying that there is some slavish obedience to "them". Even doctors are making judgements based on the evidence and knowledge available to them as applied to the situation in front of them, and let's face it, sometimes quickly and under pressure.

Being asked to explain or being challenged on decision making is in no way rude or wrong, especially when you are being asked to use those recommendations to make complex decisions about your own and your baby's healthcare.

Good luck. Here's hoping your feelings about an early natural arrival are correct and a healthy happy baby is here soon.

Agreed flibflab and to be fair when I did get to see the consultant, she did respect and understand my decision, particularly as I compromised and agreed to induction at 39 weeks not 40. My baby is also moving lots so I have been really paying attention to that. She should be round 7lbs at birth, and I am happy with that.

Get hold of the low birth weight baby policy, hypoglycaemia policy, jaundice policy from the hospital - call in if necessary, so you know what they should be doing.

I can assure you some staff choose to not follow the hospital policy with small babies so best you know what they should be doing.

Thanks Belle and sounds like you have a good course of action there - hope all continues to go well. I'm happy with anything after 37 weeks really since it's at term, it's more that it feels really confusing to be this concerned about a baby on the overall 50th centile. But I recognise it's all relative to me. I think I'm also nervous that my consultant appointment to book me in - whether it's for 37, 38 or 39 wks (planned section here) isn't actually until 36+5 so everything could feel really rushed at that stage. Maybe if I pack my hospital bag etc I'll feel a little more in control!

I am packing my bag today as well lux. I think I have everything, just not in one place. Going to put up bedside crib as well. I haven't been booked in either. Have consultant on the Monday and expect to come in on Wed or Thursday.

Last time I was in for five days, which I was not prepared for. I think this time they will be more anxious to get baby out, so hopefully won't leave me too long between procedures.

Good luck!

How are you doing, Belle?

Well seeing as you asked. All monitoring absolutely fine. Last growth scan this am and she is now in the normal range. Having got everything sorted for an induction this week, decided to go ahead, only to be told by the ward staff nope, guidance has changed, 40 weeks for you.

Ok then, agree to have sweeps and book in for 40 weeks. Change all practical plans like child care etc.

Go to the day assessment unit, they say I can choose, but if I go to 40 weeks they want daily monitoring. Hospital is not close.

So going home to discuss with DP what to do.

It all sounds very frustrating but you really are on the home stretch now!

Congratulations that baby is growing well and good luck.

So decided to go with induction next week if I haven't gone spontaneously, as very originally planned.

It was all a bit of a farce in the end. I have had 3weeks of being monitored every 3 days, and repeatedly pointed out to me that I was refusing induction against medical advice.
One scan result later and they refuse me induction at 39 weeks as growth is now normal, and that would be against protocol.

It is such an inexact science. We are asked to make decisions on the basis of imperfect information, and everyone does the best they can. I can completely understand why the clinicians advocate the options that reduce the risk of still birth the most. I won't lie I have had a few moments of really doubting my decisions. Fingers crossed it will all go as planned.

Interesting all round and glad you are getting to go with your original plan Belle. I'm in the opposite situation - growth has dropped off again and is now under 10th centile so looking more and more likely to be 37 weeks for me. So not quite the Christmas baby we were expecting! All good if happy and healthy though.

It is imperfect information and also advice is based on risk and measurement of risk is highly complex and influenced by so many factors. In your case where it really is marginal there really isn't a clear cut "best" decision it does feel like there is some need by professionals to be right or wrong and not acknowledge how wide the grey area is.

We are very lucky to live where we can know more about what is happening and also have access to information to make our own decisions.

Oh lux that sucks, but as you say the number one priority is a healthy bubs, closely followed by healthy mum. I have to say at 37 weeks, I was more than ready to drop. Hope we all have perfect little specimens in time for Christmas.

So today is D day. Off for induction in a bit. Just said goodbye to my daughter which was really hard, especially as I don't know when I will see her again. Hope it goes faster than the last 5 day marathon.