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?

Good luck today!

Good luck belle, hope all goes well and will look forward to your news. (I'm waiting for a C-section date for 37 wks - been waiting a week already and am now 35+5...nervewracking!!)

And she is here! All 7lbs 1oz of her. In the theme of this pregnancy, nothing went in a straight line. Had pessary number one, which dilated me enough to break my waters which they did.

The contractions increased in frequency and strength and was examined 4 hours later. Midwife said significant progress had not been made, still only 2cms dilated, time for the drip and I was not having the drip without the epi this time.

Then got kicked out of the birth pool room as I had said if I ended up on the drip I wouldn't use it.

In the meantime the anaesthetist went AWOL, so I had to wait. Had the cannula fitted ready for the drip. Contractions were getting more intense. I was just using TENs machine. Inrealllllly recommend. Not sure if
Pain relief or distraction, but it helped.

Then the contractions really changed, what I thought was me losing control a bit was them becoming expulsive. I looked at the midwife and said, I think I need to push. She had a look and said yep, you are fully dilated, trust your body. 4/5 pushes on G&A and out she popped. It was amazing!

I still maintain do what you need to when you need to to get baby out, but I am so glad I got the chance to do labour without the drip. Hope the rest of you ladies fare as well as I did in the end.

Congratulations! Enjoy the snuggles

Lovely news! Congratulations

Congratulations!
But I have no idea what this is all about.
Why induce a perfectly healthy baby 3 weeks early just because it's small?

Congratulations, lovely news! Enjoy the first days of hunkering down with newborn snuggles. And a great weight in the end by the sounds of it!

Congratulations OP, and best wishes to your expanded family.

As a response to this, "Congratulations!But I have no idea what this is all about.Why induce a perfectly healthy baby 3 weeks early just because it's small?"

The whole reason for induction was to ensure a perfectly healthy baby was born. A smaller than expected baby suggests that the placenta isn't doing its job correctly in transferring the full amount of nutrition the baby needs to grow to optimum size. And placentas get much more fragile and troublesome towards the end of pregnancy. The UK has had an appallingly high stillbirth rate and measures like this, flagging up babies potentially at risk and delivering babies once they reach early term, are one way to reduce it. Of course, any given baby might well have been just fine waiting for labour to start naturally at 40 weeks or beyond. But some would have terrible outcomes. And there is no way to reliably predict which baby will be fine and which won't. Why people persist in demonising appropriate medical intervention is beyond me? The safe delivery of the OP's perfectly healthy baby was exactly the point.

Anyway congratulations again OP.

Is it possible they're thinking IUGR! One of my twins was IUGR but they didn't pick up on it in the scans - they thought his growth was slowing but not a concern. Luckily I happened to go in when I didn't feel right, at 35+1, to find he'd stopped moving and had a static heartrate. I'd be having a very frank discussion about their concerns.

Congratulations! I’m rather pleased they’ve changed the guidelines, but it sounds like there is loads of confusion over how they should be applied. We had a stillbirth at 37 weeks, for no reason they could identify. In all the scans the baby stayed between 5th and 10th centile, sadly just above the level at which to trigger RCOG guidelines for early induction/c section at our hospital in early 2017 (north London) but we kept being told this was because they were comparing the baby to worldwide guidelines and because DH and I are both from an ethnic minority our baby was likely to be smaller than average anyway. It’s all bollocks IMO and I don’t think it makes any sense. In the end our son was a tiny 5lbs when he was born and it looks like his size might have been a factor in him not being able to cope with labour.

I’m pregnant again and this time the baby has stayed bang on 50th centile throughout the pregnancy - hoping she continues to do so until she’s ready to come out. It is a v inexact science but I think it’s also frustrating that they have access to the research and tools but they aren’t deployed in the best manner - which is one reason why we have a ridiculously heartbreakingly high stillbirth rate in this country.

I have also been advised that we may need induction at 37 weeks as baby is just below the 10th centile.

I'm 34 weeks and she's 4lb 7 ozs so doesn't seem small to me and surely she would be around 7lbs at 40 weeks? However they do seem concerned and said if the next scan shows 10th centile they will book induction for 37-38 weeks.

Does anyone have experience if this? Do they give steroids to mature the lungs?

Hi flossy that's pretty much the same situation as me. My scan at 34+2 gave estimated weight of 4lb 6oz (under my 10th centile) and the recommendation was for me to deliver at 37 wks. It's more of a precaution than anything else as I've also been monitored twice weekly (CTG trace and scan for blood flow and fluid level) which has all been normal. My 36+5 scan showed some more growth along the same line with estimated at 5lb 6oz. I'm now 37+1 and having section on Wed at 37+4. The issue isn't the weight or size per se, it's that it's calculated relative to you personally. I'm fairly tall and a bit overweight so should be making bigger babies than this, essentially, particularly as my last one was a whopper. HTH.

Sounds like theyre using customised growth chart. After spending a day at the perinatal institute learning about these i would grasp the induction with both hands. Her projected weight is irrelevent, its where she is on the centile for you as an individual.

Customised growth charts have cut stillbirth rates by nearly 50% in units where theyre used. I genuinely believe theyre the biggest thing in decades to improve fetal outcomes.

Ah. Read whole thread now. Congratulations.

Sorry I missed the bit about the steroids - yes they do this, I had two shots 24 hrs apart at 35 weeks. Bit uncomfortable and they gave me hot flushes and a bright red face, but all had settled within about 24 hrs of the second one.

I was induced at 37 w 0 days after being admitted and monitored for suspected IUGR a bit earlier. For me, once delivery was at or after the magic 37 weeks, they had no concerns about lung development and so I didn't have steroids. They were watching really closely and making decisions on a day-by-day basis but the second I hit 37 weeks, that was it, eviction time. I was profoundly grateful for a small but healthy baby. He did develop jaundice which is associated with early-term delivery but could also be linked with the low breastmilk supply, same as I had with my older baby born at 40+6. Overall though, once you hit 37 weeks, nothing happens in utero that can't also happen outside and so if there is any question mark or risk, getting the baby out is usually the safest course of action.

I think you need to be one hundred per cent clear on why they are advising this so if there is anything they're saying that is not clear please ask them to keep explaining until it is. I think even the most forthright of us sometimes leave appointments without fully understanding things because we don't want to keep asking. This is too important not to though. I don't have a comparable experience but i did have ds2 at 39 wks because ds1 was ten and half pounds and they let me go to 42 wks which was crazy. I was 40 when I had ds2
I have heard - and directly know - too many examples of people losing babies very late, such that I would be inclined to want to get them out as early as is safe to do so.

Doh!!! Just rft! Congrats - what a fab outcome :)

bisquick I hope everything goes as smoothly as possible this time. I have had several early miscarriages, which makes for a very anxious first few months. I just can't imagine how much strength you must need to keep yourself together losing a baby at term.

I completely agree that the work of the perinatal institute is necessary and effective at reducing still birth. In particular the introduction of personalised growth charts. However, this is relatively new research, and I think the model is still quite crude. As a result I think that for every still birth avoided, many women will be advised to have inductions unnecessarily. Only time will tell what this ratio looks like.

This would be fine if induction came with no risk of harm, but they do. There is an increased risk of emcs and instrumental delivery, with the associated risks of internal damage and prolonged recovery from birth.

I really hope the Perinatal institute continues to collect the data and refine the model to better identify those babies who are small due to an underlying issue, versus those who are Hale and hearty but just tiddlers. There is a desperate need for more research. Why, for example was my placenta not used for research?

I hope this thread has been informative and best of luck to all of you about to pop.

Oh and here she is including a rare sightings of her big blue eyes