Small baby inductions?

[coldestwinter]

Hello!

Previously posted for a bit of advice regarding growth scans. Now 34 weeks and baby is continuing under the 10th centile. I've been moved to high risk consultant led pathway.

Each scan is the same outcome just now, baby measures small (Doppler, fluid levels and NST all fine) but midwives all saying we'll just play it by ear at each scan.

I'm just wondering if other people measuring consistently small ended up being induced early or were allowed to go past 40 weeks.

I don't mind what the outcome is, I just like to have a rough idea what to expect with birth.

Thanks

The best thing to do is ask your consultant at your next consultant's appointment due to your own specific medical situation.

If they are going to induce you early they tend try for 39 weeks as research shows that has the best health outcomes for babies. However your consultant may be aiming to get you to 35 weeks, when the lungs are fully formed, or 37 weeks, when you are term.

Thank you :) I have a huge list of questions for the consultant but not seeing him until the end of next week, up until now it's all just been done through the midwives at the maternity hospital. The consultant is based at a different hospital 20 miles away.

I just wanted to be a bit more prepared in what to expect. My first baby was very straight forward, so just the total opposite to how this one is going.

I haven't spoken to anyone I know yet that has measured small during pregnancy, so no one has been able to shed any light on it.

It was picked up that my DD was measuring small at 30 weeks. I went to the hospital for scans/dopplers every week until 38 weeks then got induced at 38+3.

I think it really depends on the reason that the baby is measuring small. I forget all the technical terms now but the dopplers showed that blood wasn't flowing through the cord as well as it should be, so was induced for IUGR. DD was born on the 9th centile.

Have they discussed induction with you?

Hi OP, I've just had my small/suspected IUGR baby. She measured consistently small and under 10th centile, however at 36 weeks started dropping down the chary combined with abnormal doppler scans.

The advice I was given throughout was that a small baby in the absence of anything else wasn't necessarily a bad thing, and I would simply have very regular monitoring. There was talk of probably needing to induce and not let me go beyond 40 ish weeks. As it was, the dopplers showed something was untoward so she was delivered at 37 weeks.

Congratulations on the birth of your DD spydie. Hope it all went smoothly

I guess that's really all I can expect, that they continue the monitoring incase anything crops up. They mentioned early inducing at the first growth scan 6 weeks ago but I haven't seen the consultant since and I find the midwives, although fab at their job, obviously don't want to mention anything that is really the consultants decision. I just feel a bit in limbo with every scan. Although baby is growing along her own scale, she is below the 10th each time.

Dopplers and NTS's have all been good so far, but a midwife friend did tell me that like you, placenta and cord issues may not show themselves until a bit later.

Desperate to speak with the consultant now just to find out some more. Honestly though, they say the baby is small but she sure knows how to kick a rib!

OP could you see if you can get someone to accompany you to your consultant's appointment? That person's job is to listen to what the consultant answers to your questions and remind you if you haven't asked any questions. Also I tend to find that some HCPs are politer if you are chaperoned/accompanied.

My husband has been with me at all appointments so far and definitely has his head screwed on for questions at the appointments thankfully - I turn in to an obedient child just nodding and doing as I'm told lol!

Seeing community midwife on Friday now who is a family friend so hoping she will give me some general guidance or info

My daughter measured small consistently and had lots of growth scans , no other problems were detected until a scan at dead on 39 weeks , growth had slowed further and amniotic fluid was low, saw my consultant straight away and was induced the next morning. Daughter was fine and healthy when born.

Thanks @coldest winter all fine, I had a section rather than induction for the birth (had a previous traumatic induction and didn't want a repeat, my section and recovery was a million times easier...). Baby was small but healthy, and now thriving. At 4 weeks she's now the same weight as her older sister was at birth.

I can relate to how your feeling, I found and felt that things seemed very vague, and it really was just a case of wait and see and living scan to scan. My doppler scans were also all over the place, some weeks showing high pressure, right on the cusp of acceptable, and other weeks fine. So my head was all over the place, not knowing whether I should worry, or not. Dopplers eventually went so far over the normal range that the flow started reducing.

What I will say is keep a very close eye on movements, and don't hesitate to go in if you have any concerns... I went in loads as had lots of reduced movements, but ultimately the week that the dopplers showed as really abnormal, my DD literally stopped moving. I was kept in, but for 5 or 6 days before delivery, she just didn't move and it was really concerning. She was usually a very very wiggly and strong baby.

Thank you all very much :) feeling a lot more positive and armed with questions for the consultant.

Movements are my biggest niggle now. I know she's moving lots but if I don't feel her moving at the exact moment I think about it then I go in to panic mode! By the sounds of things I might be as well carrying my hospital bag in the car for appointments nearer the time incase I don't get home! I'm very much happy to have baby in whatever way means she's safe, I just like to be mentally prepared for things you know.. as mentally prepared for another baby as you can be! Lol

Hi OP - lots of because I remember how stressful it is!

My story (spoiler - it ends well!):

DS2 measured small (on a scan I was having for a different reason at about 30 weeks), just under the 10th centile, and I was moved to consultant pathway. I had ultrasound scans for fluid volume and Dopplers every 2 weeks until term, and everything was always fine.

But I was very suspicious of the chart that put DS2 below the 10th centile because his projected birth weight on his centile line was fine (about 3.2 kg). Turns out that because I was tall (I'm 5'11), it was factored into DS2's custom fetal growth chart and led them to expect a giant baby. DS1 wasn't giant, but they were usin a different non-custom chart back then, so hadn't been concerned.

I had a good long chat with the head consultant about the poor diagnostic value of including maternal height in fetal growth charts (I'm a scientist/statistician, so read the journal papers and could talk the talk), and he was fairly pragmatic and said he thought it was a healthy but small baby rather than IUGR. More to the point, he was happy to go along with my preference for a "watch and wait" approach until 40 weeks, so long as scans and dopplers looked good, rather than induce at 38-39 weeks (as another consultant on his team had tried to push me into).

I went into labour naturally at 40+1, had DS2 in the labour ward with just a midwife and DP in attendance (though the paediatric swat team was outside the door)... and he wasn't small at all. He was just over 3.5 kg, which I think was between 15th and 20th centile in the custom chart.

At that point, my consultant had agreed that we could go to 41 weeks on "watch and wait" but then we should induce. I was sure DS2 would arrive before then so agreed in principle... but was glad it wasn't necessary!

I had an induction for suspected iugr.

I was under a low risk hospital and when they saw the scan they couldn't get me out of the door and to the 'proper' hospital quick enough.

At the other hospital I was scanned immediately and told to come back tomorrow for an induction.

All that was at 36 weeks. Baby was 8lb! I'd been warned that newborn clothes might not fit.

Good luck, I guess you just don't know until it all happens.

Thank you Unique & Twogin!

Midwife yesterday was very helpful.. although she couldn't comment on what my outcome might be, she gave me some great general ideas for people that measure small consistently. One thing I'm wondering is if anyone had a small baby for no other reason that the baby was small. There isn't really any small people on either side of our families.
Definitely more in tune with movements now, if she hasn't moved for maybe half an hour I start panicking and wiggling my bump :p

Glad to hear all the outcomes and healthy babies

I'm working up until 37 weeks and I still haven't started packing a hospital bag so I think I'm going to need some serious planning this weekend! :p

One of my twins had undiagnosed IUGR - his growth slowed and at 28 and 32 weeks his legs were down to 5th centile. I don’t know why they didn’t take it more seriously. At 35 weeks I felt very unwell and my mw sent me in - he had stopped moving and I had no idea. Had an emcs right away and he was only 3.5lb - I would monitor movement very closely, make a note if you have to. Any issues should be easier to spot with one.

One thing I'm wondering is if anyone had a small baby for no other reason that the baby was small.

Yep, me! Both DS were born under 25th centile, even though both DP and I are tall (I'm from a very tall family, he's from a medium-to-tall family). Both DS were healthy babies, and were up to the 50th centile on length and weight by 12-18 months. Given they're from tall families, I expect they'll keep creeping up the centiles and end up as tall adults.

Not every tall adult starts off as a big baby. I didn't and neither did any of my siblings - according to my mum, my 6'6 brother was a healthy 7lbs at birth (and was a few days overdue at that). There's a lot of variation in how birth weight relates to size at age 2 or age 18.

I was also consultant led and baby was in the 10th centile. Fluids fine, baby fine, bump was small so they let me go over. She was 7 pounds at birth and has been in the 90th centile for height and weight since her 2nd month.

Sleep well dear! Your little one is fine.

My DS was under the 10th centile too.
At 40 week MW appt was sent for a growth scan.
Had the scan at 40+3 and was induced that day.
He was evicted via the sunroof the following morning.

Everything was fine, just he was small.
He was 5.3lb when he was born and now, 4 weeks later, he is just under 7lbs and and really strong.
Apparently when he was born he was at 2nd centile. (Not sure what that means but MW said he couldn't get any smaller)

Just a quick update, further growth scan showed baby has dropped considerably on the chart and now below the 5th percentile. So in tomorrow for a Doppler check etc and it will be taken from there. Consultant was very much 'we'll see what the Doppler shows in a week and discuss it then' so from that We are preparing ourselves for an early induction.

I really hate this Wait and See procedure but I guess there is no telling with a baby what might happen from one scan to the next. Just spending my days monitoring movements strictly this week!

Sorry to hear that, OP - it can be really stressful waiting. Just try to remember that most small babies are healthy babies, even if the best way to make sure they're healthy is to get them out early

Just in case it comes to it, it might be worth thinking / having a chat with your consultant about whether you would rather be induced or have an ELCS. If it's your first baby, induction is sometimes a more difficult process and can put a lot of stress on a small baby (potentially more than CS), whereas if you've previously had a VB, induction is usually more straightforward (and potentially less stressful on a small baby than CS). I don't know what's right for you, but that's the kind of thing (relative benefits and risks, etc.) a good consultant should talk through with you!

Good luck