Static growth on scan - induction or caesarean

[GodspeedJune]

Hi ladies,

I’ve been having growth scans due to my first baby being on the larger side (although not over 4kg). This baby has been growing well too, plotting high on the centiles, until today’s scan showed he has only gained around 2oz since the scan two weeks previously. The hospital class this as static growth and have recommended birth in the 39th week.

The positive signs are that baby is moving well, blood flow through the umbilical cord looks good and there isn’t excess water. This drop in growth seems to be the first sign that things have taken a turn.

I’m hoping and praying that labour starts naturally before then, but if I get to 39 weeks I’ll need to make a decision.

My first labour was 40 hours from waters breaking to birth, I did get to fully dilated and pushing, but my baby’s head was slightly in the wrong position and after failed ventouse, she was born by EMCS. I went into labour with her at 39+2.

I had my heart set on a VBAC and I know the best chance of being successful in that is to wait for spontaneous labour. I really didn’t want a CS or an induction. But I now need to take into account the finding from today’s scan.

I’ve heard lots of horror stories about inductions, but how have any 2nd time (or more) Mums found them? Could it be that having laboured to fully dilated before, my body should be more receptive and cope better with an induction than a first labour?

I was going to decline sweeps but would it be a lesser evil to try one and see if natural labour can be kickstarted?

I’m 38 weeks tomorrow by scan dates. 38 weeks on Sunday by my own dates.

Thank you.

A few things. Was the scan undertaken by the same sonographer and on the same machine? Did the sonogtapher comment on the baby’s position making it difficult to scan? The static growth may wall be explained by the margin or error in the scan.

It’s great that the cord flow etc. looks good.

Personally I would wait and see. But everyone is different. Induction isn’t usually recommended for a VBAC.

If you're set on attempting a VBAC, then yes, I would accept sweeps.

As you've had a C-section, the doctors are very adverse to using hormonal methods of induction, so you're likely already very limited. As baby is otherwise well and well grown I would be happy to at least attempt an induction, with the understanding that if labour doesn't start, I would have a C-section. I think having gotten to fully dilated and gone into labour naturally before would count in your favour for a VBAC.

I've had inductions for both my kids. The second one I got to 2cm on just one gel (compared to just 1cm after 2 gels with my first) and I tolerated the drip much better. However, in the end as baby was in a wonky undeliverable position, so I had a C-section (first was an unassisted vaginal birth). But I am far from the norm as the mantra goes "second babys come quicker and easier", and I hope that would be your experience.

Best of luck no matter what you choose.

inductions are done fairly frequently for VBACs. Different techniques will likely be used and with a lower threshold for bailing out, but they are definitely done.

I had a baby with static growth, I actually got a private scan for a second opinion before deciding. Not sure if that’s an option?

Anyway I did go in for an induction with the threshold in my mind that I would accept anything up to the hormonal drip, as everyone I know who has had this has ended up with an emergency section. I was slightly dilated and accepted a sweep which caused my waters to break, as my labour didn’t start I had a section that evening which was fine. But I didn’t have other DC to consider in my recovery and that would be my main hesitation in asking for another.

It was a different sonographer on a different machine, but yesterday’s sonographer was an advanced practitioner so would be inclined to trust their work?

Thank you for your reply.

Yes he was estimated at 7lb 2oz yesterday and 7lb two weeks prior so seems to be a sturdy size and would hopefully cope well with labour in his current state. The consultant did mention that if whatever is causing this lack of growth is left for too long baby might not be as robust during labour.

It sounds like your second labour was similar to my first in terms of baby being slightly misaligned for a natural delivery. This has been seen as a good sign by the consultant so far; hopefully just bad luck on that occasions and no reason why a VBAC wouldn’t have worked this time. It’s a shame to have this curveball of the growth thrown into the mix now.

The suggested induction would be Foley catheter followed by breaking my waters. Consultant is supportive that if that doesn’t get things started I can make a choice at that point whether to have the drip or a caesarean.

Having slept on it I am leaning towards giving a sweep a go. With my DD my waters went 3 days after the sweep, although I was 39 weeks with her and will be 38 this time.

Interested and reassured to hear there would be a lower threshold for bailing out this time.

Yes consultant has said they aren’t keen to use gels but the foley balloon, breaking my waters and the drip are options. Would really like to avoid the drip if I can as I’m worried the intensity of it could make me need an epidural then onto the cascade of intervention. Was really hoping to keep upright and active in this labour to give myself the best chance.

I do trust the sonographer and she even had a colleague in the room who said if anyone would spot an issue, it would be that lady, but a private scan is a good idea and would definitely be an option.

Was all well with your baby when he/she was born? Were you given a reason for the static growth? I’ve been told it’s usually because the placenta is deteriorating. Do you mind me asking how soon after the static growth was found they recommended getting labour started?

My DD is two so could really do with a faster recovery than my previous CS, I can’t imagine not being able to pick her up for a few weeks. The idea of giving the induction a go is tempting, just hope I’m not setting myself up for a fall. The consultant has said it’s fine to give the catheter and breaking the waters a chance and draw the line if it gets to the point where the drip is needed. Perhaps like you, that could be a good compromise for me.

It may be static growth and it is good to plan your options but it is also as previous poster mentioned to be within the margin of error. I was scanned by multiple people throughout my pregnancy and they were all perfectly good but the measurements are so small they also measured slightly differently. At one point it looked like the growth had dropped off but another scan showed it bounce back again the next week. It is possible that’s all

Agreed your first birth sounds a lot like my second. Cheeky sod was trying to look where he was going.

If it helps at all, recovery from the C-section was nowhere near as bad as anticipated with a toddler. My DD was 2 1/2 when her baby brother was born. She was told mummy couldn't pick her up and had to be gentle like with the baby, which she accepted. So long as I kept on top of painkillers (I set alarms) it was absolutely manageable. It was a balance of moving enough to not get stiff, but not over doing it and regretting it the next day. Once 2 weeks were up I was able to lift her carefully.

In defence of epidurals, there's no guarantee they will lead on to a cascade of intervention. The argument is that if your labour is lengthy and/or overly painful, you were already on track to having intervention anyway. The epidural wouldn't have changed anything. That's how I feel about the epidural I had anyway. Especially as it was given in the last couple of hours of labour. Baby was in the awkward position causing labour to be oh so very long. The writing was already on the wall that I was on track to having a C-section before I even decided on the epidural. I had the drip in both labours, but only had the epidural in the second.

@GodspeedJune there was a mix-up on my scans so the growth wasn’t really picked up until I was 38 weeks (I had growth scans at 32, 34, 36 and 38 weeks as my bump didn’t grow much). Another reason I had a private scan! I was induced at 39 weeks but after my scan at 38+5 this was the next available slot for induction. Baby was fine when born but he was very small (5lbs) and my placenta was tiny. I’ve never had a follow up from it presumably as he was healthy. He’s still small now.

I've had 3 inductions and they've all been fine. 1st was just popping my waters. 2nd was the pessary 3rd was the drip. I got a epidural as they started the drip. All different lengths of labour too 1st was 7 hours 2nd was one hour and 3rd was 5 hours.

I recommend getting the epidural at the start the drip relax and have a sleep untill the time comes to push. You'll at least already be prepped for a section if needed

It’s great that you had a sonographer that you trust!

The difficulty is that you are comparing between two different people’s work because it’s the comparison that’s causing concern rather than the estimated weight which isn’t deemed too big or too small

My induction with my second (just having waters broken) was a much better and shorter birth than the 30 odd hour labour that started naturally with my first. Try not to let the horror stories put you off, your body will know what to do this time.

Ultimately you do what you’re most comfortable with and what’s safest for the baby. Good luck with your decision whatever you decide.

I agree with this entirely. I was not sure until 38 weeks if the baby had stopped growing or was just small, and both needed a different course of action. The sonographer measurements were all wildly different. According to the growth scans the baby actually shrunk between 32 and 36 weeks!

I can't comment on the vbac thing as I had both babies induced and vaginally. If it's true that they don't like using hormones for vbacs then I'd go straight for the section. If they can use the gel then go for that one. My daughter whizzed out in just over an hour compared to my son who took around 29 hours with just about 5 years between births. Your body doesn't forget how to do it. Personally, I'd take the induction as long as it was possible

Hi there it's a labour ward midwife. I look after a look of VBAC women. You won't be offered pessary or gel. You might be offered a balloon induction if your hospital does them. Alternatively if you are at least 1 cm dilated which happens often with 2nd babies, you might just need your waters broken to send you into labour. Some of our doctors would cautiously offer oxytocin drip if the labour isn't progressing naturally. However it would be a very senior doctor decision. Most VBAC labours are naturally quicker than the 1st ones. We all get better with practice. It's a big decision to take. However induction process itself also tends to go more smoothly with 2nd babies. I presume you already had a detailed discussion about risks and benefits of VBAC versus repeat Caesarean. I hope it helps

Thank you for all your replies. It’s been a stressful few days mulling everything over. I had a sweep on Friday with a bishop score of 8. Had a bloody show over the weekend and have another sweep booked for today.

The hospital won’t do a growth scan less than two weeks apart but will see me this week to do a Doppler check through the umbilical cord and fluid levels.

Have a provisional c-sec booked but not keen on one, keep your fingers crossed for me that something happens beforehand! Thanks again for the support.

Hi there, it's a labour ward midwife again. Bishop score of 8 is really good, it means your body is ready for labour and induction is likely to work. Why wouldn't you ask for a sort of induction where they just break your waters? There's a good chance you won't need anything else. You can decline any drugs and just ask for a Caesarean if breaking your waters doesn't work

Yes I’m open minded to having my waters broken. Midwife said I am 4cm today, so another sweep done. She thinks something will happen in the next day or two. Fingers crossed.

I am keeping my fingers crossed for you. Once your waters are gone, either spontaneously or as part of induction you will most likely go into labour easily, in my experience

Oh wow. Bishop score of 8 is incredible. I hope things start happening for you soon.