Induction at 37/38 weeks for severe SGA baby (1st centile) everything else normal.

[champagneblonde90]

So I’m 34 weeks pregnant with my 2nd daughter and due to my first daughter being undiagnosed SGA (8th centile) when born @ 6 lb 8 about 2.5 yrs ago I’m now having to have growth scans every 2 weeks & take 150mg aspirin till 36 weeks with this pregnancy as ‘high risk’ as she’s now gone below the 3rd centile (1st centile currently) which is classed as severe SGA, So we’ve been referred to fetal medicine who’ve said I’ll need to deliver between 37/38 weeks due to this. Sonographer said 37 weeks.

I have no other health issues/risk factors - blood flow to placenta good, heartbeat always good, movements good.
we didn’t realise our 1st daughter was SGA till she was born but all was fine, born 40+5 days (induced due to waters breaking but labour didn’t start naturally within 24 hrs but was easy induction with no complications during pregnancy or birth. u could say Ignorance was bliss!

I don’t mind being induced again if it’s absolutely necessary but it just seems really early especially when there’s no other issues just her size.
is this necessary to be induced this early just due to size when everything else looks fine especially when apparently measurements can be way off on scans?
Their reasoning is that she’s gone from 8th to 3rd to 1st then up to 2nd then back down to 1st centile and the risk of stillbirth is higher with babies confirmed as SGA.

Anyway just looking for some advise from anyone who may have been in this situation or similar who could give some advise?
I have another scan & consultation in 2 weeks when I’ll be 36 wks so I guess they’ll make a final decision then but would like to go in and be somewhat prepared.

The thing is .... SGA babies have a higher risk of stillbrith. The majority of sga babies if left would be ok. But a higher proportion of them than bigger babies will die before birth. So you could be in that higher proportion that are fine ... but you could be the 'One' - for me I would not want to take this risk.

Whats her estimated weight? I delivered at 37 weeks, she was 4.12lbs and absolutely fine, I didn't take the risk and would strongly advise you take medical advice and deliver her at asap

Ive just been through this, my baby was born three days ago. I was originally going to be induced at 37 weeks as he was measuring at 3rd percentile. I ended up being Induced at 39 weeks as he was on 5th percentile on the 37 week scan, which made them move the induction to 39 weeks.

My baby was born measuring 3.7 percentile and is tiny! Seems the last scan was off, but I’m glad it was as he would have been so much smaller at 37 weeks. He was perfectly healthy, 10 on apgar, perfect colour and breathing etc.

I would listen to your doctor though. 1st percentile often means IUGR rather than just SGA and there could be placenta issues.

Hi thanks for your replies.

she’s measuring about 3 weeks behind, last scan at just under 35 weeks estimated weight just under 4 lb so very small (if accurate!)

they said everything looks ok but they can’t be sure and she could just be a small baby but there may be another reason like placenta issue so the dr said ‘it’ll be induction at 37 weeks’
i said about my last daughter being a small baby as well as me & husband also both well under 7 lbs at birth at full term.
they just said that’s very small!
i then said what if at the next scan she has as a big growth spurt? But they were like no it won’t make any difference and it’s very unlikely that will happen but I’ve a lot that they can have a sudden growth spurt towards the end or am I just dreaming? lol

I do feel like she’s just a small baby but it’s difficult bcos there’s no way of knowing until she’s born really is there.

Hi OP, I had a very similar experience. First baby was undetected SGA and born at 38 weeks at 0.2 percentile (spontaneous labour but ended up in emergency C-section as baby wasn't coping with labour very well). I also developed preeclampsia during labour so doctors suspected placenta issues. Second baby I was classed high risk during pregnancy so extra scans like you. At 36 weeks he was on 3rd percentile but 1 for abdominal circumference so consultant requested fetal medicine growth scan. I was being monitored every couple of days at the day assessment unit as my blood pressure was borderline. In one of those they detected a dip in baby's heart rate and so decided baby should be born on that day by emergency C-section. I was 37w6d. Baby was on 0.1 percentile and weighed just under 2kg. Completely fine and healthy but they said he wouldn't have been able to cope with labour. Just like my first didn't very well.

He's 2 months today and has more than doubled his birth weight and is a chubby little thing.

I would absolutely follow the advice and get that baby out now. After 37 weeks they're considered full term anyway so there's no benefit in keeping them in there if they're not gaining weight, which is what those last few weeks are supposed to be about.

Both my babies were super small but healthy and didn't need NICU. They started gaining weight like crazy once they were out. Trust your doctors.

this is so interesting I thought everyone was going to tell me I’m mad for even considering inducing early. Obviously I am completely wrong to ignore the advise.

can I ask what your experiences were like with inducing this early? I’ve heard it can lead to a ‘cascade of interventions’ including emcs which I’m terrified of!

my last induction was straight forward with just the drip plus I was overdue & waters already broke so was probably about to go into labour any time anyway so I know it was right, whereas this feels like such a big decision on my shoulders!

I went in to be induced at 39 weeks and was only 1cm. With my older two I went to 41 weeks so that wasn’t surprising. They gave me the balloon, which fell out after 5 hours and I was then 3cm from that. They then broke my waters, put me on drip and baby was born 4 hours later. Only gas and air no other pain relief. This was my third baby though, which may have had something to do with how easy it was.

hope yours is easy and straightforward too.

Yes I’m not expecting my body to be ready at all at 37 or even 38 weeks as my 1st was late as well but I always had this feeling this 1 would come early for reason I don’t know why.. intuition maybe .

my mum thinks I should just book a C-section but Id rather try induction 1st as had a successful induction before which really wasn’t that bad at all. Like you, had drip gas & air no other interventions needed and this is my second.

ill see how the next scan goes & take it from there!

Ah people kept telling me to ’just get a C-section, it’ll make everything easier’, seemingly oblivious to the fact it is considered major surgery. My friend had horrible recovery period with both her sections, couldn’t move for ages. My other friend got an awful infection.

I’m with you. Inductions can be hard, but with you already having had one before, I think you’ll be fine. This one will likely be like your first one, maybe even easier considering your body has done it before.

I had two SGA babies and like you, the first one wasn't picked up but the second one was. I had an induction, followed by a C-section, at 36 +5 but it all took a while so DD was born at 37+0, perfectly healthy, with no need for any special care - we were home in under 48 hours.

I was lucky in that I had an excellent consultant and senior midwife involved in my care who were happy to talk me through pros and cons of everything. I don't know what yours are like but if you're considering doing something different to what they would normally advise, I would suggest asking them to quantify the risks of that for you.

When thinking about induction vs section, one thing my consultant did say to me was that if I went into labour, even if the baby was born by C-section, that might be helpful to the baby because experiencing contractions etc might help her be ready to be born. (This discussion was over 4 years ago so this might not be the best summary!) So I was happy to be induced, even knowing there was a good chance it wouldn't work. But obviously that means you have to have both labour and a section, so it does depend whether you're up for that!

From what I understsnd about a baby being confirmed SGA is that it is different to the baby just being a small baby.

I'll tell you how I know what I know. One of my best friends (single mum, I was mainly support) had a baby who was confirmed SGA and she asked to speak to a paediatrician about it. That paediatrician clearly differentiated between a baby who was just small (usually due to genetics) and a baby who was SGA which means they think the placenta hasn't been functioning well through the pregnancy.

The former baby has the reserves of an average baby and they won't need as much special management as a baby who is confirmed SGA. For instance, he wouldn't be as concerned about a small baby who is feeding sparingly in the first few days as he would a baby who is SGA where he would have a lower threshold for recommending a feeding tube.

This brought him onto another point about what next. He said that a baby without these reserves will likely find labour more stressful than a baby who has them, particularly an induced labour.

My friend chose an elective for those reasons but she went into labour spontaneously beforehand and progressed quickly. We went to the hospital but she was fully dilated when we arrived so she ended up having a normal birth. He was small and you could see loose skin on his bum and thighs where he had lost weight in pregnancy and did require a feeding plan but he's fine.

The midwives I’ve spoken to about it haven’t been that helpful tbh, just sit there nodding their head listening to me saying ‘I know it’s difficult, I feel for you’ etc etc. not really helpful & clearly don’t want to say the wrong thing. When I asked my widwife what she would do she just said she’d be doing what I’m doing.

I’m just sick of all the staff saying ‘she’s small she’s tiny etc.’ yes I know she’s small!! U keep telling me lol. 🤦‍♀️ it annoys me bcos it makes me feel like it’s my fault but they said there’s nothing I can do so why keep going on about it?

when I went in for heartbeat & movement monitoring after my last scan the midwife said ‘its failed’ I said what is there something wrong with the machine ? She said no there’s something wrong with your baby’ I said what does that mean? She said ‘she’s too small!’ Honestly what a rude comment, who says things like that? I thought as a midwife she wasn’t very sensitive with her words.
I feel like telling them all to eff off tbh . 🤣