measuring small...what do i need to know?

[MoonFaceMamaaaaargh]

hi, i'm 36wks with dc2. I'm measuring 32/33 but as i'm nearly over the home birth finish line they are sending me for a scan to be sure.

So there are lots of things i should have asked the mw but didn't think of at the time. So please can you lovely mners help.

What will they be looking for at the scan?
If they did find something how would they suggest we handle it?
What are the risks/bennefits etc associated with this?
What are the alternatives (and risks/bennefits associted with this)?
Any stats re likelyhoods/accuracy etc?

Sorry if this sounds cynical but i know some hpc's like to do things "their way" and so aren't always forth coming about the full picture iyswim.

Ds was 8lb 11.5oz. While this baby feels smaller and less active it has felt consistant in of it's self iyswim and so i hadn't been worrie till now (naively perhaps).

Tia for sharing your knowledge and experiences.

I ,measured small with my second

I went for a scan which was actually very reassuring - they measured her thigh bone and her tummy etc

She was well within the average range and was born at 39 weeks weighing 6 lbs 6 oz

If you do measure small, they will scan again - it won't just be a one off

have you always measured small? or has there been a tail off of growth? the scan will measure baby,but also check that you have enough fluid around the baby,less fluid can be a reason for measuring small for dates. you should also have a follow up scan to check baby is continuing to grow. i had 3 term babies, 9 lbs, 6 lbs 9 oz and 7lbs 9 oz, so weight can really vary. has your midwife been plotting your fundal height, the measurement she takes from your tummy each time you go for a check?

thanks ruby and diet.

There are only three measurements in my notes, 31@31, 32@33 and then 32@36 so looks like a tail off. Iirc some of the measurements were taken by students. Infact this time the mw measured 33 and the student 32 but they decided to put down 32 to get me a scan, so any problem would be picked up before i deliver...hopefully at home!

Had this with DC4; by then I knew my body or maybe I was delusional, but it never worried me in the slightest. i've had small bumps but sizeable babies twice. (And indeed DC4 was the biggest at birth, nearly 9lbs)

What will they be looking for at the scan? Placental function & circulation (you get to see things in colour!), measurements of fetal bones & head & tummy to estimate size.

If they did find something how would they suggest we handle it?
They'll want to induce you if it's a real problem (baby does look too small or placenta compromised); else they'll send you home to go into labour naturally.

What are the risks associated with this?
Unnecessary medical intervention?

Benefits of doing it
Keeps MW off your back & lets your homebirth go ahead as planned :).

What are the alternatives
You can refuse anything they suggest or say you "must do". But I think I'd be worried sick if they could clearly show me a problem.

Any stats re likelyhoods/accuracy etc?
Not brilliant, my guess is 85-90% accurate (accurate enough for you to believe in). Late scans are notoriously bad at estimating size. I have friends who were induced for having severely undersized babies (as measured); and then baby was born a perfectly healthy size.

Hi I can't answer any of your questions about scans, risks etc but just wanted to say I am almost 36wks and also measuring small, going for a scan at 37wks. Unlike you I'm not having a homebirth as it's my first.

I have had LOTS of real life people tell me that they were measuring small and their baby ended up being on the larger size if anything (my boss's 2nd child was measured small and was 9lb5oz at birth!).

Also my MW told me that if you yourself are on the taller side you are more likely to measure small as there is more room for the baby to move into vertically but I don't know how true that is.

Anyway good luck though I'm sure you won't need it :)

thanks for that ragged, really informative. What is the thinking behind inducing for small size? I can understand why for placental problems but if the placenta is ok but baby small...? I had heard that measurements at this stage can be inaccurate. If they could tell me there was a definate problem i would have no hesitation in being induced...but i'd be reluctant to risk intervention if the evidence in it's favour was unreliable.

Good luck hp! Do come back and let me know how you get on, if you don't mind.

I'm not particularly tall and had a huge bump last time...even other midwives asking if i was having twins.

What is the thinking behind inducing for small size?

Because they assume the womb environment is compromised in some way they can't detect, and that an unknown risk is even worse than a known one, iyswim. And once out of womb the stats say baby will do better on average (for instance, you are at high risk for stillbirth with very small late term babies, I think). But am not a professional, just spouting things I seem to recall.

The bottom line is, if they seem to find a problem, any problem, and recommend a course of action you aren't sure about, ask every question you can think of. Most HCPs appreciate this, it means you are really thinking about your care & the baby.

Hello, just letting you know my experience. I was measuring small at 34 weeks (measured 30) so was sent for a scan. They measured the size of the baby, checked placental function and amniotic fluid levels. All as fine except fluid levels were low so I have had follow up scans at 35 and 36 weeks to check all was ok.
Fluid level is now within normal range so I have been told my pregnancy can progress as normal (am 37 weeks now). I'm still measuring small though, don't know where the baby is hiding as I'm only 5ft tall!
The scans were very reassuring though. I think if there were any problems found you could be induced early.

thanks ragged. The problem is knowing what to ask! Especially when things are spoken about in such absolute terms iyswim.

Good luck hazel, hope it all goes well for you and your baby.

The problem is knowing what to ask!

I know; I always remind myself that pregnancy/parenthood is a journey, & I'm not really in charge of everything that happens on a journey. Can only try to make what seems like the best decision at the time.

Hello

Sorry I can't offer much help either on the risks etc but I can tell you my experience.

I also had this when pregnant with DS. I was 36 weeks measuring 30-32 wks. I had measured 2-3 weeks behind all the way through but it seemed at that point like I was measuring anywhere between 4-6 weeks behind. As I am quite a small person in both height and weight, the midwife thought it was worth sending me for a scan so they could check for the following things:

1. The baby was a normal size indicating that the placenta was functioning ok.
2. That I had enough amniotic fluid.

I was a bit worried - I go straight for the worst-case scenario - but I did want to make sure that everything was working ok. They told me the reason they would consider induction if there was an obvious problem was that at that stage, they felt the baby would be better off outside me rather than risking stillbirth. But they would probably check again with another scan before that point anyway.

When I had the scan, the sonographer asked: "Why have you been sent to me?" I explained and she said, "Er, your baby is already nearly 7lb so he is hardly small. It's that old classic - big baby, small woman." And he was born at 8lb when I still measured 4 weeks behind dates. The consultant later told me I had strong stomach muscles and he was just very jammed up inside me.

So, hopefully you will also find this is nothing to worry about. And a friend of mine whose baby did measure small for dates was scanned a week later and when it was discovered he was still growing (if on the small side) no action was taken and he was born at 7lb at 40wks after a big growth spurt at 39wks.

Good luck with everything - hope it all goes very well.

thanks ruby, that's really reassuring.

Slim chance of it being down to strong stomach muscles in my case but as you demostrate bump and baby don't necessarily tell the same story.

I alas no longer have strong stomach muscles. :o

Good luck again.

moonface i started a thread the other day about being monitored more closely during this pregnancy as my last baby was small at full term, under 6lb.

I was measuring small at 38 weeks, the baby looked to only be about 32 weeks gestation, since i had just doctors and my new doctor didnt have my notes she sent me for a scan. the scan was very in dept. The checked the cord was still working, the fluid, the size of the baby and made sure that every part of the baby was growing at the same rate, the placenta was checked and a few other things which i have forgotten about

The main thing is that there is a growth, if you go back weekly and the growth stops then they will probably call for an induction.

As for my my doctor didn't want to take the risk, i was monitored daily until 40 weeks and then induced at 40+1 after i called the hospital in a panic due to different movements.

baby born 40+1 at 5.15lb. All they could tell me was that the placenta looked 'grainy' and was on its way out. No reason for baby being so small since placenta would of still be ok at least the week before.

good luck

Hi barbie, thanks for sharing your story. I'm so glad you and your dd are ok. Congratulations!

Looking back the last measurement was taken on our sofa,which is squishier than the bed at the docs, and i'm wondering if that could also have made a difference to the measurements...maybe i'm just being hopefull.

Hi MoonFace

What they might be looking for is placental insufficiency - this is a lovley phrase that covers a multiple of different issues for which the cause is basically unknown but means that the placenta isn't working properly and it is affecting the growth of the baby.

As barbie1 says the important thing is that there is growth.

Sorry to give not such a happy story but it was picked up on my 22 week scan that my DS1 was small and we had to have intensive monitoring (daily by the end). He had to be delivered by elcs in the end at 31 weeks as he was doing so badly that his chances of survival were much better out than in as the placenta could have failed completely. He then spent a long time in the NICU before finally coming home.

If they do need to intervene then it is usually for a very very good reason. ours is a bit of an extreme scenario and you are MUCH further along than I was but always best to get checked out. If you want any further info following the scan let me know.

p.s. DS1 now a shouty bouncy adorable 2 year old bursting with happiness (i'm so proud )

oh and in this day and age measuring a bump with a tape measure by a ham fisted lovely MW is deemed to be an accurate way of scaring the bejesus out of a pg lady - surely there MUST be a better way...

hi hawthers, it is reassuring that even a difficult situation like yours had such a very happy ending.

I'm having the scan tomorrow so hopefully will be reassured then.

It certainly does seem a very effective way of creating worry...esp as my measurements are few, by different people, and with me laid on different things...and basically stretched to get me in for a scan. I'm optimistically hoping this means it will all be a fuss over nothing. Fingers crossed.

Hello just wanted to join in because I'm measuring small (29@32 weeks) so I'm being sent for a scan too. No idea when it is, I just have to wait for a letter! I have a private one booked for Wednesday just in case I can't cope with the stress any longer!

I'm 5ft7 so mw said that could explain it and also baby has head and shoulders in my pelvis already.

hi velvet, good luck for your scan. My nhs one came through quickly, but maybe that's cause i'm almost full term. Hope you hat good news which ever scan you end up having!

moonface how did the scan go?

hope all ok

all fine. Hurrah! Thank you for asking.

I've measured at least 4-5 weeks behind in both my pregnancies. They sent m for an extra scan with my first just to be on the safe side, she was born a healthy 7lb 2. My ds was 7lb 10. Midwfire just said i must have very strong tummy muscles! I'm 20 weeks now and not showing at all so must be true.