Fundal height: three weeks small for dates at 17 weeks, please, please advise

[Upwind]

I had an appointment with my midwife today. She basically said three weeks out for the fundal measurement was the limit of what they could allow for. But you only normally see such a big discrepancy at a later stage of pregnancy. My fundal height was measured at barely 14cm.

I had a scan at thirteen weeks which showed an active healthy baby. My midwife spent ages looking for a heartbeat today and eventually found one. In my area you only get one scan, which I have had, and anyway she was adamant that a scan would not help me. I tried to argue that it might either provide reassurance or confirmation of bad news but that was brushed aside. I was feeling so shocked and distressed that I did not argue much.

Instead, I have to go back next week so the fundal height can be measured again. And I was told to call the triage number if/when I experience pains like period pains or bleeding.

I have been frantically searching the internet for information about measuring so small at such an early stage, and have not found any. I was ttcing for a long time and am absolutely certain of my dates, which tie in perfectly with the scan.

Hi upwind. Glad that everything was ok. I have to say though that I don't think your mw was scaremongering but she could have been more tactful and informative. I had the same thing with my mw although she did add that I had to go immediately to hospital for a scan and it was 'probably nothing to worry about' as I was tall and the baby may be lying sideways. It is awful though as I left my health centre with my heart in my mouth about the baby's growth and in floods of tears. I was told at the scan everything was ok (as the scanners had a two week margin) only to find out a couple of weeks later the baby wasn't growing right with IUGR but I was lucky the mw picked it up so early as I got the best possible care.

Do you get a 20 week anomoly scan where you are? It is a basic care level as recommended by NICE. Surley if you had this on offer it would prevent alot of your worries! Can you not insist on a scan?

Also I would go back to your midwife next week and give her a chance to redem herself. If you have lost the trust then it is impossible to get it back as you dont see them often enough.

It is good news for you and I hope the rest of your pregnancy is uneventful.

I am in sussex and we dont get measured until at least 28 weeks as it is not a reliable indicator of growth until baby is fully out of the pelvic region! HTH.

hanaflower the firm abdominal muscles was the first reason the registrar at the hospital came up with. Unfortunately I can rule that explanation out!

Lou the difference being that, at the hospital, both the midwife and registrar were able to explain their reasoning. They both pointed out that there could be benign reasons for measuring so much smaller than dates, and that at this stage a scan might not tell us much. If the measurement remains so small for dates I can have a growth scan at 24 weeks.

Beachbunni I do take your point and I am sorry to hear about your IUGR. I really think it was bad form of my midwife to upset me like that by only suggesting negative implications, when they won't scan me and there are other possible explanations (which I have to cling to for the next couple of months).

Ronshar that does help. I find myself wishing I had never had the measurement, because knowing something may well be wrong but being unable to have a scan is the worst of both worlds. Maybe they do early fundal measurement instead of scans here? It seems a bit pointless if unusual results raise alarm bells but nothing more! I might have to find the £150 for a private anomaly scan so I can enjoy this pregnancy.

fledtoscotland - I am in Edinburgh, I think all maternity services seem to be through the royal infirmary here. In fairness they were wonderful last night and did reassure me as much as possible.

That could be the best £150 you ever spend if it puts your mind at rest.
The last thing you need is stress and worry as that will impair the babies growth, as too much stress can cause all kinds of problems.
Dont forget lots of women on here have been where you are and or going through it right now. You are not alone. Reach out and get reassurance from everyone on MN. Thats what we are here.

if you ask your consultant for an anomaly scan (cite NICE and SIGN guidelines as well as best practice guidelines) they cant really refuse you a scan. i have had 20 weeks scans with both pregnancies. There is so much evidence to support the need for these scans that they are on dodgy grounds. its just due to funding that they dont offer it routinely like they do in England.

FWIW - when I was a midwife I was taught that fundal height measurement is useless before 20 weeks and is sometimes questionable after that time as well.

a friend from my antenatal class was scanned all the time as they said her bump was too small and she would have a small baby. He turned out to be a healthy boy of over 8lbs.....

she's pregnant again and even at 20 weeks still only looks like me at 14 weeks . Some people just don't get big bumps.

I had a very small fundal height with DS2. It was followed up by a scan which put him way ABOVE the 95th centile on the charts for growth.

I went for a further scan appointment a month later because they were now concerned that he would be too big. Junior midwife waved a tape measure at the bump and said that it was 'within dates', so I wouldn't need a scan. Oddly enough, I didn't find that helpful, given he'd been simultaneously 'huge' and 'small for dates' the previous month. (We got the scan -- he was a transverse lie and a 9 lb 2 baby, so biggish but not vast).

All this ramble is trying to say is that bump sizes can be really unreliable!

Thanks all - it is great to have confirmation that the fundal measurement is a very poor indicator!

FledtoScotland - how can I contact my consultant? I suppose I will need to call the hospital and ask for their email or phone number.

do you have the big maternity services book with contact numbers in it? it should say who your consultant is. if not, phone the triage ward at the royal and ask them.

Their name is in my blue folder. I'll wait a week or so before calling them - when I am closer to 20 weeks so hopefully in a better position to plead for a scan!

good luck and let us know how it goes. it is disgraceful that we dont get the 20 week scan here in scotland unless we ask for it

How you doing today Upwind? Any news on a scan?

On Thursday, I emailed my consultant outlining my circumstances and reasons for wanting a scan and mentioning the guidelines from NHS Quality Scotland and NICE. So far, I've not had any response or acknowledgment. It is particularly frustrating, since in trying to research what a very small fundal height means, every single resource mentions that if it is unusual your consultant will send you for an ultrasound. Not in Scotland it seems where, instead, we are expected to live with the stress and anxiety for a couple of months or so. If I had known that I would never have consented to fundal palpation - what is the point in causing such worry when no further screening is offered?

I'll follow up my email to the consultant on Monday and if/when I don't get anywhere will book a private scan. I used to think I felt fluttering after having a cold drink but I've certainly not felt anything since Friday last. I don't know if feeling the movement was all in my head but it adds to my doubt and anxiety. Can't stop obsessing over the possibility of losing this baby.

upwind - pls chase your consultant on monday if for no other reason but to put your mind at rest. scottish maternity services are so far behind england but they should offer you the anomaly scan if the m/w thinks in her professional opinion that her results indicate that something MAY be wrong.

re movements, i didnt feel anything with #1 until about 23 weeks and about 21weeks with #2

Thanks again! I tried to follow up today but have only been able to reach the consultant's secretary's answering machine. I've still had no acknowledgement of my email.

I think the best thing for me now to reduce stress is simply to book a private scan though it means cancelling a weekend away that we'd planned. Trying to fight for one on the NHS may well be futile, and I really want everyone involved on my side!

upwind - although its classed as an english bank holiday, the NHS has today as a holiday so thats why you could only get an answer phone. i would try again in the morning.

hi just to add im in birmingham and we dont have fundal measuring until 28 weeks and with my first i was always 2-3 weeks under and had a perfectly healthy 6lb 5oz er. A friend was also measured big and refered for alsorts of tests for her third as they were worried he would be soo big but again he turned out to be about 8lb .. so i would take fundal height measurements with a pinch of salt.
Also re your midwife's attitude i think you have evrey right to change from her care. You are at a vey vunerable point in your life and you not only need professional care you need sympathy and understaning if she cannot provide that for you then go somewhere else.
I have a scan booked tomorrow as on my 20 week scan they decided my baby's head is too small .. so i know what you are going through with the worry but take care and i hope you get your scan soon xx

Reban - my main problem with my midwife was that she claimed that you should only see a measurement so far off the norm at a later stage of pregnancy. But on this thread and at the hospital I've been advised that the fundal measurement is not reliable before 20 weeks! My midwife should have known this and should have explained it to me - the extreme distress I was in, believing that there was definitely a serious problem with my baby could have been damaging in itself! And she should also have explained the reasons that a measurement might be on the low side. If I am lucky enough to have subsequent pregnancies I would never consent to fundal palpation unless assured that I would be referred for a scan, should a problem be indicated!

FledtoScotland - I finally spoke to my consultant's secretary yesterday morning and she told me that I would hear back from the consultant at some stage yesterday. I had no response from her whatsoever and so left another voicemail this morning. If we do end up with a private scan DH wants to wait until at least 20 weeks to give our baby a chance to catch up if it is just a bit on the small side! We just can't afford repeated private scans if a problem is indicated. So the wait continues...

upwind - sorry to hear you still havent had the scan. I can only praise the maternity services here as they have been fabulous.

re a private scan, we have a private sexing scan at babybond in glasgow and found them to be very helpful if thats any use.

good luck

My consultant finally got back to me yesterday and we can have a scan on Tuesday, though it will not be an anomaly scan as that would be against their policy. I am more than happy with that, I just want reassurance that my baby looks to be growing okay!

thats good Upwind. at least you will get some peace of mind. out of curiosity, why dont they do anomaly scans?

no idea why they don't do anomaly scans unless as a cost saving measure - she said it was against their policy

I will ask more about it on Tuesday

if your mw is measuring with a tape measure that is not routinely done until 24 weeks isn't it - i am amazed that in 4 weeks from a scan within normal limits it should apparently change so radically - perhaps you should request to change your midwife? Contact her manager to do that. A fundal palpation at 17 weeks is laying the hand prior to a listen in to the heartbeat

aquariusgirl - that is exactly what I was told at the hospital, where I had a growth scan yesterday, which revealed normal growth

I am very with the midwife for putting me through so much stress for nothing, and for failing to explain how unreliable and inadvisable fundal measurement is at such an early stage! I would love to change midwives but she is the main one for my GP practise and I am not sure if being seen as a trouble maker might make it more difficult for me to get a home birth (which the current midwife is unsupportive of).

Thanks again to everyone who posted on this thread and helped me sort this out