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Natural Birth
Baby Measuring Small
Ok, so my midwife is on vacation until the 17th, and I went in today for my 36 week appointment (36 weeks 4 days) and saw one of the other doctors in my practice, and had an ultrasound. The Dr. was concerned because she was measuring small. She said that the baby is only measuring about 5lbs, which puts her in the 12th percentile for weight. She did an internal and I am 3cm dilated, and about 60% effaced, and the doctor was really pushing for me to get induced, because everything is looking so favorable. She is worried that the baby in not thriving as well in utero, and that baby would do better outside.
Does anyone have any experience on this or literature they can point me to, to read up on this? Supposedly heart rate and fluid levels both looked fine, my blood pressure, sugars etc are all good. I have a follow up ultrasound on Monday, but I'm expecting for them to really push induction. Obviously if it's really necessary then I'm all for it, but I'd really rather wait to at least have my midwife back in town. The doctor I saw didn't really seem to want to give me a lot of options, just kept pushing setting an induction date.
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Re: Baby Measuring Small
I don't have any literature on this, but I would be hesitant to induce. At only 36w4d, there is plenty of time for baby to continue to grow and gain weight. Also, growth u/s are often inaccurate.
I measured small my entire pregnancy - the "biggest" fundal height measurement my MW ever got was 35w on my due date. She never pushed for induction because it wasn't a matter of the baby not thriving. He continued growing at a steady pace; he was just small (I went into labor at 40w5d and my little guy was only 5lb 10oz but perfectly healthy!). So before an induction, I would rather have another u/s or fundal height check in a week or so to see if baby is still growing.
A good friend of mine had this issue. She's 5'9" but her husband is only 5'4". Her babies are just smaller, perfectly healthy, but smaller. With her first the dr. set an induction date (I think it was around 39 wks, though, it was five years ago, so I don't remember exactly) and she had the baby two days earlier on her own (naturally). With her second, the ob kept offering to induce her starting at 36 wks, but she refused and had another perfectly healthy baby.
I'd stall by at least asking to confer with your MW first.
Did you have a regular u/s or a BPP? DD #1 had both oligohydramnios and IUGR. My MW monitored her growth, fluid, and health via BPP's rather than traditional u/s's because she feels their estimates are a bit more accurate and tell you more about how baby is doing vs. just how big baby is. Some babies are just tiny ... just like some babies are just big. Just like some adults are tiny or big. You get the point.
Anyway, barring any indications that baby is in distress or growth is being restricted by a medical condition, I wouldn't worry about size. Is there a way you can get in touch with your MW before she returns?
DS2 - Oct 2010 (my VBAC baby!)
I agree with what everyone else has said. I'd definitely try to talk to your MW before you agree to any induction, especially if you've been measuring "smaller" all along.
The other issue I'd ask about is lung development. At 36 weeks, I don't think most babies' lungs are fully developed. I'd ask about the risk of under-developed lungs with an induction vs. the risk of the baby not thriving inside and waiting.
Morgan's Birth Story: http://www.fullcirclemidwifery.com/2009/06/morgans-birth/
Chloe's Birth Story: http://www.fullcirclemidwifery.com/2012/04/chloes-birth/
If heart rate & fluid levels are fine wouldn't it make more sense to let the baby have more time to grow? My last baby measured small as well & I ended up reluctantly being induced, which I still regret agreeing to. He was & still is just a small baby. My OB's poorly misjudged the size of all of my children.
Good luck in whatever you decide.
I had this problem with my first baby. Starting at 31w my fundal height was measuring behind by 1-2w. I had to have weekly BPPs to make sure that we weren't dealing with IUGR. Starting at 36w the perinatologist was pushing for induction every time I saw him. IUGR was never diagnosed, DD was growing consistently, though she was small for how far along she should have been. I knew my EDD was correct because of charting and knowing when I ovulated so it wasn't that my EDD was off. I was just small and so was she, but healthy.
Obviously if anything IS wrong you want to get the baby out and nourished. But I'd want to know for sure what's going on before rushing to induce. At your followup u/s see if baby has grown and if so, I'd probably put off making any further decisions until talking to your midwife. You could also ask for BPP (bio physical profile) and followup of that because, like pp said, they give more info. Regular u/s are notoriously wrong at guessing baby's size.