WWYD: Measuring small, inducing?

jterpbride · November 2012

I had a growth scan today. I've had them more frequently since my NT scan, and although everything has looked good since, they kept having me come in for growth scans.

I have been getting a little weary of the last few, they seemed to be unnecessary ultrasounds, so I was hoping today's would be the last if all was well.

So today, things looked fine except they think she is 4 lbs 4 ounces. Apparently at this time she should be 4-5 pounds. So this is still in the normal range but on the small side.

The doc told me to eat a lot more protein and come back in two weeks. I said okay...and then what? He said if growth is still behind they may recommend I be induced at 37 weeks.

A wha? I wasn't expecting this. At all. I have heard of inducing for larger babies but not for smaller. It was also a shock to think I may only have 3 weeks to go instead of 6.

I know we're not there yet and this would just be a recommendation anyway, but it's left me reeling. I really don't want to be coerced into induction, especially when u/s measurements aren't always accurate. I'll talk to my OB about it next week.

Has anyone heard of this, and what would you do in this situation?

Reyka9 · November 2012

I, personally, would never agree to an induction for reasons of growth because growth ultrasounds are far from accurate.

If you don't want to be induced, you have every right to put your foot down and say that unless there is a clear medical emergency you refuse to have it done.

jterpbride · November 2012

Reyka9:
I, personally, would never agree to an induction for reasons of growth because growth ultrasounds are far from accurate.
If you don't want to be induced, you have every right to put your foot down and say that unless there is a clear medical emergency you refuse to have it done.

Okay, that already makes me feel better. Glad to know I'm not the only one questioning induction for this reason. Thank you.

Reyka9 · November 2012

jterpbride:
Reyka9:
I, personally, would never agree to an induction for reasons of growth because growth ultrasounds are far from accurate.
If you don't want to be induced, you have every right to put your foot down and say that unless there is a clear medical emergency you refuse to have it done.
Okay, that already makes me feel better. Glad to know I'm not the only one questioning induction for this reason. Thank you.

And I agree that inducing for a *small* baby sounds truly strange. Why wouldn't they want the baby to stay cooking for as long as possible?

EDIT: I was intrigued so I consulted Dr Google. Apparently if the baby is measuring small they may be concerned that the placenta is starting to break down and/or the baby isn't getting the proper nourishment, so it's considered safer to just have the baby be born than to leave it be. I still wouldn't agree to an induction though, especially if your baby is still within the "normal" range. But that being said, I just read a story of someone who was induced at 37 weeks and the baby was more than a full lb than the ultrasound estimated...

sbevmc09 · November 2012

Reyka9:
jterpbride:
Reyka9:
I, personally, would never agree to an induction for reasons of growth because growth ultrasounds are far from accurate.
If you don't want to be induced, you have every right to put your foot down and say that unless there is a clear medical emergency you refuse to have it done.
Okay, that already makes me feel better. Glad to know I'm not the only one questioning induction for this reason. Thank you.
And I agree that inducing for a *small* baby sounds truly strange. Why wouldn't they want the baby to stay cooking for as long as possible?

I agree. Unless there's a reason to believe the baby is actually growth restricted. That can be serious. But that's different than a small baby. I would ask more questions of your provider and find out what they're worried about, what would happen if you wait, etc.

Also, you might consider getting a second opinion. Growth restriction is serious, but it sounds like your baby is on track so... I'm not really sure what the issue is.

Reyka9 · November 2012

sbevmc09:
Reyka9:
jterpbride:
Reyka9:
I, personally, would never agree to an induction for reasons of growth because growth ultrasounds are far from accurate.
If you don't want to be induced, you have every right to put your foot down and say that unless there is a clear medical emergency you refuse to have it done.
Okay, that already makes me feel better. Glad to know I'm not the only one questioning induction for this reason. Thank you.
And I agree that inducing for a *small* baby sounds truly strange. Why wouldn't they want the baby to stay cooking for as long as possible?
I agree. Unless there's a reason to believe the baby is actually growth restricted. That can be serious. But that's different than a small baby. I would ask more questions of your provider and find out what they're worried about, what would happen if you wait, etc.
Also, you might consider getting a second opinion. Growth restriction is serious, but it sounds like your baby is on track so... I'm not really sure what the issue is.

I agree regarding the 2nd opinion. Also I edited my response above...

sjamin9 · November 2012

I have a cousin who was induced for a small baby, but she was really not growing well. It wasn't just that she was on the small end of a normal range. They were really worried that her LO was failing to thrive in there. I feel like being within the normal range and the uncertainty around size estimations by U/S, I would totally question induction! Go with your gut and keep asking questions

PatsyGK21 · November 2012

SAME THING! Happened to me two days ago, he was measuring 4.1 lbs, which they said is small. They said I need to come back at 36 weeks, if he is still small they will talk about inducing me at 37 weeks. I tool, don't understand. I feel like there is something they arent telling me. What I also don't get is, my baby is breech, so if he is still breech at the time of indiction, they will have to give me a c-section, so essentionally I'm having a scheduled c-section! Doctor told me this is a "wait and see" situation. I dont like it. Not one bit.

jterpbride · November 2012

Thanks, all. Very helpful.

PrivacyWanted:
I would ask a lot of questions about why they are concerned about size. Was she once on a higher percentage and has since dropped? DO they think IUGR is an issue?
It seems strange that they would say induction just for a small baby, but maybe they didn't want to worry you yet?

Yeah I will ask a lot more questions. He totally dropped this in as I was heading out the door without much of a chance to discuss the "why," and he only mentioned it because I asked the "Then what?" question about the next appointment. So it seemed like he didn't want to get ahead of himself but did want to mention the more negative possibilities. But wow, am I glad I at least asked that much, because to get this bomb dropped on me at 36 weeks and then have to decide about induction sure would have sucked.

Allison546 · November 2012

It doesn't even sound like your growth is behind. The normal is 4-5 lbs and you are 4.4, so shouldn't this be considered normal?

fwiw at 32 weeks my baby was not even 4 lbs per my growth ultrasound and they said that was totally fine.. They told me he/she was 43rd percentile and no cause for concern. So kinda sounds like both of us are in the same range. I would just hang tight and hope the topic of induction doesn't need to be brought up again.

jterpbride · November 2012

PatsyGK21:
SAME THING! Happened to me two days ago, he was measuring 4.1 lbs, which they said is small. They said I need to come back at 36 weeks, if he is still small they will talk about inducing me at 37 weeks. I tool, don't understand. I feel like there is something they arent telling me. What I also don't get is, my baby is breech, so if he is still breech at the time of indiction, they will have to give me a c-section, so essentionally I'm having a scheduled c-section! Doctor told me this is a "wait and see" situation. I dont like it. Not one bit.

Ah really? Yeah, I don't get it. I think it's as pps have said, there could be risk of growth restriction but at this point they can't say. But if we're still in the normal range then why? DD is moving around in there like she's a professional soccer player who salsa dances on the weekends. I don't think she isn't thriving.

artroyer · November 2012

My friend had to have an early c-section because her babies didn't have any room to grow any bigger. She had twins which is why they went straight to the c-section instead of induction, but they had to take the babies much earlier than was ideal. Babies were 2.5 and 3.5 lbs and hadn't grown in a certain amount of time when they decided to take them out. Once they were out the doctors were able to control their food intake and help them to put on pounds and grow. They did not have any breathing issues or anything either because she was given a steroid shot ahead of time. Babies were and still are perfectly healthy! I believe this was at 33 weeks.

So if it's a growth restriction issue, I would personally go ahead with it. Especially if you wouldn't be induced until 37 weeks, since it's considered full term! That said, yes growth scans can be off, but you should use your best judgment and mommy instincts. Obviously the doctors also know the scans can be off and wouldn't suggest something that would be harmful to you or your baby!

PatchChild · November 2012

Yikes, I can't imagine the stress. I'm also cooking a little babe right now. They put her at the 38%ile at 32 weeks. Even with that there isn't talk of early delivery. My doc jus asked if DH is small, and what size my first child was. He was just under 7 at full term. Just my way of growing them

Don't let them stress you into early delivery for no reason. Especially since first babesntendmto wait until closer to 42 weeks. 37 would be 5 weeks early!

this decaf life · November 2012

Her growth isn't behind if the range is 4-5 pounds plus those scans are notoriously untrustworthy. I'd actually be really ticked off and give the doctor a piece of my mind about it that he would want to induce at 37 weeks.

PatsyGK21 · November 2012

jterpbride:
PatsyGK21:

SAME THING! Happened to me two days ago, he was measuring 4.1 lbs, which they said is small. They said I need to come back at 36 weeks, if he is still small they will talk about inducing me at 37 weeks. I tool, don't understand. I feel like there is something they arent telling me. What I also don't get is, my baby is breech, so if he is still breech at the time of indiction, they will have to give me a c-section, so essentionally I'm having a scheduled c-section! Doctor told me this is a "wait and see" situation. I dont like it. Not one bit.

Ah really? Yeah, I don't get it. I think it's as pps have said, there could be risk of growth restriction but at this point they can't say. But if we're still in the normal range then why? DD is moving around in there like she's a professional soccer player who salsa dances on the weekends. I don't think she isn't thriving.

Yeah, he moves a lot too, so I know he is more than okay in there. They told me that he was only in the 15th percentile for normal gestational weight for 33 weeks. Which makes sense cause my appointment was exactly at 33 weeks, so if you compared him to a baby that was 33 weeks and say 6 days, yeah he would be small. After DH and I discussed it, we are going to put our foot down about an induction, I could understand if he wasnt in the range at all, but he's there. Idk, I'm going to hear them out at my next appointment and then tell them I really dont want to be induced.

SWOG31 · November 2012

It's not just about where your LO's weight falls at this moment, but also about whether they are still gaining from one appointment to the next. Was there any gain between your last appointment and this one? Even if your baby is in the normal range, but hasn't gained from one appointment to the next could also indicate growth restriction. Your doctor may just be giving you a heads up on worst case scenario. Before you put your foot down about no induction, make sure you ask a lot of questions about what exactly your doctor's concerns are?

PatsyGK21 · November 2012

SWOG31:
It's not just about where your LO's weight falls at this moment, but also about whether they are still gaining from one appointment to the next. Was there any gain between your last appointment and this one? Even if your baby is in the normal range, but hasn't gained from one appointment to the next could also indicate growth restriction. Your doctor may just be giving you a heads up on worst case scenario. Before you put your foot down about no induction, make sure you ask a lot of questions about what exactly your doctor's concerns are?

Idk how my OB would know LO's growth rate because they canceled 5 of my appointments in a row and I went 10 weeks without care. I would have changed OBs but I have tricare prime and that wasnt an option. Military insureance is lovely.

jessrenee11 · November 2012

I thought I would tell my story about growth restriction as I dealt with it with DD and am starting to have it with this one. What you need to be concerned about isnt just weight but that baby is growing the same rate all over. With DD she had IUGR I had her at 37weeks 2days and she was 4lbs 9oz. Her head had kept growing but her body stopped at around 31-32 weeks. It is a very serious issue and I was going to be induced as it was safer and healthier for her to be outside the womb then inside at that point. I also went into labor on my own. Now with DS his head is measuring about a week ahead and his abdomen is almost 3-4weeks difference. I am being closely monitored and go am going to MFM next week to see a high risk ob about. I 100% am comfortable with being induced at 37 weeks with growth restrictions issues if need be. Please trust that your Dr.s will do what is best for the health of your baby. Also most growth restricted babies come out healthy but tiny because they have had to fight to survive in utero. If you have any questions please PM me!!

NewMom113 · November 2012

My baby is measuring small too. But doc told me not to worry unless he is in the 10 or less. He was 27 at one point. I would ask what yours is in. Cuz like I said my doc said anything above 10 is ok.

==N== · November 2012

If baby isnt following a normal growth curve whether it be in the 10th percentile, the 50th or the 90th it could indicate a problem. However, I would get a lot more info before agreeing to an induction.

jessrenee11 · November 2012

ClaryPax:
They are looking for Inuterine Growth Restriction.nbsp; They have to do growth ultrasounds on a regular basis to track the growth.nbsp; For some reason they thought you might be a candidate for this based on your NT. You should ask them why they think you are a candidate this.nbsp; I can't believe you don't know already.Anyway IUGR can be very serious, and can cause still birth because it usually indicates a problem with the placenta.nbsp; It doesn't really sound like you are in this IUGR range yet, so the doctor is saying that if you get diagnosed with this then the standard procedure is to induce at 37 weeks to prevent your placenta from breaking down before 40 weeks and causing harm to the baby. nbsp;I don't think he is "forcing" induction on you at this point.nbsp; I think he is not explaining himself all that well, but is telling you that you might be a candidate for this, and that they will find out in the next ultrasound, and if you are a candidate this is what they recommend. nbsp;If your baby does have IUGR then I would follow your doctors recommendations, but if the baby is still growing OK then I would try to keep LO baking longer as it is much better for LO to go to 40 weeks.I was induced at 37 weeks due to IUGR, and I think it was the best decision.nbsp; However, with my case it was a very clear cut IUGR.nbsp; DS literally stopped growing at 33 weeks, so at 37 weeks he was still measuring 33 weeks. nbsp;

This! Written so much better then mine!

TofuMama7 · November 2012

sbevmc09:

I agree. Unless there's a reason to believe the baby is actually growth restricted. That can be serious. But that's different than a small baby. I would ask more questions of your provider and find out what they're worried about, what would happen if you wait, etc.

Also, you might consider getting a second opinion. Growth restriction is serious, but it sounds like your baby is on track so... I'm not really sure what the issue is.

I completely agree with this. My baby has marginal cord insertion (her umbilical cord hooks into the side of the placenta instead of the middle) so they were monitoring me for growth restriction (which, thank God, she doesn't have - she is measuring big) Growth restriction can be serious and it can be safer to induce if the baby isn't getting the necessary nutrients, but since your baby is within normal limits I would definitely ask questions and/or get a 2nd opinion.

mistresscox · November 2012

I will tell you that after having DD with undiagnosed/unexpected IUGR the guilt that comes with it is absolutely terrible. I STILL have issues dealing with it.

With DD I had really bad hyperemesis (vomiting). Like every day I would puke 3-4 times a day, bad days I wouldn't be able to keep water down. My whole pregnancy. I told my doctor this, but apparently I wasn't vocal enough about it because he told me after the fact that he didn't realize I was *that* sick. Guess he was used to pregnant ladies complaining more than I did. When I wasn't gaining weight, that's what the nurses and the OB attributed it to-it never came up that maybe DD wasn't growing.

Anyway, when I had DD we were expecting a 9-10 lb baby, just based on how big DH and I were at birth. She came out at 5 lbs 6 ounces, full term. She was purely skin and bones-absolutely no fat on her at all. (Even typing this gets me teary eyed it was so horrible to see her the first time.)

Apparently my placenta never really attached and was extremely unhealthy. The cord was tiny and I forget how the nurse described it to me exactly, but basically looked like garbage. She told me (as a friend of mine) that it looked like someone who had gone 44 weeks pregnant....the placenta had just deteriorated and wasn't supplying DD the nutrients she needed. My OB told me the same thing basically, and said that had we known he would have recommended taking her out WAY earlier. I think as a FTM not knowing what I know now I would have fought that, but in hind sight I really wish we would have known and could have done something to help her. It feels terrible (still) knowing that I starved my baby for 9 months basically.

Now finally at 3 years old she is "catching up" size wise. She was in the less than 1 percentile for the first 2 years of her life weight wise, and I blamed all that on myself. Granted there was no way to know since I only got the 1 "big" u/s at 20 weeks and OB never said anything about measuring small (even though I was) but 1 growth ultrasound at the end could have at least given us a heads up.

This time around I'm getting monthly u/s to check on this baby. They have all been wonderful, and the last 2 the doc that does them has reassured me that the placenta looks well attached, the cord is thick and healthy looking and baby is measuring about what she should be so I'm starting to feel like they are excessive, but I can't get myself to turn them down because I still feel so traumatized over the experience with DD.

Sorry that is so long, but having gone through the guilt that goes with an IUGR baby I wouldn't wish that on anyone. If I were in your shoes I would go to the next appointment and ask about the quality of your placenta. Does it look like it is attached everywhere? (Mine was attached at less than half is what I was told.) Does the cord look thick and healthy? If any of that is a no then I would induce. If they are saying that all of that looks healthy then I would be asking a lot more questions about why they are suspecting IUGR. I'm not saying to induce or not, but go ready with lots of questions. Good luck, whatever happens!!!!

mgade001 · December 2012

I did not read all of the 26 responses prior to mine. I have some HR issues and have had to have regular u/s imaging as well. I was told that if LO was measuring small, they would do dopplers to check out cord blood flow and cerebral blood flow. If these measures were low (or some other things like fluid level), only then would they induce. I would anticipate further testing for you prior to induction. GL!

Kay1029 · December 2012

I am on the opposite end of the spectrum. At 34 weeks my LO was 5 pounds 2 ounces (estimated) with the tummy circumference coming in around the 54%tile. However, when they measured her head, she was in the 87%tile and measuring a full 3 weeks ahead. Because of the huge difference, I'm getting another scan at 36 weeks and have already discussed induction. But this is what I think is best for me and my baby. As does my doctor. Just go in with lots and lots of questions, but know that the doctors will only advise something if they think it's whats best for both your and your baby.

landosmommy · December 2012

jessrenee11:
ClaryPax:
They are looking for Inuterine Growth Restriction.nbsp; They have to do growth ultrasounds on a regular basis to track the growth.nbsp; For some reason they thought you might be a candidate for this based on your NT. You should ask them why they think you are a candidate this.nbsp; I can't believe you don't know already.Anyway IUGR can be very serious, and can cause still birth because it usually indicates a problem with the placenta.nbsp; It doesn't really sound like you are in this IUGR range yet, so the doctor is saying that if you get diagnosed with this then the standard procedure is to induce at 37 weeks to prevent your placenta from breaking down before 40 weeks and causing harm to the baby. nbsp;I don't think he is "forcing" induction on you at this point.nbsp; I think he is not explaining himself all that well, but is telling you that you might be a candidate for this, and that they will find out in the next ultrasound, and if you are a candidate this is what they recommend. nbsp;If your baby does have IUGR then I would follow your doctors recommendations, but if the baby is still growing OK then I would try to keep LO baking longer as it is much better for LO to go to 40 weeks.I was induced at 37 weeks due to IUGR, and I think it was the best decision.nbsp; However, with my case it was a very clear cut IUGR.nbsp; DS literally stopped growing at 33 weeks, so at 37 weeks he was still measuring 33 weeks. nbsp;
This! Written so much better then mine!

ugh, now I'm concerned. My fundal height was measuring small at my last appointment (not sure what the length was) but my Dr wants to do a growth U/S on Tuesday to measure LO again. At my 28 week U/S LO was measuring a week ahead, so if LO is measuring behind now, I'm going to be concerned. Tuesday can't come soon enough.

brianabrad · December 2012

Interesting thread ladies.

I'm heading in Monday for a growth scan because I'm measuring small. Measuring 31.5 and should be 34/35. My doctor doesn't tends to be very calm and relaxed and told us that most of the time baby is just fine in there and might just be a little tiny but that the scan would just make sure. He said if the scan came back with baby being truly small, concerning small, we would probably start seeing him more often and doing some NST and other test.

He didn't say anything about inducing or delivery but I'll be interested to see what he says after our scan depending on results.

WWYD: Measuring small, inducing?

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