Why induce if the baby is small?

[CoBabyMaker]

I was just reading a blog and the doctor wanted to induce because the baby was measuring small (both fundal height and U/S measurements). I've heard this before but don't quite understand it. As long as the baby IS growing wouldn't the womb be the safest place and shouldn't it stay in as long as needed? Can someone explain to me WHY this is done or is it just another unneeded intervention?

[sharr610]

From what I understand, there are some babies, for whatever reason, who are unable to get the nourishment they need from mama while in the womb, and, as a result, aren't able to grow well in that environment. Dr.s will induce/section the mama so that the baby can come out and start getting well nourished either in the NICU, with mama's milk, and/or both.

I'm sure its an unneeded intervention from time to time, but I do believe it can be a valid concern.

[Bokonon]

If the baby is showing signs of intrauterine growth restriction (IUGR), then sometimes it is safer to deliver, because it could mean lack of blood flow to the fetus. If there is asymmetrical IUGR (head measurement far ahead of abdominal measurement for example), that is usually a sign that there is a problem.

And it really would depend on how far along the mother was, and how severe the growth restriction.

[kltroy]

Yes ditto what the other posters have indicated. Small baby could indicate a problem with placenta function. If baby is at term or very close to it, it may be safer for the baby to be out rather than in.

[MsBlack]

Others have mentioned the theory behind induction for measuring small for gestational age (SGA). It needs to be pointed out that SGA does NOT necessarily mean Intra-uterine Growth Restriction (IUGR)....some babies are just small, no problems. But it can be very difficult to know the difference, and ultrasound late in pregnancy is famously inaccurate in predicting baby's actual weight. In the last year I've known 2 women whose docs told them 'it's safer to induce ASAP because baby is so small and could be in danger due to lack of adequate nourishment in the womb. It will be better for baby on the outside where we can help'. In both cases, the babies were more than 2lbs bigger than u/s indicated, and not at all in danger.

Luckily, both families opted to wait for labor, and had fine natural births, healthy moms and babies

Fundal height is not a reliable measurement, by the way. I've seen women who never got past 34 centimeters fundal height, go on to have 8lb babies. I've seen women measuring several cms large, go on to have average size babies (7ish pounds). Many factors influence fundal height measurements--including mom's height and build, amount of amniotic fluid, other... I would trust the manual palpation estimation of someone with experience in guesstimating growth and size of babies this way, FAR more than I would trust fundal height combined with u/s results.

We are in the middle of an induction epidemic, fueled by doc's increasing fear of lawsuits. I am very skeptical of all these 'need to induce' theories currently proliferating.

[COgirl19]

Sorry, this is kind of long. I was induced at 38 weeks with DD1 for intrauterine growth restriction. Looking back, I think it was completely unnecessary. They kind of scared me into it (first time mom, DH away a lot with the Navy, ect.). But here are some things specific to my situation why I think it was unnecessary now:

1. Fluid levels were perfect.
2. Placenta was fine
3. DD passed every BPP and NST with flying colors

That said, she was born at 5 lbs 7 oz. and her head was a little ahead growth wise. HOWEVER - I think that had more to do with genetics. DH's family has always head larger than normal or top of the growth curve heads. DH even got picked on in the Navy because his uniform hats never fit right, even in extra large. They don't LOOK different from anyone else but it's just the way they are. Also, both DH and I were small babies, 6 lbs and under and are not big people to begin with. So I think in MY situation, this was unnecessary and I am NOT going to induce this time with DD2 unless she actually starts failing BPPs or NSTs or something else.

Another factor was this OB practice was VERY intervention heavy (typical with military insurance). They induced EVERY mother by 40 weeks regardless of her situation because they were convinced it wasn't "safe" to go past 40 weeks. They would also C-section at the drop of a hat. NO VBACS at all either.

So yes I DO think IGR can occur and be a real problem for some women but I think it is over-diagnosed and a lot of other factors should be taken into account including the BPPs and NSTs, genetics and family history, and how prone the OB practice is to intervention anyway. FWIW, I also known a couple people who were induced for IGR and they ended up having 7 lb babies, U/S was totally off.

[curvyred]

I'm in this boat at the moment, with babe being suspected of having IUGR due to asymmetrical growth (head is in the 40-something percentile, leg and abdominal measurements in the 6th and 10th percentiles and blood flow in brain potentially showing signs of brain sparing.)

Until yesterday I was seeing midwives with a planned birth center birth. They consulted with my doc (family doc who does OB) and she in turn consulted with an OB whom she believes is fairly low-intervention. The OB said I need to transfer to OB care.

SO . . . I'll be curious to see how this plays out!

But yeah--if they truly aren't growing inside, then they're better out where we know they're getting oxygen and food. Determining what's actually happening is the hard part. I believe that asymmetrical growth is statistically a bigger deal and a bigger red flag than a symmetrically SGA (Small for Gestational Age) baby because a certain number of "SGA" babes are just genetically destined to be small.

[CoBabyMaker]

Thank you all for shedding some light on this for me. I can certainly see where it would be important. I guess my initial concern is what MsBlack talked about, just that SO MANY docs seem so intervention-happy. Then you end up with a frustrating situation like COgirl19 talked about. I guess that's just it, we can't know everything that is going on in our wombs and sometimes there are hard calls to make.
CurvyRed, I hope that everything goes well for you and your little one.

[curvyred]

Originally Posted by COgirl19

That said, she was born at 5 lbs 7 oz. and her head was a little ahead growth wise.

Just curious COgirl, how much ahead is "a little ahead?" Did you have doppler readings that indicated brain sparing as well, or just size discrepancy?

[COgirl19]

Originally Posted by curvyred

Just curious COgirl, how much ahead is "a little ahead?" Did you have doppler readings that indicated brain sparing as well, or just size discrepancy?

The head was right on track for gestational age, the abdomen was a week or 2 behind. It was growing, just lagging behind the head. No signs of brain sparing or anything, blood flow, BPPs, NSTs and ultrasounds showed everything was otherwise normal. Her head pretty much stayed in the >90% percentile until she was two with the rest of her measurements at 50% or so. That has been exactly DH's pattern growth. Both are very normal, healthy intelligent people so it really seems like a genetic thing to me.

[curvyred]

Originally Posted by COgirl19

The head was right on track for gestational age, the abdomen was a week or 2 behind. It was growing, just lagging behind the head. No signs of brain sparing or anything, blood flow, BPPs, NSTs and ultrasounds showed everything was otherwise normal. Her head pretty much stayed in the >90% percentile until she was two with the rest of her measurements at 50% or so. That has been exactly DH's pattern growth. Both are very normal, healthy intelligent people so it really seems like a genetic thing to me.

Ah, I can see how that would make you wonder then. I don't know in terms of weeks for me, more percentiles, but little guy's brain doppler readings are also indicating brain sparing, so it's a bit different.

My oldest son (not bio) had a huge head too. He was average size when born (7lb4oz) but his head was literally hovered above the charts until he was like a year.

[AlexisT]

The other thing I was told is that a baby who is small, but has a consistent growth curve, is less concerning than a baby who starts dropping down the percentiles.

[curvyred]

The other thing I was told is that a baby who is small, but has a consistent growth curve, is less concerning than a baby who starts dropping down the percentiles.

Well, I haven't had any other ultrasounds, so we don't have anything to compare to since 18 weeks (when he was measuring right on.) With the variability in US as high as it is right now, not sure how much I'd trust a comparison a week apart.

Somebody on another thread posted a link to an article done in the Netherlands showing that, for babies diagnosed after 36 weeks, monitoring and waiting for labor had comparable outcomes in APGAR scores and NICU admissions compared to induction. Something to discuss when I have my appointment Thursday.

[AlexisT]

I probably would be skeptical at this point as well--I assume they were talking about women who got regular growth ultrasounds for whatever reason. If you've been doing them regularly from early enough, I would think the curve would be easier to plot and more reliable.

[curvyred]

Originally Posted by AlexisT

I probably would be skeptical at this point as well--I assume they were talking about women who got regular growth ultrasounds for whatever reason. If you've been doing them regularly from early enough, I would think the curve would be easier to plot and more reliable.

I know fundal measurements aren't the greatest, but those did track for me very consistently until 30 weeks, then stopped for six weeks.

I actually got to see the radiology report today and both umbilical cord blood flow AND blood flow in the brain were outside normal limits. At this point, I'm satisfied that we're outside the norm but it doesn't matter because I officially risk out of the birth center.

I got a referral to an OB that my midwives love (downside is she's at a hospital an hour from home instead of 30 minutes) so we'll see.

[nia82]

I know this is an old thread... So My fundal height last week was at 35 (36 weeks into pregnancy), this week at 33... The midwife wasn't too concerned but recommended an ultrasound next week. She said it might be the way baby is balled up down low. I mean I never get stomach kicks from this baby! By palpating she guesstimated 6lbs (I'm 37w5d today).... What do you all think? From experiences? The biggest baby in my family born at 40 weeks and some change weighed 6lb 6 oz, DS weighed 5lb 10oz at birth (37w2d). I'm not sure whether I should be concerned or not... And for the ultrasound, I don't care about her guesstimated weight, but just to see if placenta, fluids and stuff are normal. the midwife did ask whether I had been leaking, but definitely nope.

[HariB]

Many moms start to lose some amniotic fluid late in pregnancy--I mean, less gets made, not that you're leaking.  This is normal for many.  If you add to this, a baby who is scrunched down low (possibly engaged or nearly so), then you can get a low fundal height reading.  At this stage, especially if the baby's guesstimated weight is 6lbs, I wouldn't worry if it were me.  Fundal height is really not an accurate predictor of anything, by itself--especially early on, and very late in pregnancy like you are.