Fundal Height measuring small

[Nutter]

Is it ok if I vent a little?  Because I am a doula, and my family/friends all have pretty strong opinions on birth things I didn't really feel comfortable laying it all out there with anyone irl. 

At my 20 week appointment, my fundal height measurement was 19 cm.

At my 24 week appointment, my fundal height measurement was 21cm.

My midwife has said that this indicates I am "small for dates", and that if it doesn't get closer to 'normal' by the next appointment then they will probably recommend an ultrasound for further screening.  However, she also commented that I have very strong abdominal muscles which can cause a smaller measurement.  The reading I've done so far indicates that being of short stature (I'm 5'3") can cause a smaller measurement too.  I've also found varying guidelines which say that 1cm is acceptable variance, 2cm, or even up to 3cm is acceptable variance.  Knowing that in some circles it's allowable to be 3cm different in your measurement than you are weeks pregnant; that I am on the short side; that I do have excellent abdominal muscles... makes me feel like going for an ultrasound if I'm still measuring 1-3cm small isn't worth the stress.  I'm inclined to decline the further screening under those circumstances.

I know for those of you who aren't opposed to ultrasounds this wouldn't likely be *so* big a deal, but that's not the camp I'm in.  I've done my research - I don't need links on ultrasound benefits/safety, or stories of how ultrasound saved a baby's life.... I work in the birth field and am well aware of the information on both sides.  My choice is to avoid ultrasounds unless I am faced with both a compelling medical reason to expose my baby to what I consider untested technology AND my own intuition tells me it is the right thing to do.  (I know not everybody believes in the concept of intuition and people define it in many ways)

I know that it isn't likely as simple as one quick ultrasound either.  It is an extensive (full anatomy scan to check for heart, kidney or other defects, and to check for placenta issues) ultrasound which can take quite a long time. And if I don't get measurements they like (measurements which may or may not even be accurate!), then I am facing ultrasounds every couple weeks, non-stress tests, and OB consults.... I am NOT a fan of any of that....!

I guess the other piece of the equation is that my appointment was immediately after (ie left the hospital from a birth at 12:30pm, drove 30 min home to change & grab my binder, then drove 30 min to my appt) I had attended a marathon birth as a doula, and there was a good chance I was dehydrated (which could affect amniotic fluid volume & hence my measurement)

I know it is still 4 weeks away and the best thing I can do at this point is eat really well, take my prenatal vitamins & essential fatty acids every day, and drink plenty of fluids. I don't know that I believe in the importance of prenatal vitamins for that matter (folic acid is a different story) but I don't think a good quality vitamin is *likely* to cause harm, so I'll start being more diligent about those. And I will drink more water.  Every day.

So there's my story.  I just needed to get it off my chest in a place where nobody 'knows' me.  Thanks.

[MamaChef]

Nutter, is this your first baby?  What is a normal variance in a multip pregnancy is different in a first time pregnancy.. not saying that is the case for you, but just something to keep in mind that may help you to understand your midwife's suggestion a bit more.

Is it the same person taking your measurements each time?  Do you know how baby was laying?  Are you getting alot of low pressure that makes you believe baby is far down in your pelvis?  Have you mapped your pelvis?  Do you feel you have a high pubic arch?  All of those questions may help you make a decision that feels more empowered for you.

That being said, in your research, where is your comfort level?  If you go back in 4 weeks and you are still 3 weeks off after doing everything you outlined, not coming off a birth, etc.. what would your educated opinion be?  If it is even more of a discrepency, where would you feel comfortable with taking a look via US?  That way, you can tell your midwife, that you have done your research and until you see a x cm deficit you want to wait because your research has shown that is a reasonable approach. 

Hope venting some helped get out some of the stress and that your next appt measurements make this a nonissue.

[Nutter]

Thanks so much MamaChef. (hugs)

This is my first pregnancy.  My first two measurements have been taken by the same midwife, and they match the measurements I took myself at home as well.  Based on where she found the hb with the fetascope and where I was feeling bumps and thumps from baby, I would say that the baby was laying transverse at the time.  Now that you mention it, the day I measured I believe baby was transverse as well. Next time I believe baby is lying head down (which is most of the time) I'll be sure to grab my tape measure and see what #'s I get.

I haven't mapped my pelvis yet (just starting the Pink Kit this week) but a high pubic arch isn't something I had considered as a factor - thanks for reminding me.  I'll definitely map myself out sooner than later!

Thank you again.  Just writing it all out here helped, and your questions/information have given me some specific directions to explore.

[WeAreAllOne430]

Let it all out mama..that's what we're here for...to support and honor your choices

With that being said, I wouldn't worry about the fundal height at all.

I just had my midwife appt this afternoon..I am 22wks but only measuring 19wks.  My midwife was not concerned in the least bit (it was me who raised questions about it).  She assured me that every woman is different and their bodies grow differently and at different rates.

As long as you feel you are taking in adequate nutrition, what more can you do?  It sounds like you are on top of everything mama...take a deep breath, exhale, and know that all is well

[KarenMT]

Don't worry about venting in the least.  I would be just as worried.  I think your midwife is really just erring on the side of caution and trying to do her best to ensure that you and the baby are healthy.  I am very petite (5feet) and am usually just about measureing where I should.  But, with both of my prior two pregnancies my fundal height began to be slightly behind around the 8th month.  I also did research and my midwife agreed that really petite women do sort of top out at a certain height or, have a slightly lower height.  In all honestly, there is just no way I have any space left by the end of pregnancy- LOL.  It sounds like you are consistently growing so maybe this is just your pattern of growth.  Since this is your first they have nothing to base it on but general stats. 

I am sure that baby is quite fine and your midwife will know when to tell you if she really feels an u/s is warranted.

[DaisyMay]

Not sure if this is relevant in your case, but I've heard that ethnicity can can have a part to play in baby's size.  My cousin is Scottish and tiny (5 ft 0) and her husband is Mexican and with her first baby they referred her for loads of late ultrasounds due to  concerns about the baby measuring small.  Whenever she got to the ultrasound the technicians rolled their eyes and said that babies with a non-white parent often measured small and the doctors/midwives never seemed to take this into consideration and it really wasn't a problem warranting further investigation.  She had her baby late and she was pretty small but not worryingly so or surprisingly so considering that both of her parents are small and no health problems after birth.