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Measuring "small for dates"

post #1 of 12
Thread Starter 

Had my 35 week appt with the midwife in the practice that I would classify as more of a Med-wife than a midwife.  Two weeks ago I measured as 31.5 cms at 33 weeks and now this midwife is saying I am only 30 cms at 35 weeks. I found that number odd because I measured myself before the appt and then again this morning and I come up with about 34 cms.  I told her I'd be fine with an ultrasound at my appointment next week and I'd bring my records from my previous pregnancies so she could see I typically measure small for dates.  I think she measured wrong because 2 weeks ago I could still easily see my bikini line and now I can't while in the shower.  This baby is more active than my first and 2nd babies so I don't think this is some placenta issue.  I am also very petite- 5 feet tall and was only 5lbs at birth myself. I was told with DD1 that she was very tiny at the end of my pregnancy but I went a week past and she was born a healthy 6lbs 8oz. 

 

I'm just stressing about having to defend not being induced if they feel the baby is small. This is why I had a home birth with DD2.  I just couldn't afford it this time.... Obviously if there is something significant I don't want the baby to be at risk but my gut motherly instinct tells me that this baby is healthy and continuing to grow.

 

I'm waiting to hear back but I made a tentative appt with a home birth midwife for later tonight for a consult.  If I had the money this is the midwife I would have chosen for this birth. I just need to hear from someone (who isn't secretly pushing for induction) that the pregnancy looks fine.

 

Anyone else had a "small for dates" diagnosis with this or a prior pregnancy?

post #2 of 12

 

 

 

 

35-37 weeks is usually when you get the largest fundal size.  The baby starts dropping and then it will get smaller.  The midwife might want to take a look because of that.  As for measuring, it all depends on how you measure.  The most accurate measures are done by the same person throughout a pregnancy.  Often when you arent used to measuring you can catch the transverse colon and think it is the uterus.  The best way to make sure you arent doing this is to mark the hard top of the fundus with your hand during a contraction of the uterus, then wait for it to relax and measure.  You may get a different result, you may get the same one.. even if you did get the same one, it doesnt nessecarily mean that she is "wrong" it may mean that you are both measuring slightly differently.  5 weeks off would give many of the midwives Ive worked with pause for thought, especially if there was a multiple week jump and you had already been measuring small for dates.  Doesnt mean anything is "wrong", just that they'd probably suggest an ultrasound.. which it sounds like you have no problem with.  Ill be curious what the hb midwife advises you.

 

 

 

 

post #3 of 12
Thread Starter 

Yep, in looking at my records the most I ever measured was 36 cms at 38+ weeks.  I then was back down to 34 cms.  This was with both my first and 2nd pregnancy.  If they say the baby is symmetrically small than I will ask for a repeat u/s in 2 weeks to see what type of growth has happened. It would be hugely possible for me to have a genetically smaller baby considering my own stature, birth weight and DH's size.  If they find some anomaly with level of fluid or blood flow than I will have to really research and get a 2nd opinion. 

post #4 of 12

DDCC b/c this has happened to me twice.  I am also small framed/shorter and have trouble gaining weight, especially during pregnancy and have also been consistently "behind" in fundal height (usually 2-4cm) through both my pregnancies.  I gained 26 with my first and 22 with my second.  I gave birth to two healthy babies weighing 7lb1oz and 8lbs2oz.  I also had a CNM for my first pregnancy and most of my second.  They tend to get more concerned because of the protocols they have to follow for their licensure.  They usually have you do food diaries to keep track of your protein intake (which should be around 60g a day) first.  But, when you fall behind a certain amount for several weeks (usually 3-4 cm) then they must order a growth sono. 

 

Looking back at your records, did you have periods of no fundal growth followed by a leap in growth or a fallback pattern after a certain week?  If you can show your midwife your pattern, this should help quell some of her concerns.  Remember that sono's in the third tri are highly inaccurate so you can't really trust the weight estimate. But, it can help rule out other issues that could be happening with the placenta, IUGR, etc..

 

I have my own personal theory that sometimes providers do not measure correctly.  I think that with slender/smaller framed women, the baby can get way down there and make measuring accurately difficult.  It's just a theory.   Maybe I actually was that far behind.  It just seems odd to me that I could grow an 8lb baby with my uterus being 4cm too small.

 

I just want to throw out there that you may just grow babies in a different way and that way is not bad or wrong.  If you know that you're eating enough, stand up for yourself and your body.  I switched to a CPM near the end of my second pregnancy and was much happier.  She didn't even weigh me and was totally unphased by my fundal height.  I look forward to hearing how things turn out!

post #5 of 12
Thread Starter 

Jaimee- thanks for your input.  Looking at my records I just seem to be 2 cms behind from 28 weeks to about 37 weeks with both prior pregnancies and then went down and up a cm each week until the end.  I have a pretty short torso and there is just minimal space between my pubic bone and the edge of my ribs (leading to a whole lot of rib pain right now).  DD1 was 6lbs8oz at 41 wks and DD2 was 7lbs8oz at 40wks.  They were both tucked head down with their butt hugging the edge of my rib cage.  In both cases, they had pretty significant head molding and my HB midwife said that DD2 was wedged pretty far down.

 

I know that 3rd tri u/s are notorious for being way off on the weights so I am not going to stress too much about those numbers.  I just want to be sure that there aren't any obvious placental issues.  Maybe I'm wrong but I would think I would notice a drop in movement and this baby has, at least 2-3 periods of kick boxing per day in there.

post #6 of 12
Quote:
Originally Posted by KarenMT View Post

I have a pretty short torso and there is just minimal space between my pubic bone and the edge of my ribs (leading to a whole lot of rib pain right now). 


That's me, too!  Dd dislocated two of my ribs and my tailbone in my first pregnancy.  It hurt to sit and lay down.  I had my tailbone popped back into place by a MPT while I was still pregnant and she taped the rips as well.  But the ribs popped back out just a week later.  Dd had a scratch on her head from my tailbone!  With ds, my ribs dislocated again, but my tailbone was fine.  We'll see what happens this time around. 

 

So, I think that you I are are similar and that the baby is just tucked in there as best it can and measuring is difficult.  I would bet that nothing at all is wrong.  thumb.gif

 

post #7 of 12
Thread Starter 

Update: Went to the HB midwife for a consult.  I "love" this midwife and she has a wonderful reputation.  We talked and finally she had me lie down and examined me.  She felt I was a tad bit dehydrated (which is probably correct since I've been slacking on my water lately) but when she measured me she said I was just about 36 cms and fundus is above my ribs... which correlates with my own measurement and feelings of rib pain.  She said I am carrying the baby very deep and that baby was definitely a good size.  She measured me 3 times but was really baffled as to how the midwife came up with 30 cms.

 

We spoke about how I would really have liked a homebirth but financially it wasn't in the cards.  She said that if I wanted a home birth I could have one and she would allow me to pay her over time- up to 3 yrs if I needed.  Also, because it's so late in my pregnancy her normal rate is about 2/3rds of what it would typically be.  So... now I need to decide on whether to switch. 

post #8 of 12

Oh my gosh!  What great news!!!  Switch!  Switch!  Home birth is amazing and it sounds like this new midwife is a much better match.  You only birth a few times in your life- make it everything you want it to be.

post #9 of 12

awesome, mama!!!! So happy for you on so many counts (good news re: measurements, HB as a possibility, good fit with the midwife.) 
 

Quote:
Originally Posted by KarenMT View Post

Update: Went to the HB midwife for a consult.  I "love" this midwife and she has a wonderful reputation.  We talked and finally she had me lie down and examined me.  She felt I was a tad bit dehydrated (which is probably correct since I've been slacking on my water lately) but when she measured me she said I was just about 36 cms and fundus is above my ribs... which correlates with my own measurement and feelings of rib pain.  She said I am carrying the baby very deep and that baby was definitely a good size.  She measured me 3 times but was really baffled as to how the midwife came up with 30 cms.

 

We spoke about how I would really have liked a homebirth but financially it wasn't in the cards.  She said that if I wanted a home birth I could have one and she would allow me to pay her over time- up to 3 yrs if I needed.  Also, because it's so late in my pregnancy her normal rate is about 2/3rds of what it would typically be.  So... now I need to decide on whether to switch. 


 

 

post #10 of 12

Just chiming in to say Yeah!! SWITCH!! :) And that's wonderful that the other midwife confirmed what you felt you knew all along. I think it can be hard for some care providers to re-calibrate their heads to the reality that we're all individuals who carry and grow our babies based on our bodies, not on their charts!

post #11 of 12
Quote:
Originally Posted by KarenMT View Post

Update: Went to the HB midwife for a consult.  I "love" this midwife and she has a wonderful reputation.  We talked and finally she had me lie down and examined me.  She felt I was a tad bit dehydrated (which is probably correct since I've been slacking on my water lately) but when she measured me she said I was just about 36 cms and fundus is above my ribs... which correlates with my own measurement and feelings of rib pain.  She said I am carrying the baby very deep and that baby was definitely a good size.  She measured me 3 times but was really baffled as to how the midwife came up with 30 cms.

 

We spoke about how I would really have liked a homebirth but financially it wasn't in the cards.  She said that if I wanted a home birth I could have one and she would allow me to pay her over time- up to 3 yrs if I needed.  Also, because it's so late in my pregnancy her normal rate is about 2/3rds of what it would typically be.  So... now I need to decide on whether to switch. 




So glad you have options and a care provider you really like who is willing to work with you!

post #12 of 12

I'd switch, as it sounds like you'll be more comfortable and have a better experience that way :)

 

I also want to reassure you: I am short and small framed and gained about 30 lbs (I'm normally 120).  I measured small the whole third trimester, and finally they sent me for an u/s at 34 weeks.  Baby was 50th percentile for size, symmetrical growth.  I think some docs and midwives just want to make sure everything is ok.  It's a little odd yours was so concerned, though, since you have a history of measuring small (this is my first, so no history there!). 

 

Best of luck to you no matter what you decide!

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