Q for birth profs - 2 weeks without fundal height growth

[Smokering]

If I can pick the brain of MDC's midwives...

If one of your clients measured 31 weeks at 30 weeks, and 31 weeks again at 32 weeks, would you be concerned?

I'm in that situation at the moment, and my midwife's reaction seems a tad extreme to me. From my reading online it seems that fundal height growth is only accurate to within two weeks, dependent on the baby's position and so on. Also, my MW used a different tape measure the second time (my sewing one; she came for a home visit and left hers at the clinic), which she said can skew results.

Other info:

- I had a scan a few weeks back to check for a 3 times nuchal cord that had shown up at the anatomy scan (it was clear, BTW), and the baby was stated to measure at the 40th percentile. My MW said that this is according to new, fancy growth charts, which aren't spread over the population as a whole but take into account the mother's height, weight and ethnicity, and the weights of previous babies. Because DD was 8 pounds 7 at birth (born at 39+4, induced for pre-e), MW was expecting this baby to be a bit bigger.

- I can't remember offhand, but I think my fundal heights have been pretty bang-on up until now; nothing to cause MW concern, anyway. I have a long torso and tend to look smallish, but I suppose that's unrelated to fundal height?

- Baby's kicking OK. The ultrasound tech looked briefly at the placenta during the last scan, just to double-check for previa, and didn't make any comments or notes about calcification or anything abnormal; the cord also seemed fine.

- At both the 30-week and 32-week visit, the baby was vertex and (the MW was pretty sure) anterior. I guess he could still have been in slightly different positions for each measurement, but this isn't a "transverse one day, vertex the next" issue which might explain away the measurements.

Basically my MW made me book an ultrasound for tomorrow afternoon (I'll be one day shy of 33 weeks), and I'm going to see her tomorrow morning. If I've "grown" I can cancel the scan, but if not, I'll get one promptly. It seems like overkill to me. Obviously she's concerned about IUGR, but do you think that's warranted at this stage? She even admitted that it was possible the baby had had a growth spurt and then a plateau. I talked about this with the other mothers in my DDC and had decided not to worry, but she sounded all serious when I phoned her today and now I'm vaguely uneasy again.

And here I was planning to avoid ultrasound and doppler if possible. :p I don't feel as at ease with this MW as my last (who's unavailable for this birth, sadly), and I feel she was a bit over-dramatic about the nuchal cord issue I mentioned earlier, only to be all "Well, we knew it was nothing to worry about" afterwards. I'm just worried she's overcautious and will freak out during labour if anything isn't textbook, you know? But on the other hand, I don't want a ditz who ignores warning signs. :p So... opinions?

[imogenlily]

Not a midwife, but just wanted to say that this is relatively common, and not cause for worry without other concurrent issues.

[homemademomma]

Absolutely common, but possibly worth follow up just to be safe. This happened to me with my son- we had a good month with no change in FH. SO I had a growth scan, a few NSTs, and an uneventful homebirth.

I have to say- it sounds like the real issue is you aren't comfortable with your midwife!

[Jaimee]

BTDT!!  I've had two mw's (both CNM's) that freaked out about my weight and FH.  I grow unevenly.  So I'll be steadily moving forward, pause, and then spurt.  Not everyone grows babies the same way!  Yet both times, my mw's freaked out and demanded I do food journals to track my protein intake and told me if things didn't improve in the next 2 weeks I would need to go get a growth sono.  Needless to say it's always upsetting and for me, caused distrust to creep into our relationship.  If my mw couldn't trust me when I told her I AM eating enough and can't trust my body to grow a baby properly, can I trust her to be my care giver?  It was definitely a problem for me.  I also think that measuring can be inaccurate at times.  Depending on your body shape and the position of the baby, I think that it can be difficult to find the bottom of the uterus.  I am petite and managed to shove an 8lb2oz baby into my body.  He got down in there deep and way up into my ribs (where he dislocated them).  I've read other posts on here that talk about a similar occurrence.  I just don't see how I could have grown a baby that large being 4cm behind in FH.  And you're only talking about being behind 1cm!!  I know it's the "lack of growth" that is troubling to your mw, but I bet you'll have a spurt and be back on track soon.  

I'm not sure what advice to give you about your mw.  What she's doing is common, especially if she's a CNM.  So if you're happy with her otherwise, then I would say play along and try not to let it get to you.  Just maintain your trust in your own body.   If there are other things that really bother you about this mw, then I would consider switching.  I changed care providers at 37 weeks and was very happy that I did.  I found a CPM that was able to give me everything I needed/wanted.  She didn't even bother weighing me and was totally relaxed through the rest of my pregnancy and the birth.  Everything turned out great.  Good luck!  

[Smokering]

I have to say- it sounds like the real issue is you aren't comfortable with your midwife!

It's true! I mean, she's not awful - she had homebirths herself (three, I think?), loves that I breastfeed DD, is cool with cosleeping and non-vaxing, thinks it's awesome that I do my own research, and so on. She's never attended a Hypnobabies birth, but says she's really excited to do so. I just don't click with her nearly as well as I did with my previous MW (who's sadly unavailable for this birth), and I think a few times her response to things has been overly cautious, which makes me nervous that she'll freak out on me during labour.

Meh; I don't know. :/ I'm just about to go see her for a re-measure of my fundal height, so!

[Smokering]

34 weeks...

ETA: Heh, sorry, that was terse! DH was calling me. :p Yes... according to today's measurement I'm 34 weeks (I'm 33 weeks pregnant tomorrow). So... OK then. My MW cheerfully told me to cancel the scan, so that's good.

Edited by Smokering - 4/19/11 at 5:59pm

[HawaiianBlesing]

Glad it all worked out.  My friend just had a baby with the same scenario (kinda).  She consistently measured "behind" by at least 2 weeks from 32+ weeks on.  Her provider thought maybe she wasn't eating enough protein etc.  She's tall with a long torso as well.

They fully expected her to have a "small" baby.  Well all was well....she popped out an 8lb 10oz beautiful little girl!

[erigeron]

This tape measure bit is funny... I'm a knitter and the accepted advice for us is not to use a tape measure but rather a ruler, because tape measures can stretch and that makes a difference over a significant distance. Obviously you can't measure fundal height with a ruler, but considering the off measurement was taken with a different tape measure, I'd not put a lot of stock in it.

[Evergreen]

It's happening to me also. Im consistently two weeks behind, though, which they actually find less worrisome because it shows that there is some growth.  BUT my baby stays to the right and they measure in the middle which is not the largest part of my belly . I'm doing an ultrasound on the 29th (I'll be 36 weeks) just to get some measurements.