fundal height measurements

[Chinese Pistache]

If you've got a moment to answer, I'm curious. . .

How much stock do you put in fundal height measurements?

Are they more or less important to you based on how far along a woman is?

What variations are "normal" for you and which would you consider a problem (as in, how far would the measurement have to deviate from the number of weeks)?

How much of fundal height do you attribute to the baby's position, as opposed to the baby's growth?

Thanks for you insight

[Defenestrator]

I don't do fundal height measurements any more unless I am concerned about one of two things -- IUGR or polyhydramnios. In either case I hardly ever do them until right before the third trimester.

So much can affect them -- how short or tall a mom is, the position of the baby, how engaged the baby is, etc. That and they tend to freak moms out when they are above average.

[veg_goddess]

that is so comforting to hear. i am a student midwife who worked with a midwife who was incredibly anal about fundal height and there were a few times where she sent women for ultrasounds and to doctors because it didn't match up and everything ended up being normal except that these women didn't get the births they wanted.

[Carolinamidwife]

I put stock in them but not so much as to get real crazy about it. I mean, one woman was measuring 7-8 ahead and I thought that was a lot; she went on to have a 12 pound shoulder dystocia. So I guess I might say it would depend on a few other factors but that I do consider it worth noting when it seriously deviates, as in more than 4cm.

[BetsyS]

I think the pattern of fundal heights can be useful. Like, if someone always measures right on, then one week suddenly measures 6 cm ahead. I think it's worth figuring out what's going on. Has the baby's position suddenly changed? Or is it poly or something else? Likewise if the fundal height was measuring right on, then is 1 cm behind, then 2-3 cm behind, then 4 cm behind. At that point, I'm curious to know what is going on.

[majikfaerie]

I don't think there's too much reason to freak if a woman "deviates from the norm", but i do take sporadic measurements, just to see that there's no sudden increase or decrease in the rate of growth, which could indicate IUGR or polyhydramnios.
to get a good idea of this, I don't even bother with a tape measure, most of the time; you can use a piece of string (the same one for each mother) and just mark it at regular intervals.

[Carolinamidwife]

But don't you think taking "sporadic measurements" would be a poor way of monitoring deviations from the norm? You would need regular samples to measure a growth curve, no?

[majikfaerie]

when I said "sporadic" I meant more over my whole practice, than to an individual mama. some women are fine and healthy, and want a very 'hands-off' approach. those mamas, I would measure maybe once to get a base-line, but only if I suspected something was up. then we might do a weekly measurement, to see how she's growing.
for women who like to take measurements, I might do it every pre-natal, or every second one, depending on frequency and how the mama is doing.

and I'm not looking really for deviations from the norm, but to see how the mama's individual rate of growth looks over time. you can get an idea of that even without lots of measurements.

[Defenestrator]

I expect that midwives who have a high volume would need to do more objective measurement than I do. I see only about 20 women a year -- I can remember what their babies felt like from visit to visit.

What value is there in knowing that a baby is bigger than average at term? Inducing babies early for macrosomia is absolutely not evidence based. I would only send a baby for a c-section for size if it were unable to descend into the pelvis and I don't need fundal heights to tell that (and would also expect it to be very rare).

I have to say, though, that if you can't tell that there is polyhydramnios without measuring fundal height, then you need to practice palpation more. Once you establish that there is polyhydramnios, fundal height measurement can show the impact of any treatment, but I don't think it is more valuable than palpation for diagnosing it in the first place.