Measuring Ahead?

[MrsJewelsRae]

I am 32 weeks and have been consistently measuring several cm ahead since the start. At 20 weeks I was already measuring 5 weeks ahead by fundal height, and since then it has been up to 7 cm. This is baby #3 for me, and measuring ahead is my norm. I start out slim and am average height of 5'6 and I just get BIG! I measured 3 weeks ahead with #1 and he was 7 lbs at 38 weeks (gained 50 lbs, mostly fluid due to pre e), measured up to 7-8 cm ahead with my dd and she was 8.5 lbs born on due date (gained about 60 lbs!), this time I've gained about 30 lbs so far. My ds was a hospital birth and dd was a homebirth. I ended up having to go for a consult at 36 weeks to an OB to get the ok to homebirth with such high fundal measurements and had an u/s which showed an average sized baby. My GTTs have always been excellent. Thankfully the OB was somewhat homebirth friendly and gave the ok, but he is no longer around.

So now we are planning homebirth #2 for baby #3 and the same thing is happenning. My midwife said that if I am still measuring this far ahead at my next appointment she will have to send me for a consult. I do NOT like any of the OB options I have though and it just seems backwards to have to ask an OB for permission to homebirth. I don't want my homebirth to be botched just cause I happen to carry large- it's just me and my history shows excellent outcome, dd was born in 3 pushes!

I had to go to L&D yesterday for my rhogam shot and I just shuddered being back in there after the way my first birth went. The place is dingy, prison like and totally uninvitiing, and it's the only hospital in our area. I DO NOT WANT TO BIRTH THERE ever again. But dh and I are not comfy with UC.

What am I supposed to do? Suck it in?! (only half kidding there!) I don't want an OB involved in my pregnancy or my birth, unless there is a very good reason for it, kwim. I told the midwife flat out that I was very uncomfortable at the prospect and if I had to go to one she can call ahead and tell them that they absolutely will not get me into their stirrups, I don't want their hands in me.

ETA- My fluid levels have always been normal with all babies, thus far.

[Vespertina]

Were you poly (excessive fluid) with your last two? I measured 5-6 weeks ahead consistently starting at 26 weeks with my first. I had a mild case of poly and she was LGA (9 lbs at 38 weeks).

I measured 3 weeks ahead consistently with my second and my fluid was within normal range, though the upper side. She was bigger than average but not LGA. She was 8 lbs., 9 oz at 39 weeks.

This time I'm measuring 3 weeks ahead again and my fluid is in the upper range of normal, but all is fine with the baby. I didn't have "GD" with my last two and won't be doing the GTT this time. My midwife doesn't do them, but she will have be eat a decent breakfast and check my sugar with a meter.

I know with large fundal heights excessive fluid is what many MPs tend to look for.

[MrsJewelsRae]

Forgot to mention, fluid levels have always been within normal ranges. I am supposed to go for an u/s next week to check one last time on the baby (33.5 wks)- even though they are not a reliable indicator of baby's size this far along.

[MsBlack]

I don't really get it--sounds like this is normal for you. Fundal height measurement is NOT exact science, more of a 'rule of thumb'. If this were your first baby, I might also wonder and be a bit concerned--want to rule out twins, excess fluid, etc. But you've done this every time, and it's never been a problem. I don't understand why your mw is making a big deal out of it. I have had several clients who always measured a bit larger or smaller than average--and even 7cm isn't that much really. If I have any evidence (including just their memory of events, if no records are available from prior pregnancies) that this is just their norm, I don't worry about it.

Can you ask her to waive the issue, maybe have you sign something that affirms you take responsibility for refusing the course she recommends on this issue? Something like that....

[ktmama]

Can you get a 2nd opinion from another m/w? You might also ask in the tribes section for an OB recommendation that will suit you (if you haven't already).

[MrsJewelsRae]

She always says that it's my norm and it's not likely anything to worry over since I have no history of big babies or difficult deliveries, but then she says reluctantly that she'll have to have a consult fo me due to my size, because it's not getting any better. I just read through some of the papers they give you at your first appointment, one is titled: "Indications for Mandatory Discussion, Consultation and Transfer of Care" and among the many things listed is "innapropriate uterine growth". I guess if, despite it being normal for me to measure ahead, I were to have an 10 lb baby with shoulder dystocia, I suppose she could get some heat for not having consulted with an OB about my size.... It's just frustrating, how the College of Midwives has to answer to OBs and government regulation. It's certainly better than having no midwifery options, but it's still not freedom for me and my midwife to make full informed decisions on our own....

The OB she reccomends she says is not into client stealing. I know him, VERY nice man, BUT he was the one that was on the floor when I had my son. He's the one that broke my waters against my wishes at just 3 cm (my midwife says that all the local OBs do that and it really ticks her off), he also is my SILs OB and he is talking induction for her cause she's measuring 3 weeks ahead for #2, even though her first was only 7.5 lbs at 41 weeks. : The other 2 OBs are not options at all, for various reasons I won't go into. There is one other OB who is new in town, and she can't reccomend him or not since she has not worked with him yet.

I think that if I refuse to go to the consult she will likely refuse to attend my homebirth. There is only one midwifery practice servicing a very large area here, so going to another midwife is not an option, besides I've had this midwife for all 3 children and I really love her and don't want to lose her.

I just feel like this is all so silly for all the reasons listed, and besides, I am a well informed woman and I trust my body's ability to give birth. I doubt this baby willl be over 9 lbs, but I also am confident that I could birth a 10+ pound baby, and that it should be my responsibility. I would never consider blaming my midwife for my decision to homebirth if something went wrong.

I guess I just wait for my net appointment and hope for the best, it's all I can really do. I suppose a hospital birth with midwives in charge wouldn't be as bad as my hospital birth with the OB and nurses in charge (transfer of care at 34 wks with #1 due to pre eclampsia), but to be honest I'd rather give birth UC in my van in the hospital parking lot. Actually, my last birth went so fast that the midwives made it to my house with about 10 minutes to spare before my dd came flying out, I'm 10 mins away from the hospital so there is a possibility we might UC by accident anyways! I'd much prefer the lovely peaceful supportive homebirth with my midwives again though.

Sorry for all the rambling!

[MsBlack]

WEll really....maybe UC is the way to go. I've done it myself 3 times, in the absence of midwives available. You do sound very well informed, and experienced already at giving birth....check out the unassisted birth forum here, and go to unassistedchildbirth.com (Laura Shanley's site, where you will find info from her and a link to the Bornfree UC discussion forum--great supportive informative place!)

all the best as you make your decisions.

By the way--large babies don't necessarily show a higher fundus. In fact I can't say that I've seen any correlation at all btwn fundal height and size of baby. SO many factors enter into fundal height--woman's body type and size, fluid level, baby's lie/position, how far down in the pelvis the baby descends prior to birth, state of mom's abs..... It would not occur to me that a larger-than-usual fundus points to a very large baby. Of course, feeling mom's belly with my hands would give me lots of info on the baby's size--but I can't say that fundal height really figures in, not in any frequent way. I've seen moms with large measurements (past 40cm at term) give birth to 7-8lb babies. I've seen a few woman whose fundal height never went above 34, who gave birth to 8-9lb babies. Just saying this so you don't fear UC on the basis that a large fundal measure is all about a large baby--could be, in some cases, but not 'generally'.

Just occurred to me--might your mw wait until at least 36wks before enforcing the OB visit? It is just not that unusual for fundal ht to be large early on, and then gradually sink back toward 'normal' in last weeks. Maybe if at 36wks, your fundus growth has slowed and its size is closer to the norm, your mw will be able to back off on the OB visit? just a thought.

[MrsJewelsRae]

Thanks again Mrs Black, I'm not thinking this is an overly large baby, I have friends that had totally normal fundal measurements- right on target and had 10 lb babies and moms only gained 25 lbs. I measure way bigger than them and had 7-8 lb babies while gaining double what they did. We're all so different from one to the next, right?! My dh is really against UC, but we are going to read up on it just to be prepared in case the midwives don't make it on time. Last time dh didn't call till I was in transition, I was going through those self doubt emotions and didn't think it was time yet. I know my midwife really wants to homebirth me because she remembers fondly how awesome my last homebirth was, she just wants me to call her sooner this time so she's not rushing like a mad woman to get here (40 min drive, but my 2nd midwife who also attends is only 15 minutes max). I'm just going to have to trust in her and God and let this go so I don't stress myself and raise my blood pressure to boot!

I will ask her if we can delay the consult to see if my fundal height goes down as the baby drops more.

[MsBlack]

well, good luck, strong faith, lotsa love and trust to you guys