Fundal Height Drop at End of Pregnancy?

[Mensch]

I recently switched midwives, to do a home birth. I'm in my 39th week (1st preg.) and am expecting the baby any day. The pregnancy has been without complication. I visited the midwife today. The senior midwife was attending a home birth, so I saw her assistant (a CPM herself). My checkup was fine. No protein in urine, no swollen joints, good fetal heartbeat, great blood pressure. But, apparently, my fundal height had decreased from 37 to 34. This set off bells and whistles for the midwife, who insisted that I get an ultrasound asap. The thing is, so long as my pregnancy is going well, avoiding ultrasounds has been at the top of my list. We currently don't know the baby's gender and have become impassioned about the idea of going natural and not looking at the baby on a computer screen before he/she is born. I looked online and found that many experts say it is normal for fundal height to decrease at the end of pregnancy, once the baby's head has dropped into the birth canal. Why didn't the midwife assistant come up with this explanation? She said she could feel the baby's head in the birth canal... and yet she worried about all kinds of risks (a breech birth, a uterine growth, too little amniotic fluid ...), and said we'd only know after an ultrasound. Have many of you heard about fundal height decreases when the baby drops? Maybe it's not common knowledge? I can't understand why a midwife who specializes on homebirths could be so gungho about sending me to get an ultrasound just as I'm ready to give birth, when my pregnancy has gone so well ... I've pretty much decided to refuse it. Your thoughts?

[library lady]

It is not uncommon for fundal height to fluctuate a bit. The first flag is that you saw the assistant. How much experience does she have measuring fundal height? If she uses a slightly different method of finding the public bone, then that alone could net a slightly different measurement.

The baby's position could also have in impact on the fundal height. There are so many little factors that would account for a decrease rather than an increase in fundal height and many of them are perfectly normal. If my memory is correct, I think my fundal height decreased with my last two babes once they dropped and we were at the end. They were 9'3" and 9'14" and there was absolutely nothing wrong. Fundal height alone is no reason to have an ultrasound. Unless they can give you some other really good reasons, I would decline.

[phatchristy]

Position can definitely alter the readings, also whoever is doing it can change it as well. If you're concerned, if you have a tape measure, why don't you check it yourself? I do it for myself all the time. Sometimes the mws are a cm or two off from where I measure it. But, I'm also really good at knowing where the top of my pubic bone is, they don't always do it as carefully as I do.

If your baby has dropped that too can mean a decrease in measurement. I think that happened to me with #1 here.

[Hayes]

Different people will measure fundal height in a slightly different way. It isn't ahard and fast science. With my 3rd chlid, I measured quite large, about 6 weeks ahead. Finally, at my 40 week appointment, he FINALLY went into my pelvis instead of sitting up high. My measurement went from 45cm to 39cm in the space of 2 days. There was no concern or worry, because obviously the baby had just dropped. Sounds to me like this woman is just a worrier!

[MsBlack]

Yes, baby might have dropped--and also, amniotic fluid could have decreased some, as is perfectly NORMAL for this point in pregnancy. The pp's are also correct that your measurement only varied because of a diff. person measuring--this is not at all uncommon!

I would not be seeing this as an alarm in the least, nor would I recommend a u/s to investigate. Now, if on palpation the mw/assistant seemed to feel the baby a little *too* easily (a 'shrink-wrapped' feeling), indicating that possibly amn fluid had dropped drastically, that might be cause for concern. HOwever, before recommending u/s I'd be more likely to recommend drinking more fluids, taking a couple of good tub soaks to help increase fluid level.

Before rushing off for a u/s, I'd get another opinion. Maybe drink plenty, take a good soak, and see them again for a new measurement--and be sure to ask if it seems baby has dropped, and whether or not it seems on palpation that fluid level is way too low. You may be able to discern dropping yourself--are you feeling increased pressure down low....like a melon btwn your legs? LOL Or more crampiness or pains in your groin area?

Don't worry....just keep investigating if you feel it's necessary.

[PookieMom]

Wow! Every appointment I always cross my fingers that my fundal height is lower because it means that the baby is dropping and that gets me really excited because my other two never did. Seems odd they would get so upset. That would definitely throw me for a loop. I would seek a second opinion before agreeing to anything. GL

[etoilech]

I'd want to see the midwife herself before booking any ultrasounds and/or have the assistant explain what other symptoms she is finding and why they are indicative of ultrasound use. It's totally normal to have varying measurements especially at the end of pregnancy. Fundal measurement wouldn't make me panic, without other indications.

[Mensch]

The assistant gave the senior midwife a call, and she also confirmed I should get an ultrasound because of the fundal height drop. But it was a quick phone call, interrupting the middle of a labor, so I'm not sure how thorough the conversation was. At both midwife practices I've been to, testing, measuring and looking for abnormalities has always been the sole focus. There's been no time to discuss anything else, and I feel as if they're trying to align their care too closely with OBGYN practices. Safety is important. But at the end of my pregnancy, when everything's going great, I'd like to have a relaxed discussion ... maybe about exercises I could do to make sure the baby is in the right position... and positive feedback ... supporting my excitement about the homebirth, and assuring me that I'm strong and everything will go well. Instead, last week (week 38) they did a final round of blood and urine lab tests (just in case, although recent tests were all normal), and (just because I'm a vegetarian, and have been for 20 years ... I'm extremely conscious of balancing my diet) ... a spontaneous decision was made that I'm probably not be getting enough protein, and therefore not absorbing calcium (although I feel healthy and energetic ... and told them so). So I should take high dosage (200% of recommended daily dosage) calcium-magnesium supplements. I know that my protein and calcium intake is fine, and I've read that taking too much calcium can cause headaches, dehydration and constipation. I bought the supplements, took one dosage and got a stomach ache and extremely dehydrated. So now, this week, I'm suddenly being told that I need an ultrasound. And I will need it TODAY. Because it could be dangerous for me to go into labor without having this information. Only to find out that the fundal height, which is the only basis of this judgment, is an unscientific measure that's likely to drop at the end of pregnancy anyway. I've felt healthy, calm and self-assured about my pregnancy, but every time I go to a midwife's visit, I'm given an unnecessary reason to feel alarmed. Then I become anxious and have to go home to research the topic, only to find out that there's absolutely nothing to worry about. I really don't think prenatal care should work this way.

[sunnygir1]

I totally agree with your assessment of your care based on the information you have provided.

Even with an ob/gyn, you should have time to talk about the birth, about your worries, thoughts, concerns, excitement, etc. during your prenatal visits.

I often felt like my midwives were just kind of sitting around chatting and not doing much. They were very calm, and had a hands-off approach as long as everything was going well.

I am sorry that you are having this experience, especially this late in your pregnancy. I would just encourage you to stand up for yourself and make sure that you and your birth partner are really clear about what you want for the birth so that he/she can help you to have a wonderful birth.

[nashvillemidwife]

Did I not read correctly that this assistant is a CPM, a full-fledged midwife in her own right? Everyone's responding as if she doesn't have enough experience to know what she's doing.

[etoilech]

Originally Posted by nashvillemidwife

Did I not read correctly that this assistant is a CPM, a full-fledged midwife in her own right? Everyone's responding as if she doesn't have enough experience to know what she's doing.

Even if she is a fully qualified CPM, she should explain clearly why she feels the need for an ultrasound based on fundal height measurement. Either she has a good reason for insisting for one or not, in any case she should explain it clearly to her client.

[nashvillemidwife]

Yeah, but wouldn't the same be true for any midwife? It seems people are writing off what she said because she's "just an assistant", and I don't think that's actually the case. She may be functioning in the role of an assistant in this practice, but she's still an experienced midwife.

[Mensch]

Yes, she's a CPN and she used to practice in NM, but she moved to Maryland, where her license isn't recognized. So she works under another midwife who is a CNP. I don't have a problem with her license. But she's in her early 30s and the senior midwife is in her 60s and is a trained hypnotherapist with 30 years of experience. The younger midwife seems to like technology more. Perhaps it's a generational thing. The only reason she had for wanting me to do an ultrasound was that the fundal height had dropped. She said a drop from 37 to 34 was highly unusual and she wouldn't feel comfortable unless this were further researched. She had the attitude that an ultrasound was no big deal, and didn't understand/take seriously my reasons for not wanting one. I told her that if it were high blood pressure or something like that I could understand red flags. But my belly going down a little didn't seem like a big concern ... I didn't know at the time that the fundal size could decrease when the baby drops, or that it could be measured differently by different midwives. I think she should have known this, rather than telling me that I might have some kind of uterine growth, or some other Armageddon scenario. The week before, the older midwife told me to take mega protein/calcium supplements, because she was suspicious of my being a vegetarian (without even asking about my diet, which is extremely healthy). There's way too much emphasis is on finding abnormalities, even when I have no complaints and there's no obvious reason for concern. Perhaps it's just the age we live in, the culture of fear. But I thought that the mental state (being calm, relaxed) was supposed to be extremely important for a woman who's planning a natural birth? I have enough trouble fending off the paranoid worries of my relatives, who all have mainstream ideas about pregnancy/medicine. Both both with my old midwife practice and with the new one, every time I go to an apt. I'm given some new obscure concern to worry about. It's the wrong psychology.

[wild fire child]

I think it was more that her being the assistant means she may not measure exactly the same as the MW that all the other measurements are based off of. Not that she's inexperienced, just that she's not the same person.

[etoilech]

Originally Posted by nashvillemidwife

Yeah, but wouldn't the same be true for any midwife? It seems people are writing off what she said because she's "just an assistant", and I don't think that's actually the case. She may be functioning in the role of an assistant in this practice, but she's still an experienced midwife.

Of course the same would be true for any midwife. I didn't realise that she was a midwife from the first post and it doesn't matter. I personally would want my attending midwife to be the one to make the case for the ultrasound and do the measuring. It any case it doesn't matter, if she's not making a compelling case to her client than that tells me that the OP needs more information on why she feels this way or she needs to drop it. It doesn't matter how experienced she is, if she can't convey the reasons behind needing an ultrasound at this stage. It's pretty widely known that fundal measurements can be tricky and variable especially with different providers doing them. I understand why the OP is looking for more information.

To the OP, if you are feeling that they are not listening to you, regarding your dietary intake etc... it would give me pause about how you think they would handle the birth. I would encourage you to speak frankly with them and tell them what you have said here. It would be good if you could get on the same page with them regarding what you want... if you don't tell them how you feel they can't do anything to address it. That way you would know where they stand and they would know what you want. Clearing the air would be a good thing.