Small baby & early induction

[NiceBiscuit]

I'm currently 36 weeks with my first baby. Since 28 weeks I have had weekly doppler scans and fortnightly growth scans as baby is measuring under the 10th percentile I also had steroid injections as a precaution. After discussing with my consultant it appears that baby's head and abdomen is on the 50% but femur length is below the 10th which is showing overall as a small baby. Last scan showed if the femur length was an additional 6mm baby would be perfectly at 50%. I'm 5ft and my partner is about 5ft7 plus small babies and people run in the family.

My consultant doesn't want me to go beyond 38 wks, I'm scheduled to have a sweep at 36+5 and induction at 37+5. I doubt the sweep will work at this early stage but happy to have a go. I am concerned about early induction and need to stop listening to horror stories. Part of me wants to refuse induction and try and go naturally but feel I should be guided by the professionals and hope they are giving the correct advice. It does all seem very over cautious though, the baby doesn't appear to be iugr just short. My bp has been labile over the last trimester but all the medical appts have probably contributed to this. No other PE symptoms.

I'd be devastated if I refused intervention and something went wrong but I'm just not convinced that early induction is the right thing here. Has anyone had any similar experiences? Is there much chance of a sweep doing anything so early on?

[eurochick]

I'm in a sort of similar position. I'm 31 weeks and from 28 have been told that the baby is small. In my case, they have found the cause (poor blood flow through the placenta). Once the issue becomes too bad I am apparently facing a section, most probably at around 32-34 weeks. Have the doppler scans highlighted any issues in your case?

I'm sure I read a study that showed outcomes were not worse for IUGR babies who were monitored as opposed to induced/CS early, but I fully understand your fears.

Be aware that with an early induction you are fairly likely to end up with an EMCS or other interventions. Although a good friend of mine was induced for PE at 38 weeks and had a fairly positive birth experience.

[NiceBiscuit]

So far the blood flow and fluid volume have all been normal and baby is showing good growth along her own percentile chart but I have been warned on a weekly basis that the baby would be coming early and most likely by a section so I know we have done well by getting this far.

The eventual c section / intervention is the part that is concerning me plus friends stories who have had a horrible induction experience.

I know why they want to induce early but logically I keep thinking if the baby is small surely it's better to leave her where she is a bit longer. It would help if I saw the same consultant and could build some kind of relationship but so far I have seen 7 different ones who all seem to have differing opinions. It just seems a very over cautious approach but I have no prior experience.

Have you had the steroid injections to prepare in case of early delivery?

[ohthegoats]

Just out of interest, can you refuse induction in this situation and request a CS?

I'm likely to be in a similar situation. Dopplers have shown that one side of the placenta is good, one side less good (to simplify things without me having to go and get my notes to read the official language), and expected slow growth. I've got a growth scan on Thursday at almost 28 weeks, so well go from there, but I don't want to be induced - especially early. Would rather have a CS.

[NiceBiscuit]

I guess I could refuse induction but I haven't been given the option of a c section now that I am further along, I did express some concerns at the last appt and the consultant just asked if I had considered an epidural before the drip.

[NiceBiscuit]

ohthegoats when it was discussed that baby could be coming 28-34 weeks it was always said to be by section as it's too stressful for baby and mum to have an induction that early

[Pregnantagain7]

I've had two inductions and had really good experiences with both. I was induced for gd and spd the first induction was very straight forward pessary for 24hrs, some mild pains then waters broken followed by drip dd born about 10 hrs later I did have an epidural which was great no stitches or intervention.
Second time similar but quicker and didn't need the drip I still had an epidural because I had such a good experience the time before. Ds was huge 10lb 8 no intervention or stitches.
Induction is not always a bad experience, it looks like I'm probably going to be induced again and to be honest I'm quite happy about it. My first birth was "natural" and I actually found my inductions much more enjoyable and controlled. I also found that the midwives were much happier to give what ever pain relief I wanted. :)

[Pregnantagain7]

Oh and by the way I've lost track of how many sweeps I've had and not one has ever worked always worth a try if you're happy to but even when consultant said I was three cms and really really favourable still nothing!
Or maybe I just have cervix of steel

[NiceBiscuit]

Thanks Pregnantagain7 it's great to hear some positive induction stories as all the other stories I have heard make it sound horrendous and they almost always end in instruments or c section anyway. I'd much prefer to go naturally but it sounds like an epidural is they way to go if/when I get induced

[Northernexile]

I was told DD was going to be small, and it had weekly scans for the last few weeks. I had a sweep at 40 weeks which did nothing, then an attempted induction, which again did nothing. DD came out by EMCS in the end, and was 6lb 10oz, so not really small. CS was ok, but not what I had wanted and pretty slow recovery. I just think she wasn't ready to come out! 19 weeks now with number 2 and dearly hoping for a VBAC.

I always think I should have refused the induction, but I was too scared of something going wrong if I didn't do what I was told. It's so hard to know what to do for the best! I think if you have a clear medical reason for an early induction (which we didn't other than DD supposedly being small for dates), such as placenta issues, then it is probably best to go along with it, although I know it's probably a lot different to how you envisaged things.

Sorry for epic post!

[eurochick]

ohthegoats I've also effectively been given no choice and told that induction would be too stressful for the baby at this stage. CS would be the last thing I would ever choose. I'd go for induction every time if it were an option.

[FeelingIrie]

Hi there

I had my first baby 10 wks ago. Her slow growth was picked up at 28 wks. I too had an iffy placenta. Had lots of monitoring/dopplers/growth scans from 32 wks in the knowledge that I wouldn't go beyond 37 wks. A planned section was reccomended.

At 36 wks my consultant decided our baby would do better out than in, so to speak. She was IUGR and growth had slowed right up. I had a planned section two days later. It was a very calm, positive experience and my daughter was fine. She needed two days in SCBU to supplement feeding by tube but I established breast feeding and have recovered really well from the section. We stayed in hospital for a week and I think the enforced rest and brilliant support really helped.

After a stressful pregnancy I am so pleased that the birth, recovery, feeding etc have all been so straightforward. And my baby girl is divine! She was 4lbs 4 when she was born and seemed so tiny but has consistently put on half a pound a week since we came home so is now racing towards being a chunky 9lbs!

Good luck x

[bakingtins]

I had lots of growth scans with DD, initially due to steroid treatment in early pregnancy, then she was similar to your baby in that femurs were 5th percentile with closer to average abdomen and head. Induction was never mentioned as she was growing along the same percentiles at each scan and placental function was fine. My previous baby was small (6lb8 at 40 weeks) and history of small babies in my family. DD was born at 38 weeks, spontaneous labour, weighing 5lb9 which is just under 10th percentile for a baby of that gestation. she has short legs like many of my family!
Another factor to consider is that if your baby's birthweight is under 2.6kg (5lb10) you will go onto their hypoglycaemia/jaundice protocols which resulted in stints in SCBU for us and a 5 day hospital stay. Had DD stayed put until 40 weeks she would likely have been a pound heavier and not had her initial problems. Also being early she was slow to establish breastfeeding and took 3 weeks to regain birthweight, so whilst at 5 weeks she is gaining well she is now 0.4th percentile.
You need to weigh up likelihood of failed induction/Csection, if baby is actually IUGR or just small but growing ok, whether she'll grow more in-utero than out.
Google Bishop's score, it's a way of predicting your readiness to labour and likelihood of induction being successful. If they were saying you needed induction and it was unfavourable you could discuss elcs?

[pommedeterre]

I have had two early inductions and will have a third non October. One ended in intervention and one was spectacularly easy.

Even with the one ending in intervention I still view both as positive experiences and am glad for the medical advances we have made.

Make sure you are really well informed before it happens - getting an appointment to see an anaethetist to discuss possible medications is a good idea.

[pommedeterre]

eurochick - I agree with you on induction vs c section. Obviously if necessary of course a c section is fine but I think induction if possible is far preferable to major abdominal surgery.

[bonzo77]

Sometimes the growth seems reasonable but the baby needs to come early. I had this. It was because the placenta was failing, and if left the baby would have gradually been deprived. Sometimes the early delivery is pre-emtive. Only you can can make a final decision having assessed the risks and options.

I've been through this twice. The first time was an EMCS at my insistence after they'd tried but failed to get me into labour after 3 days. Second time was straight to CS with 2 days notice. Both times the birth was calm and I recovered quickly. 2nd time DS2 went straight to NiCU.

[KatherinaMinola]

Common sense tells me that you and your partner (at 5'0 and 5'7) would have a baby under the 10th centile - you are probably around the 0.4th centile yourself - why on earth would you have a 50th centile baby?! But I have no medical or scientific training whatsoever. I'd say get a second opinion - but it sounds as though you've had several.

[NiceBiscuit]

Thanks everyone. As far as we are aware the baby's growth isn't restricted, placenta is fine and all doppler scans normal. She just has short femur length, if her femurs were 6mm longer she would be bang on 50 percentile rather than under 10th percentile. It makes perfect sense to us that baby would be petite considering my height and also all babies in both sides of the immediate family were 6lb something at birth. But the consultants are obsessed with the graph and don't seem to apply much common sense.

I know 37w is full term but I'm concerned that taking her out before she is ready could mean an already small baby is even smaller and in need of more assistance during and after birth than if I had been left to go naturally. Consultants want her out before 38w as growth scans get more inaccurate at this late stage and they can't keep an eye on her . I feel a little powerless as though the decision has been made for us by the consultant but on the other hand this is my first baby, I have no experience and I wouldn't want to go against their advice in case the consequences are terrible. Yet I can't get the 6mm out of my head, maybe her lower leg is 6mm longer?! Baby certainly doesn't feel small to me

[bakingtins]

Could you ask about other monitoring methods if you chose not to go for early induction? Maybe going in every few days to check a CTG trace? I'm sure they can still scan to check placental blood flow at that stage too.
It strikes me that I had exactly the same findings as you but in my case they took into account that I'm small and that my previous babies and all the babies on my side of the family have been small (but perfectly formed ) and induction was never mentioned.
We would have avoided the difficult start we had with DD if she had stayed put for another fortnight and been 6lb+ like her brothers (her decision to come a bit early though!)

[KatherinaMinola]

Yes, I would ask about closer monitoring (every few days maybe) as a possible alternative to induction.

Just wanted to say also re baking's experience above:
Another factor to consider is that if your baby's birthweight is under 2.6kg (5lb10) you will go onto their hypoglycaemia/jaundice protocols which resulted in stints in SCBU for us and a 5 day hospital stay. Had DD stayed put until 40 weeks she would likely have been a pound heavier and not had her initial problems. Also being early she was slow to establish breastfeeding and took 3 weeks to regain birthweight, so whilst at 5 weeks she is gaining well she is now 0.4th percentile.

• I had a sub-2.6kg baby and did not have either of these issues - we were not put onto any special protocols possibly due to slack hospital staff and DD established breastfeeding immediately and never stopped
  
  I do think some babies are just genetically small - like their adults! (Again, disclaimer: I have no medical training).