Something seems so wrong about this

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kridda_88's picture
Joined: 01/28/08
Posts: 1798
Something seems so wrong about this

I have a friend who is just over 36 weeks pregnant and she is measuring small. She had an ultra sound done the beginning of this week and the "specialist" said the baby was perfectly healthy just small, guessing around 4 pounds. She is now taller than 5 foot and is 90 pounds soaking wet and her DH is 160 pounds and is just under 6 foot. So both on the smaller side. Between 35 and 36 weeks she was measuring 33 weeks and at her appointment today she measured 32 weeks.

Let me back track a bit. At her first appointment she was measuring big as well as baby so they moved her due date up by nearly 2 weeks and the doctor told her she would probably have a big baby and need a c-section.

Okay now the baby is measuring small and they are still leaving her due date the same rather than moving it back, where it most likely should be in the first place i'm sure, but anyways her doctor is inducing her a little before 38 weeks because he is saying the baby will grow better on the outside than the inside. Her doctor is an a$$ hole IMO and is just doing what he wants in his convenience. It just sounds far to fishy for me. You would also think that if baby was measuring smaller you would either move the date back to where it was at first or at least keep baby baking as long as possible. But nope her doc wants to get the baby out. At her appointment today they set the date for August 9th to induce and he checked her and she is dilated to a 2, so he says. I don't know if i believe a word he says. I just wish I could say more to her to get her to see but she has been so brained washed. I don't want to jeopardize our friendship either because they are really good friends of ours. IT JUST THAT THE SITUATION IS SO WRONG!!!!!

I don't know what to do. I just pray and hope all goes well and baby turns out healthy and fine. Please pray for these people. Sad

krazykat's picture
Joined: 08/11/07
Posts: 1143

Two things I know of: When the baby descends into the pelvis, it can make your fundal height measure slightly smaller, and most babies grow at the same rate up until the 20th week of pregnancy. As far as the growth rate, that is why they do dating u/s before the 20th week and typically don't move the EDD after that point b/c the bigger the baby gets, the less accurate the u/s is, and they also have spurts and slower growth periods that are different for each baby until birth.

Now, is induction the right answer? I can't tell you that. I don't know her medical history or the specific history of this pregnancy, and there are so many factors playing into the scenario that she has given you, that you have to remember you are only hearing her interpretation of what has/is happening.

It does sound a little odd, and if it were me, I would DEFINITELY be demanding a second opinion. They will definitely be in my thoughts, and I hope everything turns out for the best.

TiggersMommy's picture
Joined: 02/14/10
Posts: 6043

Her doctor's logic for inducing now (baby will grow better on the outside) seems a little off. If that's really what he said and her history doesn't suggest any other reason to induce I'd be very wary. I'm certainly no doctor, but I'd think if baby were measuring "small" then you'd want it to continue baking until it at least measured term unless there were other reasons to think the baby's health were going to be compromised. I don't know what I'd do in your situation. I think the best you can do is casually present her with some information. If she resists, you're more likely to damage your relationship than get through to her.

kridda_88's picture
Joined: 01/28/08
Posts: 1798

She has had a very healthy pregnancy so far. She was measuring right on up until 35 weeks and then she started measuring behind, that is also when she started to dilate.

The thing that gets me is right from the beginning her doctor has been coming up with "potential problems" and when one is resolved he "finds" another. I never expected her to have a big baby, generally two small parents don't = a big baby, and it's not uncommon, this being her first baby, to drop early. Which from all the evidence she has given me is the case, along with the fact that she is going to have a smaller baby anyway.

I guess I just really don't get how much trust she is putting into her doctor especially with the fact that baby is doing fine inside her and very healthy just small but the doctor wants to take the baby out because it's not growing as fast as "he" wants it to.

MrsMangoBabe's picture
Joined: 04/09/07
Posts: 2276

"Preggo_in_Tucson" wrote:

Her doctor's logic for inducing now (baby will grow better on the outside) seems a little off. If that's really what he said and her history doesn't suggest any other reason to induce I'd be very wary. I'm certainly no doctor, but I'd think if baby were measuring "small" then you'd want it to continue baking until it at least measured term unless there were other reasons to think the baby's health were going to be compromised. I don't know what I'd do in your situation. I think the best you can do is casually present her with some information. If she resists, you're more likely to damage your relationship than get through to her.

Sometimes babies experience a condition known as "intuterine growth restriction" (IUGR), which means that for some reason or another, the baby isn't growing well in the uterus. IUGR increases the risk of stillbirth, and many practitioners believe that a baby with IUGR will do better outside the womb than in. However, considering that your friend had her EDD moved earlier in her pregnancy makes me skeptical that she has IUGR. If she is really only 34 weeks now instead of 36, then she measured right on at her previous appointment and a little small this time. If her baby is really only 34 weeks developed right now, inducing her in 2 weeks from now would actually be inducing at 36 weeks, which is technically premature.

TiggersMommy's picture
Joined: 02/14/10
Posts: 6043

Isn't IUGR accompanied by additional indications such as limb lengths that don't correlate to other body measurements?

kridda_88's picture
Joined: 01/28/08
Posts: 1798

"MrsMangoBabe" wrote:

Sometimes babies experience a condition known as "intuterine growth restriction" (IUGR), which means that for some reason or another, the baby isn't growing well in the uterus. IUGR increases the risk of stillbirth, and many practitioners believe that a baby with IUGR will do better outside the womb than in. However, considering that your friend had her EDD moved earlier in her pregnancy makes me skeptical that she has IUGR. If she is really only 34 weeks now instead of 36, then she measured right on at her previous appointment and a little small this time. If her baby is really only 34 weeks developed right now, inducing her in 2 weeks from now would actually be inducing at 36 weeks, which is technically premature.

See this is one thing that has me concerned. If she was just measuring ahead at first because baby was growing a little faster than normal, at 20 weeks was measuring a little behind on u/s, and now measuring a few weeks behind, I'm wondering if she may not just be 34 weeks along now just like she had initial thought by her dates. She is too nice to question her doctor so she is just going to go along with what he is saying so no matter what she will be induced on the 9th. I just pray everything turns out okay and baby is healthy and doesn't need NICU.

Oh I also forgot to mention that from her u/s with the specialist on Monday her doctor wanted to see her 3 times a week from then on and this was her FIRST appointment sense the u/s and he is making a judgment already. Seems a little premature to me. Hopefully with in the next week the baby will grow lots and lots and they can cancel the induction.

Spacers's picture
Joined: 12/29/03
Posts: 4103

When you say "measuring ahead at first" what type of measurement did they use? Palpation could definitely be wrong by 2 weeks that early. Some uteruses (uteri?) stretch out faster, some grow more slowly, and you can't feel the baby yet, plus the baby itself is so small that 2 weeks of growth wouldn't feel much different from the outside! Fundal height isn't an accurate measurement at any time, and as a guideline for growth the "centimeter per week" doesn't start before the third trimester; before that, it's generally "out of the pelvis" by the end of the first trimester, and "at the belly button" at 20 weeks. An ultrasound done before 8 weeks is the most accurate dating measure, but the later it gets after that, the less accurate an ultrasound will be because genetics start playing. A naturally small baby can be perfectly healthy, but a small baby who is also born too early might not be! IMHO, if she's fairly sure of her dates, I would strongly encourage her to NOT allow them to induce early. Of course, I wouldn't have let them change my EDD in the first place, but that's me & not her.

Now if there is truly IUGR then that's another story, and baby might be better on the outside, but that's a completely different issue than just having a naturally small baby. IUGR requires an accurate diagnosis, which in turn requires at least two full biophysical profile ultrasounds, including Doppler cord blood supply. They should NOT be with her regular doctor, but with an ultrasound tech who is specially trained to recognize IUGR. I would encourage my friend to seek a second opinion immediately, and if the BPP findings indicate that IUGR is a possibility, they will schedule another BPP a few days later. For IUGR you usually get BPPs every other day and schedule induction immediately when baby starts dropping.

kridda_88's picture
Joined: 01/28/08
Posts: 1798

The first u/s was at 7 weeks and baby was measuring around 9 weeks. I've tried explaining all these things to her but she trusts her doctor too much. I asked her if she was sure about her dates and she said she "thinks" she was but once again trusts her doctors judgment.

As for the u/s she had on Monday, she was sent a specialist that checked everything out and just said she had a small but very healthy baby. So far they have only done one u/s with the specialist and like I said before sense her u/s with the specialist she has had one doctors appointment and at that appointment he told her he was scheduling her to be induced because baby isn't growing as fast as he wants and it will grow better on the outside. She has had 3 u/s in the pregnancy, one at 7 weeks, 20 weeks, and then the one at 36 weeks with the specialist. All have concluded a very healthy baby.

I'm scared that she is really only around 34-35 weeks right now and they are going to cause the baby to come prematurely, because their dates from the first u/s at 7 weeks said she was further along. Right now she is on cloud nine because she knows she will get to meet her baby in a little over a week. What she isn't realizing is that the baby, being small, and IMO born early, will most likely have to stay in the hospital till he weighs enough.

I will agree that if it is IUGR things will be better off if she has him sooner rather than later. But to me it just doesn't seem like that's the problem. To me it sounds more like the doctor just trying to find a problem to deliver this baby early. He never wanted her to go to the end of August. From the beginning he has been pushing her to have the baby earlier.

Spacers's picture
Joined: 12/29/03
Posts: 4103

If it were my friend, I would voice these concerns (hopefully in person) in the "I want you to have a healthy baby" kind of way. Delivering a premature baby because labor can't be stopped is one thing, forcing a baby out too early is entirely another, and IMHO it's not only dangerous, but it's unethical and medically negligent. I would strongly encourage her to get a second opinion, for the sake of her baby. And then leave it be, it's in her hands. You can lead a horse to water... Just send out good thoughts, good energy for her, say a prayer if you're inclined, and know that you did what you could.

Unless she's one of those "just get the baby out, I don't care how," kind of moms, you might also want to point out that she's a lot more likely to end up with a c-section if she induces at this point. Remind her that, if it doesn't feel right, she can always get up & leave unless she's let them break her water, and then she's on the clock, so she would be wise to avoid that.

krazykat's picture
Joined: 08/11/07
Posts: 1143

"Spacers" wrote:

If it were my friend, I would voice these concerns (hopefully in person) in the "I want you to have a healthy baby" kind of way. Delivering a premature baby because labor can't be stopped is one thing, forcing a baby out too early is entirely another, and IMHO it's not only dangerous, but it's unethical and medically negligent. I would strongly encourage her to get a second opinion, for the sake of her baby. And then leave it be, it's in her hands. You can lead a horse to water... Just send out good thoughts, good energy for her, say a prayer if you're inclined, and know that you did what you could.

Unless she's one of those "just get the baby out, I don't care how," kind of moms, you might also want to point out that she's a lot more likely to end up with a c-section if she induces at this point. Remind her that, if it doesn't feel right, she can always get up & leave unless she's let them break her water, and then she's on the clock, so she would be wise to avoid that.

I totally agree with that statement and think it is wonderful advice for you and her. Something that always helps me ease my own mind is to remember that I am likely getting a very filtered, as well as possibly very exaggerated, revision of the actual conversation that went on with the doctor, but I will never know for sure b/c I wasn't there and didn't hear it or see it with my own ears and eyes. Sometimes when stories are repeated or mulled over, facts get left out and things get added, especially if the person doesn't completely understand everything that is happening. For instance, I have seen moms go to u/s and the tech casually mentions "nice, big baby". The tech may have simply meant, a very healthy, well-nourished baby growing right on track, but the mom misinterprets it and goes home telling everyone that she's going to have to have the baby early b/c it is measuring big, and she might be induced, and on and on and on... But then when it comes down to it, and she's 39 weeks and pressing the doctor to induce, he is against it b/c there is no reason. So then the story turns to, "well, the hospital is booked, and he says he wants to wait to induce..." etc, etc. Just an example!

But like I said, she will be in my thoughts. I hope you can say what you feel you need to so this isn't weighing so heavily on you. And please KUP. I'd like to hear how everything turns out. **FINGERS CROSSED** for a healthy LO.

kridda_88's picture
Joined: 01/28/08
Posts: 1798

Well. I just finished talking to her. She has talked to several different doctors and she told me they all came to the same conclusion that baby would be better on the outside. I explained my feelings and fears for her and just let her know that i'm worried for her and baby but as long as her and her husband have honestly prayed about it, putting what everyone has told them aside, and they feel it's right then it's right. Turns out in the past week she has had 3 different u/s and has 2 more next week and some NST's as well. So far baby is doing fine he is, quote from her from her doctor, "just not growing." I really do hope baby grows a lot in the next week and a half and baby continues to look good so they don't have to induce her. I still think it sounds like her dates are off.

I ended our conversation with the last sentence of, "I'm sorry if I have caused any sort of feelings between us."

krazykat's picture
Joined: 08/11/07
Posts: 1143

*Infant loss ment.* I just spoke to a friend of mine who had IUGR to find out if she could give a better idea about the diagnosis. She was actually forced by her doctors to carry the baby to term (after begging them to induce b/c she had a "gut feeling"), and 3 days before she was scheduled for induction, she went into labor on her own and delivered a stillborn baby.

The diagnosis can be made by comparing an early u/s, to fundal height, to an u/s done in the third trimester especially when the LO is determined to be below a certain percentile for weight. So those are the only two u/s typically required. There is primary or symmetric IUGR which means all the internal organs, and the baby are small in size. BUT there is also secondary, or assymmetric IUGR, which is normally not able to be diagnosed until the third trimester. With secondary IUGR, the head and brain are normal size, but the abdomen is significantly smaller. The latter would make sense as to why your friend measured ahead before, since the head probably gave an accurate/possibly slightly ahead measurement. There are also several risk factors, including maternal weight of less than 100 lbs that seem to reinforce what the doctors are telling your friend.

Here is a very good explanation: http://www.americanpregnancy.org/pregnancycomplications/iugr.htm

To me, after reading the link, and reading about your last conversation with her, I think they are making a very good decision. Without knowing all of the facts, it definitely sounds like IUGR and the baby may very well be better off delivered, but I am no medical expert. Just my opinion...

kridda_88's picture
Joined: 01/28/08
Posts: 1798

I asked my friend if her doctor mentioned anything about IUGR and he hadn't, all he would say is that the baby is no longer growing. It may very well be IUGR and it would be the safest thing for her I will not doubt that. But as soon as I found out about IUGR I asked her about the symptoms of IUGR, knowing she had at least one u/s to check that stuff, but it's just a small baby from what she tells me. like I said before, the measurements of the baby are great, this coming from her, everything is measuring accurate but just 2-3 weeks smaller than the doctor is saying she is, that's why I question her dates.

I guess we shall see on the 9th. If it is IUGR then i'm very glad something is being done.

Joined: 08/01/10
Posts: 5

I too would be inclined to speak your HEART (not mind) about your concerns (for her and baby). You could also give her lots of resources to look into further information on the subject so that she can do her own research and it doesn't come directly from you - which might help your relationship.

I feel for you and for her. No woman should be put in a place where her care provider *may not* be giving her the best mother and baby-friendly care.

marymoonu's picture
Joined: 03/15/08
Posts: 2183

Did they measure the amount of amniotic fluid around the baby? If it is low, it could cause her to measure smaller, and if it is too low it could also be a cause for wanting to induce sooner rather than wait it out. :shrug: It does seem odd with the whole moving of the due date thing, though...

kridda_88's picture
Joined: 01/28/08
Posts: 1798

When I talked to her on the phone on Monday she said that her fluids looked good baby is looking good and healthy. He pass the NST's with flying colors, I even sent her the stuff on IUGR and she said that is not the problem. The only problem the doctors are claiming is that baby is just not growing at the rate he should be for his gestation.

Last Monday her doctor checked her and she was dilated to a 2 and she was already 85% effaced. The past week she said her contractions have increased in intensity and also frequency. She has another NST and she thinks another U/S on Thursday to look at the baby. Her doctor is planning on inducing her Monday period. She isn't going to fight it either because her doctors have her completely convinced that the baby will grow better on the outside.

I've said all i can say with out being rude so i'm just letting her make her decision with the information I gave her and just pray that her little boy is born healthy.

MrsMangoBabe's picture
Joined: 04/09/07
Posts: 2276

You did the best you could, Krista. If her cervix is favorable and she's already contracting, she is less likely to end up with a c/s for failed induction. I hope that her baby will be healthy. In my doula training, I learned about how we have to recognize that other women are coming from different persepectives than us. Some women are not at a place where they are willing to challenge their doctor. As doulas (or friends) we can share information, but women's decisions are their own. We can show them the door, but they have to walk through it themselves, and if they don't, it is not our fault. It sounds like you recognize that at this point, there isn't really anything else you can do.