Update in post #23 - Uterine growth in late pregnancy question...

[StaceyinLA]

So dd's due date has been all over the place. Follow me on this if you will, because she wants opinions about her situation before her appt. tomorrow.

 

Based on her last period, her due date is December 10th.

 

Based on her earliest ultrasound (which was around 15 weeks - for gender), she is due around the 15th. Based on her 18ish week ultrasound (which was supposed to be the big scan), her due date is December 23rd, and finally, based on one they did after she got to Louisiana (since her dates were so crazy), she's due the 27th.

 

That is, IMO, and dd's, a large discrepancy. She found out she was pg about a week after her period was due, and had been suspicious for a week or so. Even though she was nursing dgs, she had already cycled several times and the cycles were normal. They were easily able to determine gender at the 15 week gender u/s, where the lady basically told her she seemed more like 14+2-3. Still, with a 17 day difference in projected dates, she would've been less than 13 weeks at that point if their latest projections are accurate.

 

But here is the real issue; all along they have been measuring her and telling her that the growth was right on track, even though the dates keep changing. Last week though, she measured 31-32 cm. By her lmp dates, that put her 5-6 cm behind. At her latest possible date of 12/27, she would be 3-4 behind.

 

Up until now, she has not, as far as we know, measured small, even when they were going by the original lmp date.

 

They are doing a visit tomorrow, and she will have another ultrasound. Baby movement is fine, and the heart rate was good, etc. The midwife was not overly concerned.

 

Our biggest concern is that with such a big span of dates, ESP with her thinking she is more accurate in her dates than the ultrasounds, she won't really know at what point she should become concerned that she really is getting to be very overdue.

 

She is planning a water birth, so obviously avoiding intervention is great, but at the same time, she wants the baby safe also.

 

They are thinking she is pushing the issue because she wants baby to come sooner, etc. Obviously we know baby will come when ready; dd just doesn't want to be foolish either.

 

What does the hive think? Wwyd?

[Crimson Wife]

I measured "behind" with all 3 of my kids even though I knew exactly when they were conceived because I did NFP charting. My babies were 6#10 at 41 weeks, 5#12 at 39 weeks, and 6#4 at 41 weeks. I just don't grow very big babies.

[Forget-Me-Not]

Those measurements are SO subjective and they vary a lot after 20wks. Just last week, my care provider measured me twice and got two different measurements. A lot can depend on how the baby is positioned.

 

If she's very sure of her LMP, that's the most accurate date you have now, especially since her 15 wk ultrasound aligns with that w/in a week. The later you get into pg the more inaccurate ultrasound dating becomes.

[StaceyinLA]

Well, we have certainly considered that. That is what makes her feel like her ultrasound dates are inaccurate, which, in turn makes her think she could be as much as 6 cm behind. Her first baby was 7#5oz. She HAS nursed through her entire pg, which I'm thinking could be slowing the growth a little, although she eats A LOT, and has had a good weight gain (a little over 30 pounds at this point).

 

I guess she is just worried that they won't be concerned at ALL until she is coming up on the 27th, and she is thinking that will be about 2 weeks late already. Obviously she is thrilled she has a non-interventive group of midwives, but at the same time, she doesn't want them to be too nonchalant when she feels so sure about her dates.

[Starr]

My unscientific experience is that most woman are correct by dates.

[A.Balaban]

Did the midwives actually change her due date? That is interesting... It is more likely that the growth of the baby is changing then the age of the baby. LOL.

 

I would assume that the first one is the most accurate, based on her actual LMP rather than the size of the baby. Unless she is unsure of her LMP then I would go with that one...

 

Have you checked a fundal chart online? For what I am seeing, 31-32 cm seems to be adequate?? Fundal height is not always a good marker for baby growth, fwiw, my fundal height was always within acceptable range (but small side) and my babies had growth issues.

[SJ.]

Personally I would take the latest date and go with it hoping to postpone impatient doctors wanting to induce. At the end of the pregnancy you go at least once a week to see the dr. which makes me comfortable, even with a late baby.

[lifesadream83]

Our doctor said that the early ultrasounds are the most accurate. Ones prior to 10 weeks are best. After that kids tend to take on their own size and structure that is unique to them. Just as an FYI I was 40 weeks on Friday and my fundal height was 37.5 so its going to be off this late in the pregnancy. I think you should go with a cross between the first ultrasound and lmp. Not to mention you should take into account how and when she found out she was pregnant and see if pushing her due date to the 27th is even realistic... would she have known when she took the test if she wasn't due until the 27th?

[staceyobu]

Her lmp date will be the most accurate. Especially if she is confident on the dates of her period. Second to that is the earliest ultrasound. Which, with a five day difference is close enough.

 

I'm confused at why they are changing the dates based on late ultrasounds? At what point would they be concerned that the baby is not growing? You don't change dates based on late ultrasounds. Is it a midwife that is changing the dates?

[StaceyinLA]

If she's very sure of her LMP, that's the most accurate date you have now, especially since her 15 wk ultrasound aligns with that w/in a week. The later you get into pg the more inaccurate ultrasound dating becomes.

 

This is kinda what we are thinking, and I think that is why she was wondering if she should be concerned about the uterine growth since that puts her about 5 - 6 cm behind.

[StaceyinLA]

Did the midwives actually change her due date? That is interesting... It is more likely that the growth of the baby is changing then the age of the baby. LOL.

 

I would assume that the first one is the most accurate, based on her actual LMP rather than the size of the baby. Unless she is unsure of her LMP then I would go with that one...

 

Have you checked a fundal chart online? For what I am seeing, 31-32 cm seems to be adequate?? Fundal height is not always a good marker for baby growth, fwiw, my fundal height was always within acceptable range (but small side) and my babies had growth issues.

 

Yes. It has actually been all midwives that have pushed her dates back; first in Hawaii, then here.

 

She is very sure of her lmp.

[Hypatia.]

I would be wary of changing dates based on ultrasounds that weren't done early. Fundal height can vary a lot too, mine is 38 and I'm about 34 weeks. But instead of worrying about going overdue I would be worried about being pressured into an induction before the babe was ready.

[StaceyinLA]

Personally I would take the latest date and go with it hoping to postpone impatient doctors wanting to induce. At the end of the pregnancy you go at least once a week to see the dr. which makes me comfortable, even with a late baby.

 

Well, we are dealing with midwives in a group that doesn't even consider induction until at least a week past due date. If she is really due 17 days before they think she is, that could certainly become a safety issue for the baby.

[StaceyinLA]

Our doctor said that the early ultrasounds are the most accurate. Ones prior to 10 weeks are best. After that kids tend to take on their own size and structure that is unique to them. Just as an FYI I was 40 weeks on Friday and my fundal height was 37.5 so its going to be off this late in the pregnancy. I think you should go with a cross between the first ultrasound and lmp. Not to mention you should take into account how and when she found out she was pregnant and see if pushing her due date to the 27th is even realistic... would she have known when she took the test if she wasn't due until the 27th?

 

Well, she's frustrated because the reason she didn't have an early u/s is because she was sure of her lmp dates and they said no need, then they go and change her dates to 2 weeks later at 18-19 weeks! It's SO ridiculous!

 

The cross between the lmp and first u/s puts her due around the 13th. It would put her around 5-6 cm behind in fundal height. The date makes the most sense for sure, but with that much difference in fundal height, should she be concerned?

 

And yeah, the testing should certainly not have been positive if she was as late as they are saying. It just makes no sense.

[StaceyinLA]

Her lmp date will be the most accurate. Especially if she is confident on the dates of her period. Second to that is the earliest ultrasound. Which, with a five day difference is close enough.

 

I'm confused at why they are changing the dates based on late ultrasounds? At what point would they be concerned that the baby is not growing? You don't change dates based on late ultrasounds. Is it a midwife that is changing the dates?

 

You hit the nail on the head here! That's what we have asked! And yes, it is midwives changing the dates.

[StaceyinLA]

I would be wary of changing dates based on ultrasounds that weren't done early. Fundal height can vary a lot too, mine is 38 and I'm about 34 weeks. But instead of worrying about going overdue I would be worried about being pressured into an induction before the babe was ready.

 

Yeah, we know this, but the group she's in isn't going to push for induction. They don't. Period. She just doesn't want them to miss something because they are thinking she's due 17 days later than she really is...

[StaceyinLA]

Also, sorry for all the quotes and separate posts. I don't know how to quote multiple quotes in one post.

[misty.warden]

My very non-scientific belief is that doctors and midwives tend to make the measurements fit their theory of how pregnant you are rather than actually listening to the mother, who in this case definitely seems to know her cycles and when the baby-making happened, KWIM? If your dd is confident about her lmp and isn't worried about her midwife pushing for induction I'd ignore the weird dates and let her listen to her body. Measurement of babies is a sticky thing, especially when done over several weeks by multiple different people and from ultrasound images and touch.

[busymama7]

The biggest concern I see from your posts is that your daughter has a care provider(s) that doesn't listen to HER. Dates don't mean anything but a midwife worth anything is going to listen to a mom who has concerns about her baby's well being.

 

I think your daughter should focus on how she feels, how baby seems to her and not on her dates. She is unlikely to go that late anyways but if she gets concerned for baby's well being she needs to make herself heard. She will have options available to her if she go late enough to be a concern for baby's health.

 

But, she also needs to trust her body and her baby to know what they are doing. Yes, rarely, very rarely, going late will cause issues. But the vast majority of the time mom and baby are not just fine, but perfect because they went into labor together at the perfect time. She needs to really focus on that and on her own sense of her baby.

[GWOB]

I'm going to introduce a different angle. How tall is your dd? I'm only 5'2". I always measured way over wrt fundal height. I just carry my babies way, way out in front. If your dd is taller, the midwives may just be messing up their measurements. I always advocated for dating pregnancies based on lmp. I can set an atomic clock by my TOM. I knew exactly when I got pregnant. Tell your dd to speak up and speak loudly. I know how hard this is in Louisiana. I'm from Louisiana and would never voluntarily have a baby there. The childbirth culture is way behind the times. Help your dd be an advocate for her baby. It will be necessary in Louisiana.

[redheadmom]

With my dd I always measured small. When I was 40 weeks I was only measuring around 31 wks. They were very sure she would be 3 or 4 pounds. However, they never changed my due date. I went into labor 4 days after my due date, and she was 7lbs 4oz. Don't read much into those measurements. I have always heard that ultrasounds before 20 weeks are more accurate. I think once you get past the 18th I would be worried about amniotic fluid levels. Good luck.

[LMA]

I don't put a lot of stock in the ultrasounds or doctor measurements. My first one was born at 36 weeks due to pre-eclampsia and they claimed the ultrasound had him at 6 pounds. He was 4 1/2 pounds. I measured "small" with my third son one week before my c-section. They wanted an ultrasound, but I declined. He was my largest - 8 lb, 5 oz.

[StaceyinLA]

Well, dd had an appt today, and an ultrasound. They are "guesstimating" baby's size at appx 6 lbs, but do feel like there is an assymetrical growth restriction. Her stomach is measuring smaller (as in a couple weeks behind) her head for her dates. They said this is somewhat normal if the baby is not getting as much as it needs from the placenta, but, since her growth is within normal ranges, they don't feel as of now that they need to jump the gun to do anything drastic.

 

Dd's fundal height was larger than last week, so there is some growth there, her fluid levels were really good, and the placenta looked good. Baby is active and moving regularly, though she had a somewhat sluggish day yesterday. Today she has been active.

 

Dd is to keep close track of movement, and if there is any change, she will go in for monitoring. They will see her again next week, and the following week they will do another u/s if she hasn't delivered. At that point, if there hasn't been reasonable growth, they will consider induction. They did say they will try some non-drug things first if it comes to that, starting with least interventive and going from there.

 

I'm pleased they aren't jumping the gun because I know what dd is hoping for with her birth, but the mother hen in me wants that baby out in dd's arms so we will know all is well. I just feel like we are walking a fine line between waiting it out, and deciding when it might be necessary to step in.

 

Prayers would be appreciated!

[phathui5]

I would go with the date from the earliest ultrasound. Ultrasound measurements get less and less reliable the further along you are.

[StaceyinLA]

That's kind of where we are right now, but she had an appt today and I updated in the post before yours. I see you are an apprentice midwife and doula. Would you mind giving me your thoughts on my info in post #23?

[gardenmom5]

they do due dates by size. what they *don't* tell you is that they can be off by a full pound or more (consider - that is MORE than 10% of the baby's size).

 

I would go by the earlier US as they are looking at more than size, but also at development. the fact they keep pushing the due date back might indicate a problem with the baby's growth.

[MFA323]

My fundal heights were always really low at the end. They would be within a centimeter or two of normal until around 36 weeks. All three stopped increasing around then and actually went down a little around 36-37 weeks. I could tell that the babies were still growing based on my discomfort and the way my clothes fit. They were just sitting lower. With my second baby my fundal height was 34 at 40 weeks and a few days. She was born a few days later at 7#13.

I think that her initial dating based on her LMP is more accurate. I would expect the baby to make an appearance fairly soon.

[A.Balaban]

Well, dd had an appt today, and an ultrasound. They are "guesstimating" baby's size at appx 6 lbs, but do feel like there is an assymetrical growth restriction. Her stomach is measuring smaller (as in a couple weeks behind) her head for her dates. They said this is somewhat normal if the baby is not getting as much as it needs from the placenta, but, since her growth is within normal ranges, they don't feel as of now that they need to jump the gun to do anything drastic.

 

Dd's fundal height was larger than last week, so there is some growth there, her fluid levels were really good, and the placenta looked good. Baby is active and moving regularly, though she had a somewhat sluggish day yesterday. Today she has been active.

 

Dd is to keep close track of movement, and if there is any change, she will go in for monitoring. They will see her again next week, and the following week they will do another u/s if she hasn't delivered. At that point, if there hasn't been reasonable growth, they will consider induction. They did say they will try some non-drug things first if it comes to that, starting with least interventive and going from there.

 

I'm pleased they aren't jumping the gun because I know what dd is hoping for with her birth, but the mother hen in me wants that baby out in dd's arms so we will know all is well. I just feel like we are walking a fine line between waiting it out, and deciding when it might be necessary to step in.

 

Prayers would be appreciated!

 

Did they say which part of the baby wasn't growing as well as the others?

[Wendi]

:grouphug: I don't have any expertise in this area, but I just wanted to offer you a hug, because I know this is stressful. I hope you are holding your healthy new grandchild soon!

[misidawnrn]

The earlier the ultrasound, the more accurate it is. This is why inductions can be iffy. She could be induced, say the 10th, and have her baby be almost 2-3 weeks early. The baby will come when it wants. Good luck.

[StaceyinLA]

 

 

Did they say which part of the baby wasn't growing as well as the others?

 

 

Well for sure the baby's stomach growth is 2 weeks behind her head growth. She said that was common in a situation where the placenta might be starting to lose some function; the more critical organs would get what they need first. Her percentile is still ok based on the later dates, but if she is really due nearly earlier, that obviously puts her in a lower percentile.

[forty-two]

Well for sure the baby's stomach growth is 2 weeks behind her head growth. She said that was common in a situation where the placenta might be starting to lose some function; the more critical organs would get what they need first. Her percentile is still ok based on the later dates, but if she is really due nearly earlier, that obviously puts her in a lower percentile.

 

Has your dd asked them, point blank, "hey, you say baby is ok at this size for xx weeks along. But my lmp and my 11wk ultrasound say I am actually xx+2 weeks along. If baby is really xx+2 weeks old, is the baby still ok at this size, or would you be worried?"

 

Eta: my due date with ds1 was changed partly based on a pair of ultrasounds that both said he was three weeks farther along than my lmp indicated (and it really mattered, because he was being monitored for health issues, and his results were ok if the new due date were accurate, but worrisome if his old due date was accurate). The OBs asked me if I was sure about my dates or if the ultrasound dates could be plausible before officially changing my due date (after I told them that the ultrasound dates were plausible based on possible conception dates, and I wasn't sure on my lmp).

[Crimson Wife]

If she's concerned about the uneven development, I think she ought to push for a level 2 ultrasound reviewed by a neonatologist. Midwives are great in a routine pregnancy, but if there is a potential for complications, she needs to be seen by a specialist IMHO.

[StaceyinLA]

We have discussed the dates with them on nearly every visit, as it has bothered dd a lot - not that she expects the baby to come on her due date, but because of this situation right here; now we don't really know WHAT to think, or if there is really a cause for concern or what.

 

The pg hasn't been problematic in the least other than the due date differential. The thing is, we are just frustrated they would change her dates later on in the pg because we expect her to have a smaller baby. Dgs was only 18 inches long at full-term.

 

Her movement has been good though, and her heart rate is always good (132 bpm yesterday), so on the one hand we feel kinda dumb being worried, but on the other...