Posts Tagged ‘IUGR’


I was told at my 36 week ultrasound that the baby wasn’t quite as big as she “should be”.

So, who came up with this term: AGA – Appropriate for Gestational Age? And WHO decides what that should be? I am a small, petite woman – About 5 feet and not pregnant I weigh around 115. Why should my babies be 8 or 9 pounds?

 In my research, I’ve read that a normal, full-term baby is about 7 1/2 pounds, that is what is considered AGA for a newborn. A premature baby is naturally smaller, but still considered AGA because the size is appropriate for the length of time in the womb.

SGA means small for gestational age. This is an infant below the 10th percentile on a standard growth chart.

IUGR means intra-uterine growth retardation and is often used instead of SGA. People may think it’s the same thing, but it’s not. An IUGR baby is less than the 3rd percentile and there is often abnormal genetic or environmental influences affecting the baby’s growth.

This make all IUGR babies SGA, but NOT all SGA babies are IUGR.

In my case, two of my babies were SGA, NOT IUGR. However, nobody was able to determine this in time. In this last pregnancy, I was told at 36 weeks the baby measured 34 weeks. She was in the 15th percentile. 2 weeks later, I went back for another ultrasound. I was 38 weeks and she measured 35 weeks, so she was now in the 10th percentile.

It wasn’t so much that she was on the small side, but it was that she was “falling”. And for this reason, I was advised to be induced. And because everyone was nervous, I went ahead with the inductions.

With my fourth child, she weighed only 5lbs 1oz. The placenta was calcified and my doula told me it was the thinnest cord she had ever seen. I do believe inducing was the right thing to do with her. She was small and something was up with that placenta and cord.

However, with my fifth child, she weighed 6lbs 3oz, the placenta was fine, and I heard that the cord was a little thin, but not bad. One of the nurses said that she showed signs of being an IUGR baby, that her proportions were “off”. I didn’t see it. Was it “new baby syndrome”? Maybe. Still when I look back at pictures, nothing seems wrong. Maybe I should have gotten another opinion? Maybe I should have waited a few more days? Maybe I should have tried the castor oil?

*SIGH* I can’t keep harping on what I should have done or could have done though. I must move on. If we had another child and the same thing came up, I would definitely look into it more. That’s all I want anyone to do, research it.


Welcome Baby!

Wednesday January 6, 2010

After finding out that our baby was on the small side, possibly having IUGR, our midwife had us meet with her two backup doctors. Both doctors suggested an induction the 39th week. We tried every kind of natural induction we could think of at home (stripping membranes, EPO, sex, nipple stimulation, Nature’s Sunshine 5W, essential labor oils, acupressure, etc), but none of it worked. I didn’t like one of the doctors; he was funny, but not midwife friendly at all. The other doctor was more open to anything; he even had been nominated for awards by midwives. So, we went with him.

I was admitted at 7am on Wednesday January 6th.  Upon walking into labor and delivery with my husband and midwife, we were greeted by a bunch of nurses. One of them was someone my midwife knew… another midwife!! She asked the head nurse if she could be our nurse and she said sure. There was also an experienced ICU nurse who was orienteering to L&D and she was able to work with us too. I overheard the head nurse saying to the midwife who worked there that this was a good case for her to see because usually they didn’t get many natural deliveries. This would show her you don’t always have to intervene. It still blows my mind that so many people opt for all sorts of interventions.

Into room #5 we went, had to get into my lovely hospital gown, pee in the nice cup and lay in the extremely uncomfortable hospital bed. This was by far the smallest L&D room I had ever been in. It wasn’t very nice either. Pretty blah. We got started with all the questions and the prepping. After about 2 hours, they hung the antibiotics up and started the Pitocin. They started it slowly… going up by 1s. I was at 3cm and 50% effaced. We had to wait 4 hours for the antibiotic to be in my system. If I delivered before that, we’d be stuck in the hospital a longer time. At this point, I was still hoping to go home that day.

Around 12:30pm, the doctor came in and broke my water. My cervix was only about 3.5cm, but soft and stretchy. So, breaking the water was the next step. Always one I’m scared of because there’s no turning back. The contractions immediately felt different, harder and more painful. The Pit was turned up more and more and more until it hit 24, the max. And the contractions were hard, but not coming close enough. I was in the bathroom and Michael had a little chat with our “nurse midwife”. When I came back out, she asked if she could check me. So, I said sure. This was about 3pm. I got in the bed and she checked. I believe she said I was a very stretchy 5-6cm. She asked if she could keep her hand there for a contraction. Sure. So, during the contraction came and she “played around” with my cervix and when she was done she said I was 7cm. LOL! It was uncomfortable, but not real painful.

My contractions started changing at that point. Much harder and much more pressure. She said she’d like to do it one more time and that was fine with me. The quicker, the better.  So, she went in again and just held my cervix for a contraction. By the time she was done, I was 8 and feeling it good. My mom walked in at that point. They called the doctor and let him know I was at 8cm. I guess I should have mentioned that once I hit 7, birth usually happens within 5 contractions and/or a few minutes.

So, yeah, you guessed it… I had a few contractions and went “OMIGOSH, she’s coming!” I could just feel the intense pressure coming, knowing there was no stopping it and no doctor there. LOL! Of course, I wasn’t worried, there were 2 very experienced midwives right there. The nurses started yelling “head on perineum”! LOL! And a bunch of other nurses rushed in. I asked if I could push and my “nurse midwife” said I could do whatever I wanted. So, I bore down and her head came on out. I felt a couple “pops”. And they hurt! As soon as her shoulders were out, they told me to reach down and get her. So, I did. I sat up a bit, grabbed her and brought her up to my chest. She let out a cry not too long after. She was so little and so perfect. She had lots of brown hair, long fingers and was just adorable.

The next few minutes were like a whirlwind. I was trying to hold the baby and bond with her. Some nurse was trying to get some cord blood. The doctor came in and wasn’t looking too happy. He didn’t seem mad either, so who knows exactly what he was feeling. I don’t know if nurses get in trouble for not calling fast enough. She did say to him, “I left something for you to do” – meaning delivering the placenta.

When the placenta came out, I asked if I could see it. He said sure when he was done. I guess there was something “down there” bothering him, so I finally asked what was going on and was told that I had a little nick that wouldn’t stop bleeding and that it wasn’t in the normal area (like where you’d get an episiotomy). They tried to stop the bleeding for a few minutes, and then he said he’d have to stitch it up. YUCK! I hate being stitched up in that area. He did do it quickly, I’ll give him that, but it still hurt.

I know at some point they insisted on taking the baby. I never did find out why. Michael said he thought it had something to do with the cord not being clamped right or something like that. They weighed her and measured her at that point too – 6lbs 3oz and 18 ½”. Then they brought her back to me and put her on my chest – skin to skin. She started making sounds with her mouth, so I put her to my breast and she latched right on. No problems. She immediately started nursing. This was the first time any of my babies latched so quickly and easily.

During this crazy time, someone noticed the placenta wasn’t around anymore and my mom said I had wanted to see it. The doctor got mad! He asked where it was and someone said “we threw it away” and the doctor ordered them to get it out of the garbage because I had asked to see it. And they did. LOL! We got to see it and take pictures. Weird to some, but it’s so neat, seeing your baby’s home for the last 9 months.

We bonded there for a while and at some point we were told they had to take her down to the nursery and do a bunch of things. They said I could go, but at that point, I wanted to get cleaned up and get some pain meds and so on. So, Michael went with them. If I had known it was going to be about 2 more hours before I’d see her again, I would have gone.

I got cleaned up, peed and for doing that, they took my IV out. I was wheeled up to my room. Unfortunately, we were told no children under 14 were allowed at the hospital during flu season. I wish we had been told that before we checked in. It really made me mad. My doctor told me that I could leave from L&D, however the baby’s doctor had to release her too. We chose one based on my doctor’s opinion and found out he was on vacation. So, his backup said the baby had to stay for 36 hours because of my positive GBS status. So stupid. They said the hospital policy was 48 hours, so her policy was better.

The hospital stay was pretty pathetic. I hardly slept at all. I kept getting woken up by people needing something. And if that wasn’t enough, all I wanted to do was cuddle with the baby and I usually sleep with them… well that didn’t go over very well. One of the CNAs had a fit saying I wasn’t allowed to do that and that if nursery caught me, they’d take the baby back there. I looked at her and I said “Tough”. This is my 5th baby and I’ve managed never to roll on top of one or drop one while co-sleeping. Then I told her I’d be happy to check out AMA if they were going to push me. She backed off, but I was paranoid from then on. Since apparently checking out AMA could cost me a visit from CPS a denial to pay from our insurance.

We tried to get released at 36 hours which would have been 3:25am Friday, but the hospital and doctor fought us. Why say you can go home at 36 hours if you really can’t? So, on Friday January 8th, at 7am, they started getting us ready to go. The funny thing it didn’t seem like GBS keeping us there, it was some bili test for jaundice and the nurse told us it was at 8 and was low risk on her chart. When the doctor came to talk to us, she said it was a little high and she should be watched. Hmmmm… trying to justify keeping us there for that long?

Even though we were kept there for much longer than I had wanted and our kids couldn’t visit, I’m glad we went with that doctor and that hospital. We were able to have 2 midwives and a really nice nurse. The labor wasn’t too long and the delivery fairly easy.

The doctor ordered another ultrasound for the baby’s kidneys because the ultrasound I had done while pregnant showed some sort of dilation. She does have one kidney that is still dilated or something. They sent us home with antibiotics just in case its reflux, but I’m not sure about giving it to her before we know. We’re supposed to see the doctor Monday and find out what the next step is. Another ultrasound or a VCUG.  

So, I didn’t get my home birth. Seeing her size, I’m not sure I did the right thing (being induced). She was 6lbs 3oz. I read online that a baby has to be under 5lbs 13oz at birth to be considered IUGR. The “nurse midwife” told us that she had the physical characteristics of IUGR so that we made the right decision. I don’t know if she was just saying that to ease our minds… but she said she had a small head compared to her body and her limbs were smaller too. So, I guess her proportions are off. Her trunk is normal size, or something like that. I’ll have to research that a little.

Even though I didn’t get my home birth, things went well enough that I’m happy. No crazy doctor or nurses breathing down my neck. No rolling of eyes that it was supposed to be a home birth. No epidural. No c-section.

And the end product…

A beautiful, sweet, baby girl… Bella.

Low Lying Placenta

Also in the ultrasound, they noticed my placenta was close to my cervix. The ultrasound tech measured it a few times and said it was about 2cms from my cervix. When you think about it, that’s not very far. It’s not covering my cervix, so that’s really good news. She said the midwives usually like the placenta to be at least 3cms from the cervix, but even that seems ridiculously close!

Supposedly, there is plenty of time for the placenta to move on up. I asked my midwife if she ever heard of a placenta moving down closer to the cervix before and she said no. That would be MY luck! So, I’m hoping and praying that when I go back for another ultrasound in about 10 weeks that the placenta will be a higher up.

I also read that most placentas attach at the top because that area is rich in blood and therefore oxygen and nutrients. So when the placenta doesn’t attach at the top, there’s more risk of IUGR and pre-term labor. YIKES! I had IUGR with my last daughter and they induced me at 37 weeks.

Migrate placenta, migrate!!! I want a homebirth!!