our little baby is a little baby
February 16, 2012 5:50 PM   Subscribe

Please tell me your experience with a small-for-gestational-age / intrauterine growth restriction pregnancy.

It looks like our baby is small -- she's been hovering around the 7th percentile at every ultrasound we've had in the third trimester. My wife has now been placed on twice-a-week monitoring (non-stress-tests, periodic dopplers, another growth ultrasound in three weeks) and we've been told they will probably have to induce labor by 39 weeks if the baby hasn't come out on its own by then, sooner if it looks like that's necessary.

Obviously this is alarming. We've been assured by the doctor, and Google has seemingly confirmed, that SfGA and IUGR babies all basically turn out to be just fine in the end -- "some women just have small babies, and some fetuses are just small like some people are just small." Nothing in any of the scans has shown reason to be alarmed about the baby's heath; there's no indication of chromosomal anomaly or open neural tube defects. So we feel generally calm and relatively unpanicked.

As best we can tell there's no indication that IUGR is linked with a significantly higher rate of birth defects unless it becomes very severe (under the 3rd percentile) -- the primary concern seems instead to be a somewhat higher rate of stillbirth if the pregnancy were to go all the way to 40 weeks (hence the monitoring, hence the likely induction).

Do I have all this right? What are the risks and the probabilities we're looking at? Is a C-section likely? Is the baby going to have to live in the NICU? Is there any chance the ultrasound estimate is just plain wrong about all this, or that the baby's really just a week or so younger than we thought? Secret twin? Something else less scary-sounding than "growth restriction"?

What do we need to watch out for, either in the final weeks of pregnancy or after the baby is born? Is there anything we can do in the meantime?
posted by anonymous to Health & Fitness (12 answers total) 4 users marked this as a favorite
I usually shy away from advice on medical things here, because I always think there's missing information that an anonymous OP can't easily clarify. I am an OBGYN trainee, but not in the US, and I don't specialise in this area. But I also think this isn't an ideal question for internet strangers, because we give such personally biased anecdotal answers. I think you have already had good advice from your doctors, and have this well in hand.

Do I have all this right? Yes, you seem to me to have a good grasp of the issues.

What are the risks and the probabilities we're looking at? This is the 7th smallest baby among 100. The baby is heading to be somewhere between 2.5 and 3kg at birth. That is perfectly normal, and could be almost average depending on your wife's ethnicity and weight. This is highly likely to turn out just fine.

Is a C-section likely? Slightly more likely than if the baby was 50th centile, as induction is associated with increased section rates, and small babies may not tolerate labour as well.

Is the baby going to have to live in the NICU? The baby will most likely need no extra input from the neonatologists at all.

Is there any chance the ultrasound estimate is just plain wrong about all this, or that the baby's really just a week or so younger than we thought? Yes, it's possible. But, the consistent growth along the 7th centile makes it less likely that the scans are wrong. If you had a 1st trimester scan then the dates are also very unlikely to be wrong.

Secret twin? No

Something else less scary-sounding than "growth restriction"? Yes, you have a slightly smaller than average baby that is growing along its centile entirely normally.

What do we need to watch out for? Go back to your OBGYN / fetal medicine expert and discuss all your antenatal concerns again. You don't need to do anything special except follow their advice for monitoring. Post-natally you might need specialised breast feeding support.
posted by roofus at 7:02 PM on February 16, 2012 [8 favorites]

My first child was IUGR due to a 2 vessel cord. Suuuucked. Because of the cord I had to deliver via c-section which also suuucked. The good news? They were wrong - she was almost SIX pounds, not almost five. We had the same sonography tech throughout and I suspect that her measurements were just off throughout my weekly ultrasounds. There's my anecdata, hope it helps you.
posted by PorcineWithMe at 7:25 PM on February 16, 2012

Mom here. 4.5# for the first (1995), 5.5# for the second (1998).
When I asked my NP about a guesstimate for the first one (around 38 wk gest) she palpated a bit and shrugged and said "about 5 lb" I was shocked and worried (so small!) and I was sure she must be wrong cause I was so big but he came without inducement at 39 weeks; he was fine, they sent us home the next day. He's a couple inches taller than me now (I'm 5'10")
The second they did watch a little more closely than the first because of the first's weight, he was a little bigger (same story, no inducement, vag birth at 39 weeks, home the next day). He's now bigger (taller) than his older brother.
Both of them were "skinny" for babies (no cute rolls of baby fat). I joke that I chased them both around with a spoon until they were 4 y old or so (it's true) and they are both still thin - I doubt I could find a pound of fat on them combined but getting huge and well-muscled as teen-aged boys tend to do ...
Dad is 6'5", turns out family reports small-ish babies all around (we were both less than 6# as well, but bigger than both of them).
Mine were conceived and gestated in Colorado, US, which I have heard has a high rate of LBW babies (oxygen? IDK, or even if that's true)
Very little of the refined ultrasound techniques now available to us then, and the cut-off weight for NICU was 1 oz below the littlest one then.
They both seem "normal" for teen-agers now and throughout life, no health or developmental problems (one has asthma, tho, and one is "gifted").
They are healthy kids and really great people too, I'm glad to say. They eat A LOT.
Hope this helps.
Best wishes for your family!
posted by bebrave! at 8:20 PM on February 16, 2012

My teeny-tiny was IUGR as well. There are two types - symmetrical and asymmetrical, which is basically whether your baby is tiny overall or has a big head and tinier body proportionally. Ours was asymmetrical because I lost most of my amniotic fluid, and she had no room to grow, so her body compensated by prioritising her brain development over her body. She's now still slightly out of proportion but catching up overall.

It is scary to get an IUGR, but of all the baby diagnoses, by itself, it's low-risk and almost all IUGR babies turn out fine.

The upside is that thanks to the extra monitoring, any other complications are very likely to be found and that makes your baby far more likely to be delivered safe and healthy with treatment. The NICU seems scary, but the "feeder and grower" babies in there, born a little early and small are the easiest and happiest babies there.

Ask about who's doing the ultrasound measurements, as experience and training makes a huge difference in accurate measuring. Figuring out an accurate weight and length for a foetus is technically challenging.

Our baby isn't even on the percentile charts now. She was delivered at 30 weeks bigger than the ultrasounds suggested at 1.5kg which was solidly 50% percentile and then quickly dropped down. She's now the equivalent of a 3 week term baby at 2.7kg, at <0>
IUGR on its own is very rarely a problem. Ask your doctor to walk you through what could be causing IUGR, and why they've ruled them out in your case. As long as it's not a complication from something else more serious, your baby is likely to just be small and healthy.
posted by viggorlijah at 8:28 PM on February 16, 2012

My first son was an IUGR baby. He was born at 39 weeks, 5lbs 10oz. He was delivered by C-section because he wasn't tolerating even early labor very well. But he didn't need to go into the NICU, he was just small. He's now almost 5 years old, perfectly normal, and almost at 50th percentile for height, 25th for weight. He was around 6th percentile for weight for his first year or so, and I fretted endlessly over it. My pediatrician tried to reassure me that he would catch up, and I didn't really believe him. Now I do :) Oh and my experience of the weigh estimates from ultrasounds is that are very unreliable. My first was estimated to be 6lbs 7oz but came out 5lbs 10oz. My second was estimated to be about 7lbs, and he came out 8lbs 1oz. So don't take it as gospel, its more of a general guide to your baby's size.

I did have to supplement with formula for a few days while my milk came in. I couldn't breastfeed him at first, he was physically incapable of latching on, so I had to pump and bottle feed until he got bigger and we transitioned him to breastfeeding. We had to feed him every 2 hours, even during the night, so that was exhausting, but once he hit 7lbs the pediatrician it was fine to let him sleep and he pretty much slept through the night immediately after that.

That all said, remember this is anecdata, and your case will be different. Just consider these answers a menu of possibilities. Your baby will be fine!
posted by Joh at 9:39 PM on February 16, 2012

Nthing that all cases are different. My doc suspected IUGR at about 36 weeks with my first. An ultrasound showed somewhat low amniotic fluid, but not so low as to require being induced. She was born vaginally at 38w3d. She weighed 5 lb 4 oz and was 17.75 inches long but 100% healthy. She weighed less than 5 lbs when we were discharged, but we had no problems breastfeeding and she gained weight proportionally to the growth charts, just below the lowest line. She didn't even reach the 5th percentile on the growth charts until she was 2 years old. She's 5 now, in about the 25th percentile for size, smaller than her classmates but perfect. My next two weighed 7 lb 7oz and 7 lb 2 oz, also healthy.
posted by ellenaim at 4:34 AM on February 17, 2012

My now 12-yr-old daughter was born at 38 weeks; she weighed 4lbs 15 oz, and probably went home a couple days later weighing less than that. I won't bore you with the emergency c-section story, but I had high blood pressure, so maybe that contributed to LBW.

Anyway, a baby this small will fit in preemie clothes, not regular clothes, so if you suspect LBW, get yourself some preemie diapers and clothes. They can be hard to find.

She had no problems eating. She did not have to spend any time in the NICU.

She is smaller than her classmates, but every kid is different.
posted by cass at 9:18 AM on February 17, 2012

cass makes a good point. We were unprepared for a baby that small and had no preemie-size clothes (onesies, sleepers) on hand. Also, unlike most babies who outgrow newborn-sized diapers within days, my daughter was in them for 3 months.
posted by ellenaim at 10:07 AM on February 17, 2012

A friend went through this. Her daughter was/is perfectly fine (2+ yrs old now). The only real issue for my friend was that she wanted to breastfeed and had a lot of trouble. No one told her that a smaller baby might have trouble learning to latch. She wasn't able to find a helpful lactation consultant in a timely manner and didn't get good advice on pumping or other things she could do while working with her daughter on her latch. So if your wife wants to breastfeed, I'd suggest finding a good LC (who has worked with small and/or premature babies) before giving birth.
posted by mingshan at 10:07 AM on February 17, 2012

Well, my baby was a preemie, so she was small already, but she was also diagnosed with IUGR due to my pre-eclampsia (really high blood pressure that can cause seizures, brough on by pregnancy).

When she was born, at 32 weeks, she was 3 lbs, 14.5 oz and 17.5" long. Smaller than they expected, for a child that age, although I had been measuring normally all along.

Today, at 3 years, 9 months, she's 42" tall and weighs about 40 lbs. She's the tallest girl in her class, by far, but I'm 5'11". She gets mistaken for a 5-year-old quite often.

I agree with the PPs who have stated that IUGR, in and of itself, is rarely a problem. My daughter didn't have any issues related to being small for her age. She's obviously grown out of it. And, also, that ultrasounds are reliably unrealiable.

You need patience, and although it's tempting, it's not always a good idea to compare your child to anyone else's. I don't know how many old ladies told me that my daughter was too skinny. (Who says something like that?) You have do focus on your child, and tune everything else out. Some people have big babies, some have small. There's no telling; every baby can be surprising. You just never know.

Help for breastfeeding, if that's the plan, may be needed, as other posters have indicated. Our NICU nurse was the mom of a preemie herself, and was far more educated on pumping than the hospital's lactation consultant, primarily because she had lived it.

Take care of yourselves, and best wishes. Sounds like you have a good plan and a caring, involved physician taking care of your wife.
posted by FergieBelle at 10:32 AM on February 17, 2012

My daughter had IUGR, she was consistently in the 3rd percentile throughout the pregnancy and then was 1.7kg at birth (bordering on very low birthweight). She dropped to 1.4kg the day after she was born. I had daily foetal heart monitoring from seven months, which was a huge pain.

The major difficulty for her was feeding - whether breast or bottle she fell asleep after a few sucks as she found it such hard work, and we were spending hours upon hours upon hours feeding. It was hard work for both of us. So I supplemented with prescription high-calorie formula after eight weeks, which she still has now at 10 months. I look at photos now of her in those first few months and can't believe we left the house she was so teensy - but we did, long walks and picnics with her in the sling, and she was fine.

Another pain was the increased monitoring for her after she was born - the health visitor saw her twice per week for a while, then weekly until she was six months.

Otherwise though, she's absolutely fine. She wore 'tiny baby' and 'early baby' size clothes up to 16 weeks, then newborn size up to seven months. She's been in 3-6 month size since xmas. She still has a newborn car seat, and was in a crib until xmas. We used a moses basket as a travel bed until she started crawling out of it, and we didn't use a pram until she was nine months - she was perfectly happy in slings, but now I can't carry her in one all day, she's too heavy.

There haven't been any issues with her development, in fact she's quite advanced. But lo, how we celebrated when she finally hit the bottom line on the growth chart (0.3%) last month! This month she's 9th percentile! She eats like a horse and is an adorable little doll. She might always be small, but hey - neither her father nor myself are tall so that's the way it goes.

Oh one major plus of a tiny baby - I barely gained any weight during pregnancy and only bought one pair of maternity pants, otherwise I wore my normal clothes. Except bras, of course.

My daughter was in the NICU but that was due to needing surgery (for a birth defect, which caused the IUGR but about which we knew from the second trimester), not due to her size.

Good luck!
posted by goo at 12:53 PM on February 17, 2012

Also, I asked this question when preparing for my own tiny baby, and got some very helpful responses.
posted by goo at 1:38 PM on February 17, 2012

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