An IUGR baby: Made to Measure

Throughout my four pregnancies, the tape measure has rarely been my friend. I used to refer to it as ‘the dreaded tape measure’ and the more people that I asked, the more it was determined in my mind that nobody was able to accurately measure a baby with one. I seemed to hear so many stories where baby had been measuring four weeks ahead, and pregnancies were shrouded in the panic and fear of a gigantic baby that turned out to be a neat 7lb something. On the other scale, I always measured small, and had the worry that something was wrong with my babies.

An IUGR baby_Made to Measure~ Ghostwritermummy.co.uk

 

I still remember the first time that the term IUGR (IntraUterine Growth Restriction) was mentioned. It was during my first pregnancy over ten years ago. A routine midwife appointment had resulted in an emergency scan at the hospital as baby was measuring 4 weeks behind what was deemed as normal. Once at the hospital, the scan confirmed that baby was small, but within normal parameters for my husband and I, who are not giants. Still, that term swam around my head for the rest of my pregnancy and we were more alert when the same thing happened second time around.

The fact that my son measured 5 weeks behind meant that the elective section I dearly wanted was refused. I was told that baby would be too small at 38 weeks and that the doctors would prefer me to go to term so that he had more chance to grow. On the night that I arrived at the hospital in labour, I was measured again at 36cm, despite being over 41 weeks pregnant.

During my third pregnancy, I measured small all the way through, and my husband and I were now well versed with the curse of the tape measure. We knew that I would measure small. We knew the growth scan would not highlight any issues. We knew that baby would be fine. At 39 weeks she was tiny for her age, but we knew by then that small babies were our thing. Some ladies have big babies (a friend delivered a 10lb 7 baby just days after me and we often laughed about him being double the weight of my baby) and some have small. Part of the rich tapestry of life, etc.

When I booked in at the hospital for my dating scan at the start of this, my 4th pregnancy, I was given a personalised growth chart. How extreme, I thought. Don’t they know by now that I always have small babies? They even went to the trouble of booking three growth scans for me, at 28, 32, and 36 weeks. We decided quickly that we’d attend the first growth scan, but would probably cancel the rest as it would become clear that our baby was small, but fine.

Midwives begin to measure the uterus from around 28 weeks gestation. The first measurement in this pregnancy was not 28cm, it was 24. Already 4 weeks behind. I wasn’t worried and as I had a growth scan already booked, the midwife was reassured that I was being taken care of. We attended that first scan with every confidence that we’d be told baby was fine, but small.

Instead, we were told to prepare for a very different scenario. The doctor told us that our baby was measuring small on our chart. Yes, yes, our babies do that. But our chart was not a chart for the average woman, as we’d had before. It was a chart with percentiles designed specifically for me. And my baby was measuring way below what was deemed as normal for me. Personalised growth charts are made up from personal data- height, weight at beginning of pregnancy, ethnic origin, and weights of previous babies. This is because all babies are unique to their mother; it is possible to track a baby’s growth based on what is normal for her, and not thousands of other women. The charts cost just 50p per pregnancy to produce.

At home I scrutinised my chart. The threat of delivering baby at 34 weeks, no VBAC, and possible time in special care had me worried. I was still sure that they were wrong about it all, but we weren’t about to cancel our future scans. We’d been asked to return in two weeks rather than four, and we were scared. My chart has a box a the top with my previous baby’s weights listed and by the girls the letters SGA, which I discovered means Small for Gestational Age. This data, along with my weight and height etc had alerted doctors to the fact that my unborn baby could be at risk of growth restriction or other issues, and was the reason why the growth scans had been booked.

My next appointment involved a doppler scan, which showed reduced flow through the cord to the placenta. This abnormal reading led doctors to amend my appointments to weekly. With baby still falling on the personalised chart, we were really worried by this point. The next two scans showed improved flow, which is excellent news, and we are now in the grateful position of being able to deliver much later, at 37 weeks. Only 3 weeks difference to 34 but an ocean away in terms of the special care that baby will need at birth. And three more weeks to gain essential weight, since baby is still way below the 10th percentile on my chart.

We don’t really know why baby’s growth is being restricted. For some babies, IUGR is unexplained and that can be hard to swallow. You want to know that you’re doing all you can to help the situation, and it’s hard knowing that you can’t really do anything. At 37 weeks I will be given steroids to mature baby’s lungs and baby will be born via c-section, Doctors do not believe that a vaginal birth is possible, partly due to having had three previous sections, and partly because the growth restriction carries issues of it’s own. Baby is likely to be weak, and organs not as mature as would be expected in a 37 weeker. The stress of labour and delivery may be too much for this baby. Special care may still be needed when baby is born, and my placenta will be taken for tests to try and figure out the cause of the growth restriction.

In the UK, 3,000 babies are still born every year. Doctors believe that half of those babies could be saved with personalised growth charts and doppler scans. It is unthinkable that many hospitals in the UK do not offer these things as standard to pregnant women. I am lucky that my hospital does; my story may well have been very different without this service.

The Mama Academy’s Made to Measure campaign is calling for ALL NHS trusts in the UK to adopt the Growth Assessment Protocol Programme (GAP) as a matter of course, so that all babies can be tracked for growth according to their mother’s data. Of the hospitals that have adopted the scheme, still birth rates have dropped by 22%, the first reduction for 20 years!

You can find out if your local trust uses GAP here.

“If your trust hasn’t yet introduced GAP, email your Head Of Midwifery a link to this web page and encourage them to call The Perinatal Institute on 0121 607 0101 to find out how to enrol on the GAP programme. We have put together an example letter to assist you. You can also print our Made to Measure flyers to give to your maternity team.”

(from Mama Academy)

I am supporting the Made to Measure campaign because I am certain that the extra vigilance of my hospital has helped to save my baby. We are being cared for and that is a huge comfort at this time of great uncertainty. I am lucky. If you’ve also been affected by IUGR please do get in touch by emailing contact@mamaacademy.org.uk to see how you can help too.

Lastly, please sign the petition to urge all Heads of Midwifery to adopt the Perinatal Institute’s GAP programme.

 

*Incidentally, Mama Academy also feature lots of training and support for midwives and other professionals on the site, including guidance on using the ‘dreaded tape measure’. At my last appointment, a student midwife measured me at 30 weeks, which was 100% spot on for that day’s ultrasound measurements.

Did you see that Ghostwritermummy has been short listed for a BIBs award?? Yes, really! If you fancy helping me get a little bit further, click the badge below and vote for me in the INSPIRE category.

BritMums

Your vote would mean the world and would help me continue to raise awareness of maternity matters, IUGR and birth trauma in even wider circles. Thank you!

32 Comments

32 Comments on An IUGR baby: Made to Measure

  1. Katrina @ beau twins
    October 2, 2014 at 6:58 pm (2 years ago)

    I can’t imagine how you feel. I’m fairly small with a small frame & had SPD in week 11 onwards. My mums friend who is super titchy had twins. You just don’t think about te possibility of IUGR.
    As a twin pregnancy I was so overwhelmed with the amount of appointments and I could get over how a non multiple pregnancy was allowed to go 20 weeks without a scan, growth appt etc. It should be standard. I know that previous pregnancies will dictate (or they should) if some difficulties occurred but all women should be treated the same. Each baby is special and important and should be under the watchful eye at all times. I’ll be sure to sign the petition. Sending lots of hugs. Xxx
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    Reply
    • ghostwritermummy
      October 3, 2014 at 6:15 am (2 years ago)

      I agree, all women should be treated the same, and with just one doppler scan around 20 weeks so many potential problems could be picked up too. Thanks for signing x x x

      Reply
  2. Molly
    October 2, 2014 at 8:26 pm (2 years ago)

    This is fascinating – and pretty scary reading too. Fascinating because I’d never heard of IUGR before and scary because I can’t believe these growth charts aren’t available to ALL women who need them. I’m so glad your story is turning into a more positive one and you’re getting good news now and the care that all women deserve. x
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    Reply
    • ghostwritermummy
      October 3, 2014 at 6:14 am (2 years ago)

      I know what you mean. I think that the charts should be there for all women no matter their history or whether or not it’s their first baby. For 50p it could make the difference x x x

      Reply
  3. Caroline (BecomingaSAHM)
    October 2, 2014 at 9:44 pm (2 years ago)

    Fascinating post hon and incredible to think that it could save so many lives if this was adopted in all hospitals. Still birth has got to be one of the biggest fears of all pregnant women and to think it could be prevented in many cases by something like this, well its crazy that it isn’t already standard everywhere! I am so pleased that you have had the care etc. that you need and hope they continue to look after you! Xx #blogbumpclub
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    Reply
    • ghostwritermummy
      October 3, 2014 at 6:13 am (2 years ago)

      Yes it’s so strange to think that something so simple could save so many babies. We really have been so lucky x x

      Reply
  4. Carie
    October 2, 2014 at 11:11 pm (2 years ago)

    Until I read this I had no idea that personalised growth charts weren’t the standard; our NHS trust is fully signed up and has had them for at least four and a bit years because I’ve had one with every pregnancy, the latter two listing my previous deliveries and where they fell on the percentage chart. It seems such an obvious thing to provide doesn’t it, I mean I’m 6’0″ and my husband is 6’1″, the chances are we’re going to have bigger babies than a couple who are a petite 5’5″ apiece, and in fact my girls’ birth weights were on the 25th and 18th centiles on my growth chart even though they clocked in at 91 and 75% on the baby girl growth charts!
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    Reply
    • ghostwritermummy
      October 3, 2014 at 6:12 am (2 years ago)

      I wish it were standard for all trusts. I’ve had two babies at one hospital in my area, and soon to be two at this current hospital. My last baby was born just under 3 years ago and I had no personalised chart with her, yet both the hospitals now use them, which is wonderful. The work now is to get all hospitals to use them so that all women get customised care.x x x

      Reply
  5. Karen Hannah
    October 3, 2014 at 9:11 am (2 years ago)

    Susanne, what a worrying time for you. I’m so surprised that this isn’t a standard procedure for all expectant mothers – especially at a cost of just 50p per woman. Great news that your more recent scans have shown improvement though. Not long now until the worrying is over and you’ll have your number four <3

    #ShareFriday
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    Reply
    • ghostwritermummy
      October 4, 2014 at 7:35 am (2 years ago)

      It really should be standard shouldn’t it? Maybe one day. And yes, we seem to be on the home run now! One more scan and then baby will be here! x x x

      Reply
  6. Notmyyearoff
    October 3, 2014 at 9:44 am (2 years ago)

    I hate that bloomin tape measure. I always feel like its not accurate and there must be so many other factors they need to take into account, like some women have tonnes of water in there so surely its a rough science? I was always measuring “fine” but Z was teeny tiny at 5lb. 50p per pregnant lady is absolutely nothing and a complete no brainer!! Whyyy don’t they use common sense. It would help so many women wouldn’t it?
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    • ghostwritermummy
      October 4, 2014 at 7:27 am (2 years ago)

      I hate the tape measure too but without it I may not be where I am in this pregnancy now.There is SO much room for error, which is why Mama Academy’s training it so essential. The student midwife who measured me got it spot on this time and I was secretly very impressed! x x x

      Reply
  7. Rachel @ The Ordinary Lovely
    October 3, 2014 at 2:30 pm (2 years ago)

    I’m always interested to read about the procedures over here as both my boys were born in Switzerland. To be honest, while I think the NHS is, on the whole, a marvellous organisation, I’m often a little bit horrified when I compare my pre and post natal care to that in the UK. I struggle to believe that even something as simple and low cost as a personalised growth plan isn’t standard. It seems ridiculous, to be honest. Anyway, I hope that you’re okay and I’m keeping my fingers crossed that the next few weeks pass without incident x
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    Reply
    • ghostwritermummy
      October 4, 2014 at 7:24 am (2 years ago)

      I think we are so lucky to have the NHS but I really wish it was less disjointed. During this pregnancy I have seen 4 different community midwives and can never speak to anyone on the phone when I need to; I have seen 3 different doctors and my named consultant re-introduces herself every time we meet as she doesn’t remember me; my midwife cannot take my bloods as she can only send them to the hospital she works at and not the hospital I have chosen for my maternity care; I have community midwife appointments in one town, antenatal check ups and scans in another town, and will deliver my baby in the city! Yet despite it all, between them I know I am being cared for. It is more the personal communication that is lacking. I wish all the hospitals connected and talked to each other and adopted the same life saving schemes! Hopefully this will change x x x

      Reply
  8. Christine
    October 3, 2014 at 7:58 pm (2 years ago)

    I had my babies a few years back now but I’d never heard of IUGR before, thanks for highlighting it. I hope everything goes well for you with the birth of baby no 4!

    Reply
  9. Emma Lander
    October 3, 2014 at 8:26 pm (2 years ago)

    I watched that programme about still birth this week which put the fear of god in me. Prob not the best thing to watch when I am pregnant but I am high risk and I know I will also be monitored closely so I am glad for that.
    But goodness me, you have really been through it and I really feel for you. These things are out of our hands but at least they are keeping a close eye on you. Big hugs xx

    Reply
    • ghostwritermummy
      October 4, 2014 at 7:15 am (2 years ago)

      I actually felt some comfort watching the program and thought it would upset me a lot more than it did. My heart broke for the families who lost their babies, but I feel so very lucky for the care we’ve had. The lady who delivered her baby at 35 weeks was in the exact same position as me and to see her wheel her pram out of the hospital was amazing x x

      Reply
  10. Julia @ rainbeaubelle
    October 3, 2014 at 8:31 pm (2 years ago)

    I never knew you could get personalised growth scans, it’s so good that they are monitoring you so well. You must be absolutely sick of all the worry. I’m glad you are being closely followed and can’t wait to hear news of your gorgeous baby coming into the world xx
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    Reply
    • ghostwritermummy
      October 4, 2014 at 7:12 am (2 years ago)

      I never knew either and we honestly thought they were being over cautious with us. Thank goodness they made us one and we were able to track this baby as well as we have! x x

      Reply
  11. Katy {What Katy Said}
    October 4, 2014 at 9:47 am (2 years ago)

    I have never heard of this before. My first pregnancy I measured a couple weeks ahead each week but in the end had a small baby. Second pregnancy measured small each week and had a whopper! Definitely think there should me more scans and a tailored growth chart is a very sensible idea! Off to sign now xx
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    Reply
    • ghostwritermummy
      October 5, 2014 at 4:26 pm (2 years ago)

      I agree- personalised charts and more scans would help a great deal when it comes to lowering the stillbirth rate in the UK x x

      Reply
  12. Working mum blog
    October 4, 2014 at 6:41 pm (2 years ago)

    Brilliant post! Really useful so thank you for sharing. There was a documentary on BBC about this campaign earlier this week too. It should indeed be standard especially at 50 p! Thanks for raising awareness about this x

    Reply
    • ghostwritermummy
      October 5, 2014 at 4:25 pm (2 years ago)

      Yes, the documentary has been fantastic in raising awareness. The lady in the program who delivered early was in the same position as me and we’ve both been so lucky to have received personalised care x x

      Reply
  13. Erin
    October 4, 2014 at 9:26 pm (2 years ago)

    What a great post. Amazing how many people (myself included) who have never heard of a personalized growth chart. It makes so much sence though! Thanks for covering such an important cause! Hopefully more hospitals will take this up.
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    Reply
    • ghostwritermummy
      October 5, 2014 at 4:24 pm (2 years ago)

      I really hope they do! x x

      Reply
  14. Sara (@mumturnedmom)
    October 5, 2014 at 1:24 am (2 years ago)

    I had no idea you could get personalised growth plans, makes perfect sense that you can and at 50p I can’t believe that they aren’t standard practice. Thinking of you, not too long to go now, I’m so glad that they are taking such good care of you xx
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    Reply
    • ghostwritermummy
      October 5, 2014 at 4:24 pm (2 years ago)

      I had no idea either until this pregnancy. Thank you for your kind wishes x x x

      Reply
  15. Colette B
    October 6, 2014 at 11:49 am (2 years ago)

    I hated that tape measure too – I measured anywhere between 2 and 5 weeks “too big” each time but had three perfectly healthy babies ranging between 7lb 12 and 8lb 14 – which were all perfectly sensible weights for my body.
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    Reply
    • ghostwritermummy
      October 6, 2014 at 4:58 pm (2 years ago)

      It just goes to show that they never really know much until the baby is born. I hope their estimates of 4lb something are way out and we have a nice healthy size after all! x x

      Reply
  16. Franglaise Mummy
    October 6, 2014 at 4:48 pm (2 years ago)

    Wow! This is very interesting – I was 5lb 5oz when I was born, Hubs was 5lb 10oz and everyone was surprised when we had a 5lb 10oz baby. Then when I was pregnant with our second we had to have a growth scan as she was small, but she ended up being 7lb. I knew it was all fine, we’re both small and my mum only had small babies, but everyone kept stressing us over both babies’ size. This sounds great, I have signed the petition. Thanks for sharing and I hope everything goes smoothly now you’re being followed so closely xx
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    Reply
    • ghostwritermummy
      October 6, 2014 at 4:57 pm (2 years ago)

      Thank you so much for signing! I too was a small baby, husband not quite so small but there was never really much chance of our babies being huge! This time though problems were caught early on so we’ve been really lucky x

      Reply
  17. Ceri
    April 22, 2015 at 7:15 am (1 year ago)

    my healthcare trust does use these charts. However, this is a first pregnancy for me & none of it was explained.
    I was measured last week at 3 weeks ahead. This combined with people’s comments that I ‘will never last till July’ has quite honestly sent me into utter panic.
    Reading this post and some further reading in the subject has really calmed me down.
    Although my chart is personalised to my height and weight, I didn’t find out I was pregnant until 15 weeks. My weight was taken then. I had already gained some which I thought was unexplained.
    I’m also tall. 5ft 9 and well built .
    Lean all over and carry all my weight on my stomach. My stomach was not measured before.
    The panic I’ve felt from a midwife telling me my stomach is too big has been ridiculous.
    My mother gained 4 stone carrying my brother, was warned all the way through he would be at least 10lb. He was 6.5lbs full term!
    I’ll be more likely to speak up next appointment. Thank you so much for writing this x

    Reply

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