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.
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!
“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 firstname.lastname@example.org to see how you can help too.
*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.
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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!