My first daughter Maeve was born on 2nd centile and so we began routine growth scans at 28 weeks due to being on the "SGA pathway" (small for gestational age) I couldn't decide whether to go ahead with these because I was confident that I more than likely just grow smaller babies but was intrigued to find out whether that was the case as everyone kept telling me how much bigger I was this time.
I decided to go along to the first scan and would decide from there what to do. As I expected this baby was plotting on the 3rd centile, the same as Maeve. The lovely midwife told me "you probably just grow smaller babies than the computer thinks you should" which is something that has really stuck with me and became a bit of a positive affirmation for me. The consultant noted that it's "probably just another small baby" and whilst I was booked in for another scan in 2 weeks I felt I was out of the woods.
Oh, how wrong I was. The problem with growth scans is, once you've had one they have something to compare to so they're just constantly looking for something to go "wrong". Now don't get me wrong, in genuine cases of small and struggling babies this is amazing but the likelihood is that your baby is doing just fine in there and it's the over medicalisation of the entire process which throws up false anomalies.
For example, at 32 weeks after a bit of a miserable weekend I went up for another growth scan, my blood pressure was a little high so it was rechecked 10 minutes later, it was now even higher and I was sent to DAU for monitoring and to have my bloods and urine tested for pre-eclampsia. Thankfully they were clear but I was sent home 10 hours later with hypertensive medication (beta-blockers) and slapped with a gestational hypertension red flag/high risk label. By checking my blood pressure at home and trialling different doses of medication (as discussed with my consultant) by 36 weeks I was off the hypertensives and had a normal BP but it was still 4 weeks of unnecessary medication caused by an anxious trip to hospital for something that was causing me unnecessary worry.
My growth scans and doppler's continued hovering between the 3rd & 10th centile, one week (32+3) they struggled to get a decent tummy measurement and the next week (34+3) a decent head measurement. This completely threw the estimated foetal weight off and we dipped under 3rd centile - danger zone! We were back a week later for a doppler just to check baby was doing ok with this supposed dip in growth. I had been seeing the same consultant regularly at this point and we were both confident that it was likely the head measurement throwing it off a bit - it makes a huge difference to have continuity of carer with consultants. Being familiar with each other, the back story and your aims really helps maintain a level of trust between you both.
The following week (35+3) the sonographer was unable to get a decent trace on one of the cerebral arteries (a tiny little vein in the tiny babies tiny little head) and ended up cutting back the trace almost in half. I didn't think much of it at the time given my lack of sonography training but I'm really glad I noticed it. It was the bank holiday after Christmas and so we saw a different Doctor for my review, a male Registrar who I had to guide through my notes and fill him in on what's been happening becuase he was too flustered to make any sesnse of it himself. He left the room then came back 5 minutes later telling me he'd spoken to his consultant (not mine, another person who knew absolutely nothing about me other than the 2 minute introduction I gave him plus what the charts and graphs were showing him) and they suggested induction at 36 weeks due to Hypertension, drop in growth and the cerebral artery Doppler being on 5th centile (but within normal limits). After bursting out laughing I politely declined induction based on the fact that I knew the dip in growth was due to a dodgy measurement as discussed with my consultant, that the Doppler on 5th centile was due to a dodgy trace that the sonographer messed about with and hypertension was a total non-issue considering I hadn't been taking my hypertensives and my BP was still under control so we compromised on a plan for a little extra monitoring and another Doppler in a few days until I could speak with my trusty consultant.
At 35+6 we came down with covid so all my appointments were rearranged but due to being "high risk" I was encouraged to continue attending all the additional monitoring. During this week I finally got to speak to my named consultant (a different one to the one I'd had a good relationship with!) Another Doctor who had the time to get to know me, my history and engage in a two-way conversation with me. We decided on another doppler scan that afternoon to double check that dodgy trace. If all was well as I assumed it was, she was happy for me to go home and wait for my next scheduled scan - which of course it was!
At 36+4 I had my next scheduled growth scan, baby had shot up to 10th centile. My usual consultant was really happy, told me I did the right thing declining induction and to continue what ever I was doing (eating like its Christmas and not taking my Hypertensivesl!!) There was a lot of chat still about induction which made me feel uneasy as I thought I'd made my feelings on that quite clear but I ignored it and went home buzzing and booked in for a long awaited midwife appointment at 37 weeks.
At 37 weeks I finally caught up with my midwife, we chatted about what had been going on recently and the plan moving forward. She asked how I felt about the growth scans and chat about induction, I told her I hated it, every appointment up there filled me with anxiety and dread which is really unlike me and I knew, due to the guidelines they work to that I'd just be under more pressure moving forward. She made the suggestion that we propose a plan B to the consultant, where I see the Midwives in the community for a little more monitoring in the hope that I don't have to have any more growth scans or threats of induction. She palpated baby and was confident it didn't feel like a tiny baby - it was everything I needed to hear and I went away much more positive. I cancelled the upcoming Doppler scan and enjoyed a peaceful 2 weeks break away from that dreaded place. During this fortnight - without having any anxiety or pressure hanging over me baby was dancing away more than ever before. They never ever gave me a reason to doubt that they weren't thriving in there.
I received a phone call from antenatal clinic the afternoon that should have been my growth scan as I had assumed it had been cancelled... but it hadn't. This resulted in me having a fairly uncomfortable phone call with one of the consultants who tried their very best to convince me to come back for one last growth scan. Using phrases like "it's best we get baby out soon before their placenta starts failing and they struggle during labour" and "I know it's all doom and gloom up here". I suggested that the only way I would consider another growth scan would be if I could have a specific sonographer and see one of two consultants for my review. She advised they would check the sonographers schedule and that a review with them wouldn't be an issue as they're both around full time. I received a call later that day booking me in for Thursday (38+6) I said I still wasn't sure whether I wanted to attend but would decide in the morning. I chatted to some family, friends and my husband who all encouraged me to go for one last scan in the hope it would keep them off my back. I took a friend with me to the appt as morale support and a sounding board and I'm glad I did!! Whilst the scan was amazing, I was assured everything was within normal limits. We saw babies hand up by her face, some chubby hamster cheeks and nostrils and lips! We waited for one of my familiar female consultants only to be greeted by a random man in scrubs. I explained that without being rude I was only prepared to speak with 2 specific Dr's. He advised that neither was around today - one was around but too busy. He hadn't seen the other. I suggested he try and locate one of them. He arrived back in the room 10.minutes later, clutching my notes advising he has spoken to my consultant in person but she's too busy to come and see me but she advises induction ASAP. My jaw dropped and I was waiting for him to laugh as I thought be was joking but he was deadly serious.
We asked his reasonings for this decision and he advised "because baby is small and struggling" so I requested he showed me why he thought baby was struggling as all the Doppler results were within normal limits, he agreed. He pointed to the growth chart which showed growth had "dropped" from 1oth to 3rd centile. I suggested that rather than it dropping it looks like it's just returned to its usual curve, again he agreed. We felt a little like he might have felt a bit awkward playing messenger so asked his opinion and he stated that he would "also recommend induction because that's what the guidelines say" despite the scan results showing there was nothing to be concerned about. He suggested I come back over the weekend for daily CTG's and rebook a Doppler for early next week. I advised I would see how I feel over the weekend.
Later than afternoon I contacted our family experience midwife as I felt totally unsupported. My consultant was "too busy" to come and see me. My midwife had been off with covid. I was 39 weeks and had no plan in place, other than of course an induction as soon as I wanted it. The next day I worked on boosting my oxytocin levels back up, I took my toddler to her favourite gym class, then we went to our local pub for a pizza. I then had a call from the FL midwife who advised she had arranged an appt with my local community team that afternoon.
It dawned on me that afternoon that as a natural people pleaser that's all I was trying to do - please the Consultants by attending the growth scans. It didn't make any difference to me. I had a baby that was wriggling inside me and the confidence in my own body to grow a healthy baby. I didn't need their technical assurance and because I'm such a trusting & non-confrontational person I found it really difficult to stand up for myself. The whole process just goes against who I am as a person and meant I just wasn't in the right headspace to allow labour to happen - that and the fact the Antenatal Clinic had become a massive oxytocin blocker.
It was then most positive, uplifting supportive and and transformative 2 hours of my pregnancy. We talked through my birth preferences, which were essentially just leave me alone please, we talked about reasons for transfer to hospital and whether I'd be happy to go then we signed the paperwork and I was told I'd receive a copy later by email. I felt in incredibly safe hands with these women. They gave me the confidence boost I needed by really supporting me taking back control of my pregnancy and birth.
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