Growth Scan - large abdominal & head circumference - big baby - c-section?

[mpg1502]

Hi there,

I wonder if anyone has anyone advice. My baby is measuring "off the scale" on abdominal and head circumference (ie past the 95th percentile). I am 33 weeks +5 days and due to have another growth scan on Friday (at 34 weeks).

The baby is also 95th percentile weight (at 31 weeks was 4lbs 8 oz) - seems to be putting on just over half a pound a week. So on course for 9 or 10 pounder. Though it is not the weight of the baby that concerns me but the abdominal and head measurements as these are both off the scale.

They were concerned I may have gestational diabetes but had a blood test done and glucose levels currently seem fine.

I saw my consultant midwife yesterday and she did say it was a particularly large baby for its age and to await further measurments on Friday. I am 5ft 5", normally a size 12 and have put on 24 pounds.

It is estimated that this week the baby will be as follows:-

Biparietal Diameter - 86mm
Head Circumference - 355mm
Abdominal Circumference - 345mm
Femur Length - 61mm
Est Fetal Weight - 6lbs 3oz

Does anyone else have any measurments at the 34 week marker that compare? And if so, what questions or concerns should I raise with my consultant? I am under their care for threatened pre-term labour and cervical stitch (at 24 weeks). I had an 8 week course of Indometacin and two shots of steroids for the baby's lungs.

My main concerns are of course birth! I already have significant damage to my cervix and extremely weakened muscles vaginally. If there is a direct correlation between abdominal/head and shoulder width then this baby is quite likely to get stuck on the way out. I had requested an elective c-section anyway because of the trauma not only during pregnancy but also prior to this as I have had a substantial cervical cone biopsy to remove cancerous cells and a chronic bowel condition (for which I will be having a significant proportion of my bowel removed resulting in a much shorter transit time, and my surgeon has warned me that I should avoid tearing or episiotemy as this will increase my risk of not only urinary incontinence but also faecal).

However, my hospital are discounting my concerns and suggest that a normal vaginal birth is still possible and although I may still have to have a c-section if there is medical reason nearer the time, they won't agree to an elective on these grounds.

To say I'm having sleepless nights is an understatement, I have been through so much this pregnancy already - bleeding from week 5, severe morning sickness weeks 9-20 (I was bedridden), colposcopy 16 weeks, pre-term labour 23 weeks, cervical stitch 24 weeks, uterine artery notching and complications and pretty much full time bed rest since then!

Any advice or thoughts welcome.

 

[FlatShoes]

Awwww hun - sounds like you've had a really bad time of it.

I can't offer any advice except that if youi want a c-section push for it! Sounds like you have more than enough reasons to!

xxx

 

[Phinners]

They are saying no to an elective but saying you might need an emergency section? Hmm do they know the term 'medico-legal' at all? I'd stand your ground hun, the emergency section carries the biggest set of risks of all.

 

[SophiasMummy]

my measurements at 34 weeks were:

head circumference 314.7 mm
abdominal circumference 301.5 mm
femur length 69.1 mm (her dads fault as he is 6ft 3)
and they estimated her to be 5 lb 8 oz

mine are all higher end of average they sed my LO will be around 8 and half - 9 lbs if she comes on her due date

i personally think that my baby sounds big as im only 5ft 4 but drs sed i should be able to deliver her without problems. but if she was any bigger i would be pushing for a c section aswell even without al the problems that you have had.

i hope they let you have your baby the way you want to

 

[Noodlejuice]

Personally, with your medical concerns relating to procedures you're going to have to have done it sounds like you do have "medical grounds" for a c-section, especially with a larger baby to boot! I'd keep pushing for the c-section if that's what you want hon - do you have a consultant or doctor who knows more about your other conditions who could maybe fight your corner on this?

xxx

 

[mpg1502]

They are saying no to an elective but saying you might need an emergency section? Hmm do they know the term 'medico-legal' at all? I'd stand your ground hun, the emergency section carries the biggest set of risks of all.

Thanks Phinners, I have to do what's best for the baby and me. I am not taking a c-section lightly, far from it. It's major abdominal surgery and that also scares me to death. Six weeks of no driving, difficulty moving around etc. I'm under no illusions.

All along they have suggested that I may require a c-section, now I've been lucky enough to get to 34 weeks and the cervical stitch has more than done its job they seem to have about turned and said, well actually despite all your other problems and the potential problem that if this baby continues to grow at this rate then it will more than likely cause complications we think you can just have this baby normally. They are particularly taking my bowel surgery lightly, my consultant even had the audacity to say that "all Harley Street surgeons are charlatans"... excuse me I've had this condition for over 20 years, I always knew at some point that I would have to have the majority of my bowel removed. I've had several "second opinions" on this and the conclusion is always the same. My bowel does not work and without surgery it will only get worse. I cannot even begin to think about a life of double incontinency.

All in all I feel a bit let down really and am beginning to feel a deep sense of foreboding about the whole thing. Having gone from one set of worries that we would lose our baby, to doing all we can to keep her in, to worrying about the potential serious effects of all the medication on the baby, I am now only sleeping 2 hours a night wondering how how on earth I am going to get through the birth and how it will affect me afterwards. I have also been told that there is a chance of vaginal prolapse because my cervix is so weak. Anything else I can possibly fit in do you think????

Sorry to rant on!!

 

[Phinners]

Have you come across the NICE guidlines on cesarians? This is what they all go by now.

https://guidance.nice.org.uk/CG13

It's lengthy at 160 pages but it's very comprehensive, it may help you.

 

[Natasha87]

I would definitely stand your ground and demand a c section. By the sounds of it, You surely have enough medical reason for one. Good luck for your scan Friday xxxxx

 

[Phinners]

They are saying no to an elective but saying you might need an emergency section? Hmm do they know the term 'medico-legal' at all? I'd stand your ground hun, the emergency section carries the biggest set of risks of all.

Thanks Phinners, I have to do what's best for the baby and me. I am not taking a c-section lightly, far from it. It's major abdominal surgery and that also scares me to death. Six weeks of no driving, difficulty moving around etc. I'm under no illusions.

All along they have suggested that I may require a c-section, now I've been lucky enough to get to 34 weeks and the cervical stitch has more than done its job they seem to have about turned and said, well actually despite all your other problems and the potential problem that if this baby continues to grow at this rate then it will more than likely cause complications we think you can just have this baby normally. They are particularly taking my bowel surgery lightly, my consultant even had the audacity to say that "all Harley Street surgeons are charlatans"... excuse me I've had this condition for over 20 years, I always knew at some point that I would have to have the majority of my bowel removed. I've had several "second opinions" on this and the conclusion is always the same. My bowel does not work and without surgery it will only get worse. I cannot even begin to think about a life of double incontinency.

All in all I feel a bit let down really and am beginning to feel a deep sense of foreboding about the whole thing. Having gone from one set of worries that we would lose our baby, to doing all we can to keep her in, to worrying about the potential serious effects of all the medication on the baby, I am now only sleeping 2 hours a night wondering how how on earth I am going to get through the birth and how it will affect me afterwards. I have also been told that there is a chance of vaginal prolapse because my cervix is so weak. Anything else I can possibly fit in do you think????

Sorry to rant on!!

Oh hun that all soudns just awful, I really feel for you. What a bunch of ****s, to put it quite mildy actually.

There has to be other cons you can see, I would look at a 2nd opinion. In fact they HAVE to refer you for a 2nd opinion if they do not agree to an elective. It states this in the NICE guidlines.

 

[mpg1502]

Personally, with your medical concerns relating to procedures you're going to have to have done it sounds like you do have "medical grounds" for a c-section, especially with a larger baby to boot! I'd keep pushing for the c-section if that's what you want hon - do you have a consultant or doctor who knows more about your other conditions who could maybe fight your corner on this?

xxx

Thanks Noodlejuice, it's interesting you should say that I have medical grounds as the midwife even admitted that at "any other hospital" I would be given an elective on these grounds but at this hospital they just do not give elective c-sections UNLESS.... and here is the interesting part... I say that on pyschological grounds I am not up to it.

She also said that nearer the time this may change and they may suggest a c-section due to abdominal/head size or if the baby stays in breech position but I cannot choose to have one myself. And I was also told that I could not say in my birth plan that I would not want Forceps used. Apparently you cannot say that?

So even though I think I do have substantial medical grounds for a c-section I feel really like I'm being bullied into doing whats easiest for them. Despite the potential risks that I may have to not only my bowel but my future ability to have babies. Not that that's likely as I have been 11 years trying to have this one!!!

So unless I just throw in the towel and say, I am psychologically unprepared for birth and not able to go through with it they won't consider it unless I get myself into some sort of emergency situation.

Its crazy.

 

[Phinners]

Wtf, they sound potty. Of course you can say what you want in your birth plan. Anyone comes near me with forceps there will be a fuck load of trouble! And I will make sure my wishes are known on that. I am amazed that they are still used. I'm really quite cross now.

 

[mpg1502]

Thank you all for your replies, I really had begun to think I was just being pathetic and asking too much (and I'm sure that some people will think I am) but I really don't want a c-section because I think its an easier way out.

I have been through hell and back to have this little baby, a decade of trying, 5 years of assisted conception, IVF, operations etc. I don't want to fall at the last hurdle and ruin where I've got to.

I've already nearly lost her once, I don't want to even contemplate losing her again. And I want to be the best mother I can be once she gets here, I don't want to be in a terrible state after a traumatic birth with more years of surgery and repair ahead.

 

[Phinners]

Oh god, I'm so sorry I totally misunderstood, I thought you wanted a section! My apologies xx I hope you get what you want ansd all goes smoothly.

 

[mpg1502]

No you haven't misunderstood, I DO WANT A C-SECTION !!! most definitely

sorry if I confused you!!

 

[mpg1502]

Sorry Phinners,

What I meant was I DO WANT a c-section but not because I think its an easy way out but because I think it is the best option in the circumstances.

God sorry, just ready what I put and its totally confusing... lack of sleep you see !!

At this rate I will be totally incapable psychologically !!!!

 

[Phinners]

heheh glad we sorted that, sorry for the confusion about the confusion. Yes I want a section too, not because its the easy way (which it fooking isnt) but because I feel it's the safest option for us both.

phew blimey.

Right missus, go and read those NICE guidlines and get a good understanding of the policy and fight your corner using the evidence - then declare you are a bit tapped and they must agree to your demands. (tongue in cheek there, but you know what I mean)

 

[mpg1502]

Phinners, you have cheered me up no end! Thank you

Yup, I'll just have to go for the..

"Sorry I'm a complete loon and I won't let you take the cervical stitch out unless you agree to a c-section"


Thanks also for the document, just scanned through and now its all clear - costs!

Vaginal Birth £1698
C-Section (planned or emergency) £3,200

I'll gladly pay the difference !!!

 

[mpg1502]

Phinners, have just PM'd you

 

[Phinners]

Got it ta

I'd gladly pay the difference too - on the surface it does appear to be a cost cutting excercise and a stats lowering one too.

Isnt it just so horrible to be so in limbo and out of control with what is going to happen. I would love to be one of these tree hugging ladies who pop babies out in half an hour with not even so much as a twinge let alone a drop of 'ceuticals - but I'm not and not likely to be!

 

[Mrs IKW]

Im in a similar situation - I dont know all the measurements unless they are on my scan (Ill have a look in a minute) but estimated weight from the scan that I had at 35+2 was 6.5 pounds and I was told that LO's head is VERY big. When I asked about having an epidural the doctor said 'you will need an epidural with the size of that baby's head!!!' and she laughed! (I laughed too but from shock!) I have a fairly small pelvis so it could be a squeeze!

I am being sent for fetal monitoring on Monday when I will be 37+2 and to have another growth scan. The doctor said that if LO has continued to grow then she will recommend an elective C-section. If LO has slowed down then she will let me carry on.

Im a bit confused as she also said that due to the head size she will not induce me under any circumstances as if the head starts off in the wrong position in labour then it could mean problems and an emergancy c-section anyway.... I need to ask on Monday what will happen if I carry on and look like Im going to go overdue - if they wont induce me then what happens if the baby carries on growing - ie is really big at 41 weeks? Will it be a c-section then anyway?!

I guess I need to wait and see on Monday.... If I need to have a c-section then Id much rather have an elective planned one than an emergancy but who knows what she will recommend!!!

Ill see if I can find my measurements on my notes or on the scan...