MSE Parents Club Part 3

Lu_T

Skint - have you talked to anyone at NCT or similar? I know how you feel not wanting to be in hospital (it was absolutely NOT going to happen with me and Imogen), but I ended up being blue-lighted from the birth centre to the hospital and eventually had a c-section and 3 nights on the ward. It was sooo not what I wanted, but was actually the best thing in the end. I had refused to visit the labour ward up until being about 36 weeks, but did relent and have a quick walk round one evening after I'd had to go in to be monitored. In hindsight that was a good thing.

I guess my only advice is to focus on getting a good outcome in the long term, rather than just at the birth. By the time baby is 4 weeks old you probably won't mind at all what happened as you'll be so wrapped up in your gorgeous little bundle.

I can see your point about baby's weight and may well feel similarly if I was in your situation. Have they said what they would do in hospital if babes had to go? Perhaps if they were more specific about, "We'll have to do this and that test, it will take about X hours, then you can probably go home," you'd feel a bit better?

Sorry if this is a bit rambling. It's just off the top of my head.

Right, Imogen's just handed my her PJ bottoms (I'm dressed, she's refusing) and nipped off upstairs so I'd better investigate the banging. Hope you're all enjoying the sunshine - while it lasts!

r.mac_2

fingers crossed for you sami - that's just how I felt before going into labour x

LO being very good today and I even got to sleep last night so our staying at home day today is lots of fun. SO far we've played with all the rattles, played on the play mat and have been singing lots of songs. I'm hoping to get to jump in the shower in a minute or two.......

skintchick

MrsTine wrote: »

Just because your family history is of small babies doesn't mean much
My family: 7lb or slightly under
DHs family: Boys about 7lb spot on - girls: MIL - 9lb, SIL - 10lb and a few oz, Niece - 11lb exactly.

Roo: 8lb 2oz... so didn't follow either family trait and if you'd seen my belly you'd have said she'd have been a 10+lb baby!
8 weeks before due date I was measuring off the size they were happy with - yet last 2-3 visits I was back spot on again and they decided not to do any scans... The scans won't give an accurate weight really from what I have gathered - but more likely to tell you if you have a short or long baby LOL

I meant both families - my Oh is the same height as me! We are both from VERY small families. MIL is under 5ft and my maternal grandfather was also under 5ft. No giants in these families! The tallest we get is 5ft 8ins.

So definitely a short baby!

But yes I do know these things are not an exact science. Which is why it surprises me that they have this arbitrary 7lbs 'rule'.

Sami_Bee

Skinty - hopefully Weezl can wave her magic wand and find you some good research to help back you up, have you looked for any research on the cochrane database?
Its really annoyed me that they have said that about 7lbs when a baby isn't considered low birth weight unless they are less than 2500g (5.5ish lbs) Chris was 6lb 12oz and perfectly normal and healthy as was my sister and I at 6lb 5 and 6lb 6oz
average birth weight of full term babies is considered to be 6-9lbs also

My_Fathers_Daughter

Could the hospital stay be something to do with establishing feeding?

Benjamin lost 11.3% of his birth weight in the first 3 days and we were given a day to turn it around and start gaining weight or we would have been sent back to hospital to make sure Benjamin was feeding okay.

emlou2009

seth needs a cot, stat!! sami you do make me chuckle :rotfl: oooh that sounds a bit like i felt in the week before i went into labour, hopefully it will be a little speedier than that for you!!

beenie, how about clothes? i find parents of 1 year olds always despair of the amount of toys they get as they can only play with one at once, and you dont need to spend a fortune, we got lots of lovely clothes for seth as gifts from asda and you wouldnt know they were cheap ones.

FWIW i agree with mrstine about hospitals, theres a reason hospitals are there to be given birth in which is the reason i wouldnt personally ever give birth either at home or in a MW led unit, but in your case i think the 7lb is silly. do you know if they would make you go? someone at work fell down the stairs once and was given the choice by the paramedic to go to hospital or not and she flatly refused, IMO falling down the stairs has to be worse than a 6.5lbish baby IYSWIM!?

r.mac_2

My_Fathers_Daughter wrote: »

Could the hospital stay be something to do with establishing feeding?

Benjamin lost 11.3% of his birth weight in the first 3 days and we were given a day to turn it around and start gaining weight or we would have been sent back to hospital to make sure Benjamin was feeding okay.

just to carry on this conversation - my LO lost 10% of her birth weight in the first 5 days but they let us home from hospital - after another 3 days she was still loosing and we were told to formula supplement or have her taken back into hospital where she would be given formula (problem was my milk hadn't yet come in - so expressing and feeding in hospital wasn't an option).

MFD - I'm glad they gave you the option and that it's been so successful for you. Benjamin is thriving in his latest photos

Feelie - Annabel hasn't suffered from mixed feeding at all - she's a bouncy healthy little girl who takes EBM when I can get it, formula and still latches on too. Remember that we as mums are just as important as the babies - we need to look after ourselves in order to look after them.

right - spent too long on ebay - mse means I can no longer just go to a shop when I want to buy something - I have to spend DAYS researching the best price/package/offer/discount/ bargain out there! then we get onto the new or nearly new debate - :eek:

skintchick

My_Fathers_Daughter wrote: »

Could the hospital stay be something to do with establishing feeding?

Benjamin lost 11.3% of his birth weight in the first 3 days and we were given a day to turn it around and start gaining weight or we would have been sent back to hospital to make sure Benjamin was feeding okay.

No. She said it was to do with maintaining body temperature, as low wieght babies have trouble doing that. Which is fine, I just disagree with what they call low weight.

Sami_Bee wrote: »

Skinty - hopefully Weezl can wave her magic wand and find you some good research to help back you up, have you looked for any research on the cochrane database?
Its really annoyed me that they have said that about 7lbs when a baby isn't considered low birth weight unless they are less than 2500g (5.5ish lbs) Chris was 6lb 12oz and perfectly normal and healthy as was my sister and I at 6lb 5 and 6lb 6oz
average birth weight of full term babies is considered to be 6-9lbs also

I was rather hoping Weezl might be able to help!

I will look on that database - hadn;t heard of it before.

Do you have anything official to back up that 5.5lbs thing? Because that is more the kind of weight I'd consider to be low, and I'd love to be able to prove that to the consultant in an official way.

weezl74

skintchick wrote: »

on a different note I wondered if any people who have been through this can help me? I am measuring small for dates and going for a scan next Thursday. But no-one in our family has been over 6lbs, and I've been told that if the baby is under 7lb then even if I have a homebirth (they will try to bully me into hospital if baby is small, despite it clearly being the family norm) then baby will have to go into hospital straight after.

Obviously the point of a HB is not to go into hospital, so I wondered if anyone had been through this and could advise?

Hi skintchick,

this is from the homebirth.org website:

wrote:

'A bit small' needn't be a problem; what you really need to find out is if, as is most likely, your baby is just 'constitutionally small' , ie smaller than average because that's the right size for him/her, eg if you yourself are small, OR if your baby may be suffering from intra-uterine growth restriction (IUGR), which is where the baby is not fulfilling its growth potential because it has a health problem or is not receiving enough nourishment through the placenta.
Being 'constitutionally small' isn't a big deal as far as homebirth is concerned - the issues are just keeping warm and establishing breastfeeding, both of which can be done as well or better at home as in hospital.
Babies who are suffering from IUGR are at genuinely increased risk of stillbirth and other complications, especially post-dates. It's part of an obstetrician's job to help tell IUGR babies from babies who are constitutionally small, and while it's not foolproof, there are characteristics which can be used to identify IUGR babies. Some research on post-dates pregnancy suggests that the vast majority of stillbirths post 42-weeks is actually in babies suffering from IUGR (see https://www.gentlebirth.org/archives/datesppr.html). It's certainly arguable that many IUGR babies might be better off in hospital, and it sounds like many will benefit from being induced before term if they really aren't doing well in the womb, but what about all the babies who are small, but who aren't suffering from IUGR? Exposing them to unnecessary intervention, and delivering them before they are ready, is not being 'on the safe side' as far as those babies are concerned; it is actually increasing their risk of problems.
Looking at the NHS guidance on Small for Gestational Age (SGA) babies, it seems it's common to flag up the 10th centile and below, and some people will call all these babies "IUGR". There is a good article about this on the NHS's patient database (http://www.patient.co.uk/showdoc/40000204/)
In fact, according to that source and others, about 7 out of 10 of those babies in the bottom 10% for size/weight will be "constitutionally small", ie this is the right size for them given their genetic background - but the remaining 3 out of 10 are suffering from growth restriction. Here's some of the text:

Of the 10% of babies with IUGR by the definition, about 7% will be constitutionally small and 3% will have pathology. Babies may be genetically small without pathology as are adults. Perhaps both parents are small. There may be racial differences. Babies of Indian race tend to be a little smaller. If the fetus is in the lower centiles but continues to grow within those centiles, this is reassuring but if growth is slow and the fetus is falling into lower centiles, this is cause for concern.

from http://www.patient.co.uk/showdoc/40000204/
There are ways of identifying the baby who is suffering from true IUGR rather than just being constitutionally small:

By and large, when the problem is placental insufficiency, the head is not as restricted in size as the abdominal girth. This represents preferential nutrition to the brain with a lack of glycogen stored in the liver...
...Criteria suggesting IUGR include an increased ratio of femoral length to abdominal circumference, an increased ratio of head circumference to abdominal circumference and oligohydramnios.

The GROW customised growth charts are recommended by the NHS Perinatal Institute to help sort out the babies who are constitutionally small, from those who are genuinely at risk. They customise expected foetal growth based on the mother's individual size, ethnic background etc, to reduce the number of babies who are flagged up as 'small for dates' when actually they're perfect for their own family.
Here is some info from the GROW website:

GROW (Gestation Related Optimal Weight) is the software used to generate a customised antenatal growth chart. The chart is based on the calculation of an individualised weight standard for the duration of the pregnancy, adjusted for the physiological variables of maternal height, weight in early pregnancy, parity and ethnic group.
After the maternal and pregnancy details (including expected date of delivery) are entered into the software, the chart can be printed out and attached to the maternity record. The Perinatal Institute has developed hand held Pregnancy Notes (https://www.preg.info) with an adhesive strip for the charts and explanation of their use for fetal growth assessment.
The charts can be used for plotting fundal height and estimated fetal weight, and assessed against the individually predicted or 'customised' standard.

(https://www.gestation.net/fetal_growth/fetal_growth.htm)
Here's some more References on GROW charts from the NHS Perinatal Institute about those charts - http://www.preg.info/evidence/page12/page12.htm - might be useful if you want to investigate it further, or if your midwife/doc is not familiar with the customised charts.
Another useful resource for anyone worrying about a small baby is the Royal College of Obstetricians and Gynaecologists' guidelines on the Small-for-Gestational-Age (SGA) baby, Guideline no 31, November 2002, http://www.rcog.org.uk/resources/Public/pdf/Small_Gest_Age_Fetus_No31.pdf
They say that screening tests need to be interpreted carefully as most make no allowance for other factors known to affect foetal size, such as mother's ethnicity and height, parity and foetal gender. (p2). They also say that if SGA is defined as the lowest 10% of birthweight, about 50 - 70% of these babies are constitutionally small and the rest will be suffering from Fetal Growth Restriction (FGR) - another term for IUGR. It explains that SGA babies are at increased risk of stillbirth and hypoxia and other complications, but that the reason for the increased risks is the high proportion of small babies who are actually suffering from growth restriction.
The RCOG recommend use of the GROW customised foetal growth charts because it is better at detecting small babies than the standard charts, and reduces unnecessary hospital visits for further investigations. These customised charts are apparently better for fundal height, growth scans and birthweight (p3/4). Furthermore, looking at whether the baby is growing over a period of at least two weeks is more accurate than looking at a snapshot at one point in time. The interval between scans should be at least two weeks.
They also say that :

"A systematic Cochrane review has shown that routine ultrasound after 24 weeks in low-risk pregnancy does not improve perinatal outcome". (p4)

Something else interesting: where it really does look like the baby may have a problem, umbilical artery doppler scans have been shown to significantly improve outcomes while reducing unnecessary induction and other interventions. It's not recommended as a routine screening tool, only to be used selectively where there is concern about a small baby .(p5/6). Now that does sound like a good use of the technology.
The RCOG guidelines finish with something a bit less detailed, and not as sensible-sounding to me, but I'm biased! I don't want to cherry-pick and only draw attention to the bits I agree with, though - having spent most of the paper saying, basically, most SGA babies are perfectly normal and here are ways to identify the ones who may need extra help, they then say all SGA babies should have continuous monitoring in labour. Now I suppose if you've used a customised growth chart then many babies would not be labelled as SGA in the first place, so this wouldn't apply.

seems the main reason for wanting to monitor the newborn then would be because of the risk of deaqth in IUGR babies who'd gone postdates? If they thought you were a likelihood of IUGR they'd have flagged this up already and therefore odd to threaten it after the birth IYSWIM? I think you've got a good case for standing your ground.

Another thing I'd add though, if it's ok to give my 2p, is that my feeling on HB was that I wanted us to labour at home for as long as possible because I believed it was safest for us to do so, with even every half hour mattering. Therefore it wouldn't be a failure to transfer in either during or after the birth, cos I'd have done my best to stay at home as long as poss. So I guess what I'm trying to say is, even if they do decide to take you in afterwards, you've still gained loads by labouring at home as long as you could...

r.mac_2

great googling again weezle

I have a problem emerging that I want to try and tackle - can anyone help?

LO is 4 months old. She was sleeping 8-10hrs through the night until the weekend of hot weather. Now she will go to sleep (usually feeding/nursing) for 45 mins then wake up and cry - really cry! so we try and settle her, when she goes back down its again for only 45 mins. Eventually the pattern continues until she's really upset and we're really upset and we cave in and she ends up in bed with me for the night

she's not hungry or needing changed and is the right temp now the weather is back to normal. the HV suggested putting her down awake (v hard but we are trying) and letting her cry for a max 5 mins then going in settling her and letting her try herself again. We've been trying our hardest, but she's getting herslef sooooo worked up and upset.

she's currently refusing to sleep and letting everyone kow about it!

Can anyone offer any tips to try? Head a bit fuddled with screaming so soryr if this makes no sense