In general, I lucked out with my pregnancy. Morning sickness was brief, I had minimal food aversions, managed my sciatica, and avoided health conditions like preeclampsia and gestational diabetes. The worst part was the toll on my body from gaining 40: pelvic/pubic pain, hip pain and lower back pain.
My third trimester was a little different than the rest. In bringing closure to my pregnancy journey, I hope that my story resonates with and supports another mom out there.
By my third trimester, I really thought that I had done everything “right”. I was eating healthy and lightly exercising most days. My weight gain was consistent month after month. Most importantly, baby’s heartrate was strong at every appointment.
My doctor mentioned a few times during the second trimester that the baby was on the smaller side. At my 19-week anatomy scan, the baby looked to be 5 days smaller than the gestational age. At a 23 week ultrasound, it remained a few days small. Nothing of major concern, to my understanding.
I can’t remember if my 27-week ultrasound was routine, or scheduled specifically to check its size. Regardless, it was then that my doctor had a more serious conversation with me – it still looked small, specifically the abdomen, and I was going to need to return in another month for a growth scan.
My 31-week appointment: unlike every other appointment, I saw my doctor before the ultrasound. As a result, I received the results of the growth scan via a phone call from a nurse whom I had never met. In what seemed like a foreign language, she said I was being referred to maternal fetal medicine (MFM) for inter-uterine growth restriction (IUGR).
I didn’t know anything about MFM other than I needed to go to the hospital to see them. Then nurse was clearly not very familiar with IUGR. The only helpful tid-bit she relayed was that “maybe” the notes said “something” about the 5th percentile.
At 32 weeks I went to see an MFM for the first time. From then on, my pregnancy stopped being routine.
IUGR is when a fetus in the less than 10th percentile for its gestational. The baby can show asymmetrical or symmetrical growth restriction. Asymmetrical growth restriction, which was my case, is when one of those measurements is disproportionate to the rest, most commonly the abdomen.
IUGR is usually caused by one of three things: Infection, Down Syndrome (or chromosomal abnormality), or an unhealthy placenta. A small abdomen suggests that the placenta is not providing the baby enough adequate nutrients, therefore the fetus allocates the nutrients to the vital organs like the brain and heart and neglects the stomach. It is also possible that the mom simply grows small babies.
Small babies are at higher risk for pregnancy or birth complications. Specifically, babies in the 3rd percentile are at higher risk of still birth. Because of this, patients with IUGR get referred to MFM.
At 32 weeks my baby’s growth had been slowing and the total weight measured in the 3.5% percentile. The measurement that was skewing the total was the abdomen, which was in the <1%. I was determined to be a high-risk pregnancy and told that I would not be carrying to term.
IUGR patients are induced between 37 and 39 weeks. In my case, the MFM doctor didn’t advise carrying beyond 37 weeks. Rather, I was to have a growth scan at 34-weeks to make sure the baby was continuing to grow. If the baby didn’t show enough progress I would be induced then. The rationale was that the environment in the NICU would be more conducive to growth than the womb.
With this knowledge, it was time to take action. The first thing the doctor’s recommended was to eliminate some “causes” of the IUGR. I got blood work done and was able to rule out infection. Mark and I opted out of genetic testing – we were largely influenced by the doctors assuring us there were no other physical markers of a disorder. Lastly, there is no way to “test” the health of the placenta.
The second thing the doctors did was establish a new protocol for how I would be monitored. In addition to bi-weekly growth scans (34 weeks and 36 weeks to be done with the MFM doctors), I was to have weekly NSTs and BPPs. Any abnormalities in these tests could result in an early delivery.
NSTs (non-stress tests) are common for a range of “complications”. You sit reclined in a comfy chair with a monitor around your belly for 20 minutes. The monitor tracks the baby’s movement and heart rate. The doctor looks for three movements/accelerations and for it to regulate itself afterwards. BPPs (bio-physical profiles) are ultra-sounds that monitor eight characteristics of baby’s health, such as fluid level, heart rate, a doppler reading of the blood flow in the umbilical cord, and movements of the diaphragm (hiccups or the baby practicing breathing). You get scored 8/8 if everything checks out perfectly.
I was given all of this information in a15-20-minute conversation with the high risk doctor. It was too much to process. Mark came home early from work that day and we spent the day on the couch with lots of cookies.
Yet it was hard to panic. Up until that day we were told everything looked great. All of the organs were growing and functioning as they should. The baby was moving a LOT, which both MFM and my OBGYN said was the most promising sign. The heart rate was strong. It was almost impossible to wrap our heads around something being wrong.
Many people would have been frustrated, anxious, or overwhelmed by the lack of control. I surprised myself when I realized this made me more calm. I knew I had done everything “right”, therefore I believed that if my child did have a disorder or needed to be induced pre-maturely, I was chosen to be his or her mother for a reason.
There were two nights those first two weeks that I prayed to my abuela. My version of prayer is to internally talk to her after I lie down to go to bed. I asked that she take care of my baby. Whether the baby was small, had a health condition, or the placenta was unhealthy, I believed Abuela would make sure the baby came into this world safely.
Sure enough, at my 34-week growth scan, the baby had gained a full pound. While the abdomen was still in the <1%, the total size increased from the 3rd percentile to the 9th. The MFM recommendation changed from inducing me at 37 weeks (March 2nd as discussed with my OBGYN) to 38 weeks. I now believe my baby has a guardian angel in Abuela.
Despite this good news, my next NST didn’t go as smoothly. The baby was incredibly active – kicking and rolling back and forth. The baby was so active that the baseline of the heart rate was consistently close to 180 beats per minute (vs. my typical 150-160). The heart rate hit 190 a lot. The doctor kept me hooked up for a full hour vs. 20 minutes, and the baby’s heart rate never normalized. I was sent to labor and delivery at the hospital.
They checked me in as if I was having the baby. Not knowing what to expect, I looked for cues from the doctors and nurses to gauge if Mark needed to leave work and come to the hospital. They hooked me up to the monitors and I waited. Luckily, the baby’s heart rate had normalized, and I was able to go home after another hour of monitoring.
The Monday of week 36 I went back to MFM for a growth scan and their final recommendation for delivery. This time the news seemed even better. The baby had gained over another pound. The abdomen had increased from the <1% to the 6th percentile. The total weight of the baby increased to the 17th percentile. For the most part, we were out of the woods.
The fact that the abdomen was still asymmetrically small and within the 10th percentile warranted an early delivery. The MFM doctor gave a final recommendation of delivering at 39 weeks. I asked what the difference was between 39 weeks and carrying to term, but she still felt that the risks associated with delivering a baby with a small abdomen outweighed the benefits of going into labor naturally. I was to continue weekly NSTs and BPPs and, like before, if anything looked less than perfect, would be sent to labor and delivery. My last growth scan would be set for a few days before my induction date.
The Tuesday of week 36 I went to my OB/GYN for an NST. My OB/GYN was thrilled with the growth and we scheduled my induction for March 15th. We also scheduled a BPP for that Friday. Technically I got my weekly BPP at MFM that Monday, but my doctor suggested that I go at the end of the week as to not go too long between scans.
The Friday of week 36 I logged off of work early and went to my BPP. At first the ultrasound tech said that the baby’s diaphragm wasn’t moving. According to her, this isn’t atypical. While babies get the hiccups and practice breathing in the womb, it doesn’t happen 24/7. However, that brought my BPP score to a 7/8 and I would need to have an NST. After about 10 minutes of monitoring, the nurse practitioner came in with some news I wasn’t expecting.
It was time.
The way she described it was that doppler of the umbilical cord indicated that the placenta was working too hard to flow blood to the baby. That brought my BPP score to a 6/8. The lower score in consideration with the reactive NST at 34 weeks and the small abdomen brought the doctors to determine I should be induced that night – midnight on the dot so that I would officially be 37 weeks.
And just like that, my third trimester and entire pregnancy came to an end! Two days later our sweet, healthy, baby boy Grady was born, and our lives are forever changed.
Though we are assuming an unhealthy placenta caused the IUGR, the cause of Grady’s small size was never diagnosed. In fact, none of the doctors or nurses mentioned the IUGR after he arrived safely. For something that caused so much stress and called for so much attention for so many weeks, it shocks me that it warrants almost no conversation after the fact. I am already wondering how they are going to treat my next pregnancy. If I have another small baby, will they put me through the extra testing? Will it be accepted that I simply grow small babies? Luckily we don’t have to worry about it for another few years.
For the most part, I was able to stay positive during my third trimester. Rather than look at all of my extra appointments as an inconvenience, I told myself I was lucky to hear my baby’s heartbeat every week and see it in an ultrasound every week – most women only get that a few times during their pregnancy.
How did I cope with all the uncertainty? I focused on controlling the controllable. I packed our hospital bag at 33 weeks in case I had to be induced. I packed the hospital bag as if we were going to stay 4-5 days for a c-section (which was more likely with a small baby). I hustled to finish prepping my frozen meals by week 34 as well. When I had my baby shower at 35 weeks, I had my family help set everything up immediately afterwards, not knowing what would come of my 36 week ultra sound.
And ultimately, I trusted the doctors and my Abuela.
Stay tuned for my next post that shares all about my experience being induced.
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