QuestionHi there,
I'm a pregnant nurse, but not an L&D nurse, so I'm looking forward to your input. Last week, at 34 weeks gestation the sonogram said my (female) infant was only 3 pounds 13 ounces, but had grown an appropriate amount in the last month. I've had varying reports--that's somewhere between the 5th and 12th percentile for growth. Soond, I'll be getting a second opinion from a perinatologist because my ob/gyn's ultrasound was dead wrong a few months ago about me having low amniotic fluid, no truth to that ultrasound at all when I got a second opinion. I have many questions, but for one, if they are right, that she's IUGR, should I ask for a 3rd opinion before letting anybody deliver me early? AND if they are wrong, should I just try to switch to using the perinatologist this late in the pregnancy because of all the false alarms from my ob gyn office? I like my midwife/obgyn team, but I don't trust their sonographer's results in the least.
AnswerIt sounds like you are getting scared over a few things that really are nothing to get worked up over. First, the "low fluid" reading at your ultrasound. This is a newly-fashionable, yet highly suspicious, measurement. Measuring fluid levels at term is more of an art than a science, and as you have seen, two different people measuring the same woman can come up with wildly different results. The thing is, the studies that doctors are using to make these "low fluid" determinations were done on second-trimester fluid measurements and the resulting outcomes. Fluid levels at term are normally variable and can be very low without causing any harm to the baby. Based on the combination of these two factors, I would never make a decision on treatment based solely on a late-term ultrasound measurement of fluid levels...even if it was verified by two or three doctors. To me, the evidence doesn't back it up.
Now, to the IUGR. When it comes to babies, we have an unfortunate tendency to forget that human beings come in all shapes and sizes. Adults can range in size from 4'10" to 6'10", and this entire range in size is absolutely normal. But for some reason, we allow a similar size difference in babies and children, even when unaccompanied by any actual health problems, to be a "problem" all by itself. I don't feel this is healthy. Unless your uterine environment is truly compromised, your baby will almost always be better off inside than outside until she decides she is ready to be born...even if that means waiting until 42 weeks gestation. Meanwhile, as long as she is growing at a steady rate, it doesn't matter where she is on the "official" charts. If she has her own curve, that's okay, too. The concern would be if she suddenly stopped growing completely. Slow growth, in an otherwise completely healthy baby, is just a variation of normal.
Now, it is entirely possible to change doctors, even this late in the game. You have the right to change care providers even while you're in labor! I don't think you should switch to using a perinatologist as your primary care provider; as long as you don't have any demonstrable health concerns, you should be just fine with a midwife, and you will be safer during delivery. You can always transfer to the perinatologist down the road if it is necessary, but it doesn't sound like it is just now.
