What if Your Baby is Measuring too Small?

The numbers of labor inductions are increasing today. It seems that there are a host of reasons that a care provider may recommend an induction, including going past a due date or for a suspected big baby. Even women who are told their baby is too small may be advised to induce their labor.

What is IUGR (intrauterine growth restriction)?

IUGR is an acronym for “intrauterine growth restriction.” An older term for this same condition was known as “intrauterine growth retardation.” IUGR means that the baby is small for his/her gestational age. Or your care provider may explain that the baby is not falling within the expected growth pattern for that particular week of pregnancy.

What is SGA (Small for Gestational Age)?

One result of IUGR is that babies are frequently born with a lower birthweight. If these babies are under the 10th percentile for the gestational week, they are called “SGA” or small for gestational age. It is more likely for babies with SGA to have complications such as longer stays in the NICU, trouble maintaining their temperature and problems with meconium. This is one reason why care providers watch mothers with IUGR more closely during pregnancy.

Why is Labor Induction Advised with IUGR?

One of the long-held beliefs about a baby with IUGR is that if the baby too small in utero, the baby will thrive better outside the uterus. Providers have recommended early induction of labor in order to give the baby a better chance to begin to gain weight.

Statistics show that in some areas, twice as many women with IUGR are induced early as compared to women without IUGR. It’s not surprising that these early inductions can more likely lead to instrumental deliveries and cesareans without showing improved health outcomes with babies.

Mothers who know little about IUGR may agree to an induction simply because they are not informed about any other options and do not wish to go against their provider’s advice. The truth is that there is growing evidence that recommending an early induction for babies who are small may not necessarily be the best course of action for every mother with IUGR.

Is it Safe to Wait for Labor to Start if You Have IUGR?

So the real question is that even though we know babies are at a higher risk for complications when they are small, does the mother or baby benefit from being induced?

Researchers in the Netherlands looked at this very issue. 650 mothers diagnosed with IUGR from 40 hospitals were randomly assigned to two groups; one where the mothers were induced and the other group of mothers who waited for labor to start.

Results showed that the median birth weight of the babies whose mothers had been induced was significantly lower than the weight of babies whose mothers were not induced. Outcomes of babies in both groups were similar. As a result, the lead physician in this study states that:

“We now have an evidence-based reason to individualize care and to allow women to do what they are most comfortable with when deciding whether to induce labor or wait, although long term outcomes [from the study] have to be awaited.”

In some cases, it may be perfectly safe to wait for labor to start even if mom is told her baby is too small. Parents should be encouraged to seek out all options for a baby who is measuring small during pregnancy to be certain of what is best for their baby.