# IUGR Induction- When is section 'safer'?



## onetwoten (Aug 13, 2007)

First off- there was a fantastic post a few weeks ago filled with ideas to naturally induce- does anyone have it bookmarked? I can't find it...

I have a client, 35 weeks, with suspected IUGR from about 21 weeks on. Baby has been growing fine until this last FA, where he hasn't grown in three weeks, he's sitting at about 4.5lbs. Mom also has been struggling with alternating high BP, but last Wednesday, she was completely normal, back to about 115 over 70 again. They're keeping an eye on her.

She goes to her doctor on Wednesday, and another fetal assessment next week, but they're already on high alert for induction, and she's very worried about the cascade effect. Anything we can do to eliminate the need for a chemical induction, and then an epidural, and then a c-section, would be fantastic... I swear I remember reading a study about the gestational age at which is was safer for a baby to be born vaginally than by c-section, but I can't find it, or even figure out what search terms would get me close. We want some hard evidence, so that when the OB tells her she "has" to have a section, we have something to back us up. I'm hoping for if nothing else, then a trial labor, with some fetal monitoring- my understanding is that as long as the baby's heart rate is responding fine, a vaginal birth should be better for him?

For induction, I'm going to mention evening primrose to her, so that if they DO induce her, hopefully it will take better, and they can turn the pitocin off, and also won't tell her that it's "not working" and wheel her in for a section. Any other ideas are greatly appreciated. We're also looking at having her eat as much as she can before she goes to the hospital so that she's not feeling weak and tired, as well as as much walking and standing as possible, even with the monitor on, if they'll let her. We want to avoid them breaking the waters until her cxns get going as well.

Any other suggestions? I'd love to find the research about safety of vaginal as opposed to c-section.


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## kerikadi (Nov 22, 2001)

Quote:


Originally Posted by *jeninejessica* 
I have a client, 35 weeks, with *suspected* IUGR from about 21 weeks on. Baby has been growing fine until this last FA, where he hasn't grown in three weeks, he's sitting at about 4.5lbs.

How could they possibly know baby's weight?
Any chance it is better for her to just wait for natural labor? Will she entertain that idea?

Quote:


Originally Posted by *jeninejessica* 
I swear I remember reading a study about the gestational age at which is was safer for a baby to be born vaginally than by c-section, but I can't find it, or even figure out what search terms would get me close.

Ummmm how about always? Everything I have ever read says vaginal birth is always safer than cesarean unless there are some major issues and a true emergency cesarean is necessary ie cord prolapse and true previa.


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## zoeyzoo (Jul 6, 2007)

Hopefully someone will have the link but u/s weight estimates can be off two pounds toward the end of gestation.


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## onetwoten (Aug 13, 2007)

Ohh trust me, I know how much weight estimates can be off! I think it was more that the measurements have beenlow, but increasing ok up until last week, and then there was no change from the fetal assessment three weeks ago. The reason it was 'suspected' at 21 weeks is because her placenta looks like it did not form properly- it's over my head, but the explanation she got was that the sounds from the doppler indicate that the blood flow through the cord isn't 'normal'. Up until now it's given no problems, but it looks like it might be making a difference finally.

For now we're just hoping baby will hold over, and they are doing an assessment again a week after the last to see if maybe it was a fluke, but since we've been warned of this, we're preparing ourselves that they say baby needs to come out sooner rather than later. From research I've done- iugr is one of the few times that induction is actually necessary- unfortunately it usually results in a c-section, which we don't want.

I should have explained about the c-section being better part- a lot of doctors will tell you it's safer to have a c-section for preemies because it puts them under less stress. I read a study once that talked about a gestation period at which the baby was more likely to fare better if born vaginally- the study found that before that, it actually *was* better to have a section. I liked this study though because the dat ewas early- I think it was 32 weeks- and since she's past that- I wanted to be able to give it to the doctor and say well here- research shows she's better to deliver vaginally.


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## Lousli (Nov 4, 2003)

Very tiny preemies can fare better with a C-section, it lowers the risk of a brain bleed. But this is for babies that are very premature, I think probably as early as 26 weeks or less. Larger preemies will do better with a vaginal birth because it helps them clear fluid from their lungs.

Has her OB already started pushing the idea of a c-section or are you just preparing for that possibility? I'm wondering because when I had my dd (33 weeks, 4 pounds) they were very hopeful for a vaginal birth and tried to encourage it.


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## onetwoten (Aug 13, 2007)

She's hasn't pushed yet, she actually seems to be pretty supportive of her going natural, but since it's on rotation, and we don't even know for sure who we will get, we want to be armed with information to back us up. She's also very worried about being induced, and then ended up with an epidural, and then ending up with a section. It just seems like every new 'thing' that pops up, upps her chances for them wanting it medicalized.


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## Robinna (Aug 11, 2003)

I tried a google scholar search for you yesterday on this one but nothing is coming up that isn't related to very specific fetal issues. will try again later if I get a chance.


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## etoilech (Mar 25, 2004)

Quote:


Originally Posted by *Lousli* 
Very tiny preemies can fare better with a C-section, it lowers the risk of a brain bleed. But this is for babies that are very premature, I think probably as early as 26 weeks or less.

Do you have a reference on that? I'd be really interested in adding this to my "birth files". Thanks!


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## Lousli (Nov 4, 2003)

I don't have a reference. It is something I've read many times from other preemie moms here. Many of the micropreemie moms here have referenced this. I assume that they know their stuff.


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## Leav97 (Oct 23, 2004)

It's been a while since I did any research on IUGR.

When I looked into IUGR complications after my DD was born (full term 4lbs 14oz) one of the common complications is that the baby is not as likely to handle birth as well. With my DD we had problems with her heart rate dropping and ended up having a vaccum delivery. I would think an induction would make these problems more likely.


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## etoilech (Mar 25, 2004)

Quote:


Originally Posted by *Lousli* 
I don't have a reference. It is something I've read many times from other preemie moms here. Many of the micropreemie moms here have referenced this. I assume that they know their stuff.

I am sure they do, it just doesn't help me when writing a paper. I'll ask elsewhere. FTR, I am a preemie mum and I've never heard this which is why I asked, in addition to having a nifty, handy reference for my midwifery course work.


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## JElaineB (Nov 12, 2005)

Quote:


Originally Posted by *ZoeyZoo* 
Hopefully someone will have the link but u/s weight estimates can be off two pounds toward the end of gestation.

I'm sure they can be, but they can also be very accurate. DS was estimated to be 5.5 lbs. on Monday or Tuesday before his due date, and he was born 5.5 lbs on his due date (Friday) at full term. We knew about the growth restriction for several months. Since he was going down in percentiles I was induced. For 2 days and they did everything they could to get him to come out without a c-section, but my cervix didn't budge. Turns out something like 30% of my placenta was dead. I had many post-birth complications that I believe were caused at least in part by the induction. If I was ever in that situation again and did not go into labor on my own I would go for a c-section instead of induction, as for me trying another induction would not be worth it.


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## onetwoten (Aug 13, 2007)

Thanks for the discussion guys. She's holding on ok so far, although feeling guilty that she can't 'provide better' for him. Her mother keeps telling her to give up hopes for a natural birth and not be selfish, as long as he's healthy. It breaks my heart to hear people say that.

She has another assessment on Tuesday as well as a Dr's appt right afterwards, and they'll make their decision then. If he hasn't grown, then they'll start induction on Wednesday likely. Her Dr prepared her that an induction will take a few days (YAY for smart doctors who know their stuff!) and this would work well because her Dr is on call next weekend, so would get to deliver. She will also be 36 weeks on Friday, so this means she wouldn't have to automatically go to the High Risk, which her caregiver is trying to avoid. I'm liking this Dr more and more every time I hear from ehr!!
I told my client she should look into taking EPO to help soften her cervix for the induction. Of course we're both still praying that baby will have grown a little bit, in which case they said they'll hold off until the week after- 37 weeks and term.


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