Fetal Growth Percentiles

One of the aspects of "growing children" that I find personally fascinating is growth percentiles.
These percentile measurements begin in the second trimester and continue all through childhood as a way of monitoring growth, both height and weight.

My interest in percentiles began in high school when my first standardized testing scores came in the mail. I had scored between 95th and 99th percentile in every category and wanted to know what that meant.

In the simplest terms, it meant that in any given group of approximately 100 students, my scores were better than 95-99 of them. I was pretty pleased with myself, to say the least!

Once I entered the second trimester of my first pregnancy, I began to follow my daughter's fetal growth in terms of percentiles.  She tended to measure well above the 80th percentile and even after birth, has been consistently on the tall side for her age group. I realize this won't last through puberty (she is not destined to be 6 feet tall), but it has been a lot of fun being the mom to "the tall kid".

Her younger sister, on the other hand, has always measured below the 60th percentile.  Even now at 4 years of age, her height and weight remain in the 40th to 50th percentile. She's my averaged sized kid, even if she seems so tiny to me!

My last growth scan was 3 weeks ago.  I mentioned in that post that Dash was measuring in the 40th percentile and although it made me a little uncomfortable to have her on the lower half of the growth chart, I wasn't too concerned because my second child is smaller.

Fetal Growth Chart

Well, that has all changed. . . for the better!

To calculate percentiles in fetal growth, several methods can be used. The methods I'm most familiar with include measuring the length of the femur, the circumference of the abdomen, and head circumference. The measurements are put into formulas that calculate the percentile for each as well as an overall measurement.

They can also be used to estimate fetal weight.  Today, Dash's measurements put her at 760 grams, or 1 lb 10 oz. For someone who has no idea how that compares based on her expected growth, the percentile measurement gives me information that is more relevant to my knowledge base: 69th percentile.

The technician and doctor were both thrilled and wanted to know if I'd made any dietary changes to have allowed my daughter to grow so much and other than being very diligent about taking all my vitamins and supplements, I couldn't think of anything.

Dr. Hamersley gave me the choice of coming in again in either 2 weeks or 3 weeks for our next growth scan. Because Dash's growth hasn't been incredibly consistent, I chose to go with 2 weeks. She's once again measuring a few days ahead, which is where I'd like her to stay.

We also discussed our road trip protocol. My husband and I were clearly instructed! I am to get out of the van and walk around (doesn't have to be long) every hour. This means we'll be setting a timer and simply taking the next exit so I can get out and walk around the van a few times before climbing right back in and getting right back on the road. Chances are good that every other stop will also include a quick trip to the bathroom for any and all in the vehicle who need to stop, but there's no need to do a full bathroom stop every hour.

Compression stockings aren't needed, but I've been instructed to wear my belly band. It needs to be snug enough to provide support and lift, but not so snug as to leave marks.

The final bit of news has to do with Dash's positioning. Again, the news was good. Today she was not only head down, but also facing my spine, which is the ideal position for birth. I know she'll continue to flip around for another couple of weeks, but she showed us today that she's at least willing to be head down and I hope that by continuing my stretches, she'll gain a preference for that position.

Now, I realize this is "out of place" but I found this comparative chart regarding outcomes for severely premature births. These are outcomes from the UK, not the US, for 1995 and 2006.

I'll let you make any conclusions you'd like from the chart. Enjoy!

Mystery Solvers

Everybody needs a day off sometimes, and doctors are no exception. Whether my doctor is having health problems of her own or is a busy mama with college aged children or something else--she finds doctors who can fill in for her and for that I'm grateful.

Today I met one of her subs. He was a middle aged man who clearly loves his job. As he picked through my printed medical records, he noticed that Dr. H had run the SSA/SSB antibody test but couldn't see the results, so he made sure to hunt those down.

My tests for both were negative. Although it wouldn't have changed any of the medications I'm currently taking, he said he'd have me come in sooner to have the baby's heart checked if either or both had been positive.

This doctor and I also talked a little about my loss and that I don't fit into the normal medical category. His comment was something to the effect of "I love mysteries because I always learn something new and that makes me a better doctor."

I liked that attitude. That my specific "case" is unusual didn't bother him, but rather was fascinating.

We also talked a little about college football (he went to West Point and rather snickered at how awful their football team is) and large families. Near the end of the appointment, he noticed that I had seen Dr. Jane Allen and mentioned that he went to school with her. He then proceeded to let me know that I need to ask her about the placenta study they did that their mentor wouldn't let them publish because the mentor felt the results were not strong enough.

So then we talked about how hard it is to find doctors and pathologists who really understand the placenta and can do proper studies on them.

Yes, I liked the sub today.

Curious about Dash yet??

Dash is still growing okay. She's measuring a day behind where I am gestationally (again) but 3 days behind where she ought to have been based on the last growth scan if growth was continuous.

It's not the most yippee!!! news, but it wasn't bad, either. She's measuring in the 40th percentile, so smaller than my other girls, but still not worrisome. Her weight is approximately 14oz.

The newest development? She's frank breech. With my other pregnancies, once my babies were head down, they really liked to stay that way.

Not Dash. Oh no. She likes to do everything her own way.

And I thought my second daughter marched to her own drum. She may be a cake walk in comparison!

She needs a boring, unassuming name; something to give her a chance at serene and dignified behavior.

Oh, who am I kidding. She'll be Dash no matter what her birth certificate says.

And yes, I'm starting to believe she'll be born alive. I'm still not making any preparations (what's the point??) but my mental planning is starting to take place more often than in the past.

This is the first image of her I've been able to take home that I felt was worth posting in several weeks. She kept her hands and feet right up in front of her face pretty much the entire time, making measuring a little tough--another reason I'm not too concerned about the mildly smaller measurements. If you're familiar with these kinds of images, what do you think you see?

Growth Scan and Substitute Doctors

My good friend, R, was able to tell me today that Dr. H was out of the office until early September. A heads' up is always appreciated!

So I had the opportunity to meet with the substitute doctor. I am not familiar with her background, but since I was doing a growth scan and not much more, I wasn't too worried.

The results: We did lose a few days growth with my anti-Xa slumping. Not much, but enough to let me know that we came closer than I wanted to a repeat with how we lost Jackson.

I know from experience that my babies, once ahead of the growth curve, stay that way unless something starts to go wrong. Three weeks ago, Dash measured at 12w+3d, so exactly 3 weeks later, she should have been measuring at 15w+3d but that is not what happened.  Instead, she is right back at 15w+0d. I know that 3 days isn't really a big deal, but multiplied over a couple of weeks and we are back at "fetal demise".

Technically, being at 15w+0d is still within normal, but these doctors don't have my records from my pregnancies with my daughters.  Even Jackson stayed right-on-dates until his 19 weeks scan, so to have only 18 days' growth in 21 days' time is something that makes me not too happy but certainly happier than I'd be if she were measuring behind.

I can only hope that the mildly compromised blood flow for those three-ish weeks didn't also affect her brain development or any of her major organ systems.

Her anatomy scan is scheduled for three weeks from tomorrow. And yes, I'm nervous as heck. Jackson's anatomy scan was the last time I saw him alive, so I'm quite fearful.

The doctor was willing to sign another requisition form for another anti-Xa test. I'll get that done early next week, so that this test and my last one are just over 2 weeks apart.

I'd rather have the test done and show perfect clotting levels then forego the test and find out later that my meds were off again.  I explained this briefly to the doctor and she understood.

Unfortunately, since she's not familiar with my overall history, I was unable to discuss what my risks were as far as obstetric care and the possibility of finding a midwife.

It turns out that although the nursing staff and facilities at the Birthing Inn are pretty awesome, there is an extreme shortage of awesome doctors that deliver there. 

Even the doctor I was considering is now out. Another patient of his complained late last night, online, and another woman piped up that she'd had the same experience. The woman appears to be experiencing prodromal labor and was already 3 cm dilated at her check earlier that day and the doctor told her to call back when she's "in so much pain [she's]crying". 

Not everyone cries in pain!! The doctor appears to be super fantastic with c-sections and inductions but doesn't like having his sleep interrupted for anything else.

So scratch that one off the list.

My hunt continues and I'm feeling really let down that finding someone compassionate, more natural-minded, and that delivers at the Birthing Inn is so hard. It shouldn't be this hard.