Blanche’s Grandbaby – Do small babies need to be born by C-section?



Blanche emailed last week with a really good question:

Our son and daughter-in-law have been told that the doctors are thinking about having her come in for a C-section at 37 weeks, because baby is on the small side. The baby is very active and heart, etc. all sound real good. Our children would love it, if she could carry to full term to get a little more meat on his bones. What do you think?

Blanche, I think your son and daughter-in-law need more information. Here are a few questions they should ask:

  • Is their doctor suggesting that their baby has fetal growth restriction – AKA – intrauterine growth restriction (IUGR), or is their baby just a little small?
  • How, exactly does the doc know the baby is “on the small side?” Did he do an ultrasound that suggested the baby was small or is this just a hunch based on the way your daughter-in-law’s belly feels or measures?
  • Why a C-section? Is there something wrong with the umbilical artery, placenta or baby that requires a C-section delivery?

These are questions your kids need answered before they consent to a 37-week C-section. If the baby’s size is really of concern because he or she isn’t growing properly in the uterus, then an early delivery might be essential. Some babies grow better outside the uterus than inside, but according to the World Health Organization, only about 5% of babies fall in this category. They define IUGR as having an estimated weight that’s below the 10% percentile of the recommended gender-specific birthweight for gestational age reference curves (Williams 1982, WHO 1995).

If baby is growing just fine, but is just petite, than early delivery isn’t necessarily a good idea. 37 weeks isn’t full term and while chances are very good your grandbaby will be just fine, he or she would be healthier if delivered at full term (40-weeks) – but that’s only IF there’s nothing preventing him from growing properly in the uterus.

It can be very tricky to diagnose an IUGR baby. Here’s what the American College of Obstetricians and Gynecologists says about it:

Fetal growth restriction [IUGR]… is a common complication of pregnancy that has been associated with a variety of adverse perinatal outcomes. There is a lack of consensus regarding terminology, etiology, and diagnostic criteria for fetal growth restriction, with uncertainty surrounding the optimal management and timing of delivery for the growth-restricted fetus. An additional challenge is the difficulty in differentiating between the fetus that is constitutionally small and fulfilling its growth potential and the small fetus that is not fulfilling its growth potential because of an underlying pathologic condition. 

So, why is your grandbaby small? Is it because of a maternal problem like smoking, substance abuse, hypertension, infection, poor nutrition or some other health condition? Is it a placental problem that’s preventing baby from getting enough circulation and nutrition? Is it a fetal problem like a congenital abnormality? OR Blanche, is grandbaby just a little squirt who’s entirely normal?

If the doctor is gauging fetal size based on a single ultrasound – that might not be enough to diagnose fetal growth restriction. Ultrasounds can be way off the mark when it comes to determining size and weight. Too many women I know have been induced or delivered by C-section because an ultrasound said their baby was too big or too small for a naturally occurring labor and vaginal delivery. Then after delivery, when the baby turns out to be a perfectly normal size, mom’s left wondering, “What the heck was that about?”

Now, about that 37-week C-section. If baby has problems with the placenta, umbilical cord or some other condition that makes a vaginal birth dangerous – then a C-section might be the only safe choice. If baby is perfectly healthy though, why the heck is the doc so eager to deliver a premature baby surgically?   Unless baby’s growth is severely restricted and keeping him/her in the uterus is dangerous, then an early delivery might not be necessary. If baby is just small, but is growing in a healthy way, then carrying him/her to full-term and delivering vaginally might be a perfectly safe plan. It allows baby to “get a little more meat on his bones,” fully develop his/her lungs and do all the intricate finish work babies need to do in the final days and weeks of pregnancy. A spontaneous labor (not induced) near mom’s due date almost always progresses more smoothly than an early induced labor because mom’s body is ready to deliver.

Avoiding a first C-section is a huge national focus right now as doctors, hospitals, patients and the American College of Obstetricians and Gynecologists (not to mention the World Health Organization) recognize we do too, darn many surgical births, especially when vaginal births are almost always the safer option. C-sections come with risks for complications like hemorrhage, infection and uterine scarring, which can impact subsequent pregnancies. Seriously – you don’t want to have a C-section if you don’t absolutely need one. Check out ACOG’s criteria for when C-sections are and are not appropriate. In fact Blanche, print it out and hand it to your daughter-in-law.

My concern, Blanche, is that your daughter-in-law’s doctor hasn’t given her enough information to warrant an early C-section. They need to ask more questions, challenge his opinion that a 37-week C-section is absolutely necessary and then make their own choice as to how to proceed. If they’re not satisfied with his explanation and baby isn’t showing any signs of distress and is continuing to grow – they can simply say, “No thanks, Doc. We’ll leave baby where she is for now.”


photo credit:  ceejayoz


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