Confused: doctors disagree on bedrest

[dana2006]

I posted a few weeks ago that the baby has fallen behind in his growth. I've since had 2 more u/s at MFM. The one a week ago shows that he'd dropped from the 15th percentile to the 9th, and the one I had this morning just focused on the umbilical blood flow, which was fine. I had an appointment with my OB this afternoon and this is the first time I'd had a chance to discuss what MFM had discovered about baby's growth. The OB basically flipped out at the 9th percentile figure. She ordered me to immediately go on a modified bedrest, saying she's never had a patient with a baby below the 10th percentile not going on it. I said MFM never mentioned anything about bedrest, only that I should not exercise (but walking and prenatal yoga are still okay). The OB then got on the phone with my MFM doctor. After about 10 minutes, she came back and said that they have a difference in professional opinion: while she, the OB, wants me to telework from now on, avoid all outings if at all possible, and stop cooking/cleaning/grocery shopping etc., the MFM doctor feels that it's fine if I continued to commute to work every day (I have a desk job) and otherwise carry on some light activities. So the OB said it's up to me. She did emphasize that in any event, I should seriously cut back on my activities and take it easy from now on to avoid full bedrest and preterm labor. I'm currently 28w5d.

What do I do? Split the difference? My bosses would be supportive of me teleworking, but I do need to go in to the office for some essential meetings for a project that's just gearing up for its busiest time this month.

[robyn]

Oh man that's stressful! I think splitting the difference makes the most sense. If your bosses are supportive of your working from home, maybe do that most of the time, but head in to the office for the essential meetings? I would definitely take the OB's advice to seriously cut back though in as many areas as you can, especially if preterm labor is a worry. Good luck!

[starlily]

FWIW, my OB did mention to me that the newer school of thought tries to limit bedrest unless absolutely necessary, in favor of the light activity model.

Other than the growth issue, do you have any other indications of preterm labor, or a previous preterm birth? If not, I'd probably spilt the difference as well and cut back on activity

[Blue Moon]

Wow, I'm sorry that happened. I wouldn't know what to do either, but if your boss is supportive of teleworking then I'd probably err on the side of caution and go with that recommendation. I would hate to go into preterm labor and wonder if there was anything I could have done to stop it.

[dana2006]

May 5, 2014 16:59:47 GMT -5 starlily said:

FWIW, my OB did mention to me that the newer school of thought tries to limit bedrest unless absolutely necessary, in favor of the light activity model.

Other than the growth issue, do you have any other indications of preterm labor, or a previous preterm birth? If not, I'd probably spilt the difference as well and cut back on activity

This makes sense. My OB is older, and the MFM doctor is younger and holding her ground on this issue.

I don't have any other indications of preterm labor. This is my first pregnancy. The biggest concern is that he's not growing fast enough, and the OB thinks bedrest is the best remedy.

[flamingeaux]

Could you do Bedrest, for a while, and then try gradually adding back activities?

[ringstrue]

Only thing I can think of as even a possibly is something like oxygen level. Like, exercising to the point of faster breathing you should probably avoid. Teleworking and desk work to me seem similar enough unless you walk a lot or stand a lot in your commute. So like if you take a subway or train in that might be too much walking, but if you can park close to your home and work building then it's ok.

GL I hope things turn around soon.

[MrsDarcy]

Oh man, so sorry you're going through this. I would probably err on the side of caution and do the least amount of everything possible. Telework, and go in only if absolutely necessary. Best of luck!

[mrspost08]

I would telecommute as much as possible. Go to the office on the day of a meeting & then rest as much as possible. That's what I would do if I was in that position.

[orangeglow]

I will give my opinion with a grain of salt.  MFM deals with high risk pregnancy almost exclusively.  Your OB most likely does not.  I would personally weight MFM's opinion much higher than an OB's.  My OB even told me she always defers to MFM.

If you are still unsure, is there another MFM local you could get another opinion from?

[jeaniebueller]

I would follow the more restrictive of the recommendations just to be safe.

[sillygoosegirl]

The <10th percentile sounds bogus to me. That would mean 10% of pregnant women are placed on bedrest JUST for the baby measuring small, not including all the other issues that can indicate bedrest. I think I'd know many more people who'd spent their 3rd trimester on bedrest if this was really standard practice.

[sillygoosegirl]

May 5, 2014 18:45:54 GMT -5 jeaniebueller said:

I would follow the more restrictive of the recommendations just to be safe.

If the suggested course of treatment is without side effects, I'd agree.  But bedrest is not without side effects, so it's not really that simple.

[phdprocrastinator]

In Expecting Better, the author discusses bedrest and how, in general, it doesn't seem to lead to any difference in outcome. This may be why the new school is recommending bed rest less than they used to. At the same time, I know I would be super worried in this situation. I would probably try to telecommute as much as possible, limiting my outings to essential duties/meetings.

Best of luck to you!

[anaps28]

If you go on bed rest when will they monitor growth next? Honestly I would do the bed rest and see if there is any improvement. That is just my PGAL brain though.

[dana2006]

I'll have my next growth scan a week from now. Basically I'll be going in weekly, alternating b/w growth scan and umbilical cord flow (doppler) check.

I was also having a hard time understanding where the 9% came from. At 25 wks the baby was measuring 3 wks behind. At 27 wks he was again measuring 3 wks behind, which to me indicated that he's grown in the interim wks. However they calculated that he'd dropped from 15% to 9% during that period.

My plan is to work from home tomorrow, call MFM to clarify, and go from there. In any event I'd want to telework more and now have the perfect excuse.

Thanks guys for your support.

[rbp]

May 5, 2014 19:01:26 GMT -5 sillygoosegirl said:

The <10th percentile sounds bogus to me. That would mean 10% of pregnant women are placed on bedrest JUST for the baby measuring small, not including all the other issues that can indicate bedrest. I think I'd know many more people who'd spent their 3rd trimester on bedrest if this was really standard practice.

Seriously. Not all babies need to be eight pounds to be healthy. 

Sorry you are going through this, dana2006. It sounds really stressful. 

[starlily]

May 5, 2014 19:09:00 GMT -5 phdprocrastinator said:

In Expecting Better, the author discusses bedrest and how, in general, it doesn't seem to lead to any difference in outcome. This may be why the new school is recommending bed rest less than they used to. At the same time, I know I would be super worried in this situation. I would probably try to telecommute as much as possible, limiting my outings to essential duties/meetings.

Best of luck to you!

This is pretty much how my OB explained it to me, combined with the side effects of bedrest.

[earlgreyhot]

May 5, 2014 19:08:15 GMT -5 sillygoosegirl said:

May 5, 2014 18:45:54 GMT -5 jeaniebueller said:

I would follow the more restrictive of the recommendations just to be safe.

If the suggested course of treatment is without side effects, I'd agree.  But bedrest is not without side effects, so it's not really that simple.

I agree. I think asking your MFM what the reasoning is behind reducing activity would be and let that be your guide. I'd also inquire if there was some nutritional suggestions. My midwives have struck diets in order to not grow babies that are too big...is it possible the opposite is true? Are there foods that work more optimally than others in getting to the baby? (Just a question, I've never really heard anything...).

Is also think about resting positions that are not just laying in your back or side that might be helpful as well. Your prenatal yoga instructor might have some suggestions for that.

Good luck, I'm sure everyone is erring on the side of caution.

[D2M]

I'm sorry you have to deal with this. I don't have much to offer except that orangeglow's advice seems spot on; the MFM doctor is more specialized than the OB and if he/she isn't sounding alarms, that would give me some comfort. Take advantage of the telework arrangement, though. That sounds like a good way to kind of split the difference.

[FastHands]

May 5, 2014 20:41:28 GMT -5 dana2006 said:

I was also having a hard time understanding where the 9% came from. At 25 wks the baby was measuring 3 wks behind. At 27 wks he was again measuring 3 wks behind, which to me indicated that he's grown in the interim wks. However they calculated that he'd dropped from 15% to 9% during that period.

I'm guessing that the percentile is not based on actual size, but where the baby fits on the spectrum of ALL babies. So it's not that at one appointment he was 15% of the weight they want him to be and then, after growing, he was at 9% of where they want him to be. Instead it's that, at 27 weeks, 85% of babies are larger than he is, and at  28 weeks, 91% of babies are larger than he is. What this probably means is that it's more common for babies to measure behind early and then catch up -- so 6% of babies that were in the same spot as yours at 27 weeks hit more of a spurt between 27 and 28, and moved a bit ahead of where he is. Or in other words, he didn't LOSE size, it's just that he didn't gain weight/size as fast as the average baby does during that same week.

It's very possible that the MFM isn't concerned BECAUSE you're still holding steady at 3 weeks behind, whereas the ob is being all about the percentages.

[dana2006]

I just got off the phone with the nurse at MFM. She said that bedrest and protein shakes used to be the standard prescribed treatment for IUGR, but there's not enough evidence to show that they make any difference in outcome, so they stopped recommending that. She also said the doctor did not want to put me in the middle of their difference of opinion, so she supports me taking the more conservative route for the time being if I'm more comfortable with that. One thing I read on an IUGR forum is to focus on the net weight gain between u/s, instead of the percentile, which could be dropping while the baby is still gaining weight. So that's a bit of comfort there, since he is putting on weight.

I'm teleworking for the rest of this week, and hopefully will find out more at my next u/s on Monday.

Thanks again guys!

[Deleted]

May 6, 2014 12:58:56 GMT -5 dana2006 said:

I just got off the phone with the nurse at MFM. She said that bedrest and protein shakes used to be the standard prescribed treatment for IUGR, but there's not enough evidence to show that they make any difference in outcome, so they stopped recommending that.

Ditto.  This is an old recommendation.  My IUGR 9th percentile baby was born in 2011 and they were not even recommending it then.  2 wks after the IUGR was found I was put on bedrest for PTL. I can tell you in my case the bedrest was great for the PTL as soon as I got off bedrest I went right into labor.  It did absolutely nothing for my IUGR 3lb baby.

[kershnic]

I had an IUGR baby. My MFM said all bedrest does is cause women to go crazy. He only recommends it if you go into preterm labor.

I was told that nothing I could do would impact the blood flow in the cord, which is what they are often watching for in a potentially iugr baby.

Fetal weight estimates have a wide margin of error and at the ends a very small weight difference makes the difference between a few percentiles. The concern is the drop in percentile not the percentile itself. A baby that is consistently small is safer than a baby that stops growing.

Sorry you're in this position I know how stressful it is. Here's to good cord flow and pudgy babies.