Until a couple of weeks ago I’d shared little about my pregnancy, and then all of a sudden as history seemed to repeat itself, things seemed very real and I decided to finally relive the story of Pixie’s birth. Really, it’s all been leading to this post. Here I’ll be sharing some information about GAP and GROW, the pregnancy programme designed to monitor your baby’s progress during gestation, and what that means for me personally – and perhaps you too if it’s something you’ll be facing yourself.
At my very first midwife appointment for my current pregnancy, I was blown away by the fact that – before I had to mention anything at all about last time – the midwife told me my notes had been reviewed and special measures for my care had automatically been put in place.
What Is Pregnancy GAP and GROW?
GROW is an acronym for gestation related optimal weight; the pregnancy GAP programme (Growth Assessment Protocol) has been developed in the couple of years since Pixie’s arrival. It’s designed to monitor potential problems during gestation, specifically for women who have previously delivered very small babies (or large, I’m led to believe). Incredibly about 80% of pregnant women are on this programme.
My personal experience was that I continuously measured small with a tape measure throughout my first pregnancy. However that method is really not an exact science in terms of your baby’s true size – we each hold a different volume of amniotic fluid for a start. For every woman who is interested in my story and wants to know more, there are ten others who get cross that they’ve been put through growth scans for no reason at all.
In many cases they are unnecessary. But in some situations – such as mine – they’re crucial to your baby’s health and wellbeing.
Had I measured small and gone on to have a ‘normal’ sized baby, it’s unlikely I’d have been placed on the programme; however Pixie arrived at 5lb 4oz following early induction over concerns for her weight. And they were right to do that.
What Does the GAP and GROW Programme Entail?
I was told at that very first appointment that as of 28 weeks I’d be scanned three-weekly until I deliver. I was also booked in early on to meet with a consultant to discuss my care, which I fully expected to be a waste of time at that stage (it was – I’m currently low risk!), and I’m due to see him again at 36 weeks.
I had two growth scans with Pixie. The first was nothing to be concerned about; the second led to her induction the following day.
I was told that some other things have changed since Pixie was born, too. New research means it may not always be necessary to induce on the basis of a single scan result, like it once was. Instead, your consultant will be looking at a series of results on which to base their decision; essentially, if your baby is continuing to grow – even if it’s smaller than deemed average or normal – they may decide it’s acceptable for baby to remain in utero.
I was told that if my baby is looking small again, I’ll be allowed to carry to 39 weeks before induction.
One of the other – and probably most critical – deciding factors for if and when to induce will be placental blood circulation, which I was advised by my midwife is an additional check carried out during growth scans. This essential function is vital to your baby’s wellbeing, and any impairment is a serious cause for concern. It may indicate premature deterioration of the placenta – and that’s a situation which must be urgently addressed. In these circumstances, induction will be recommended.
However, it’s equally possible that if you and your partner are small-framed as we are, it may simply be your normal to have tiny babies – it doesn’t necessarily mean there’s anything ‘wrong’. Personally, I’d prefer to be monitored, even if it ends up being unnecessary.
So Why Was Pixie Tiny?
This is my main source of anxiety – nobody is certain.
The placenta I delivered looked healthy; I ate well and stayed active throughout my pregnancy; I didn’t smoke or drink; I gained an appropriate amount of weight myself – I was low risk right up until induction (at which point a woman automatically becomes high risk). Yet Pixie was a low birth weight.
Low birth weight in itself may not be a disaster – plenty of babies are born at the weight Pixie was with no problems. In fact, we were sent home relatively quickly… Only we were readmitted within hours and Pixie was quite poorly for several days.
So what went wrong?
My final growth scan indicated that Pixie’s abdominal circumference was small for her size. That was the concern and the reason I was induced. Despite an apparently well-functioning placenta, Pixie was not gaining weight. Following the new research I mentioned, it’s possible I wouldn’t be induced in a similar situation – but given that Pixie ended up poorly, nobody is quite sure what went wrong, hence my fears and anxieties.
Essentially, Pixie presented as a preemie, despite not technically being so at 16 days early: she was too lethargic to feed and this led to severe dehydration.
I have worries of a similar situation with my second baby, but ultimately I’m being closely monitored via the pregnancy GAP and GROW programme and I cannot ask for more. I have a better understanding of what to expect and what to look out for this time in terms of dehydration, and I have to place my faith in the hospital caring for us.
They didn’t let me down last time, and I have to trust that they’ll help me to safely deliver my second baby too.
Update: my second daughter was born a healthy 7lb exactly! Read our birth story for all the details.
(Additional research suggests that the degree of stress I was under at work may well have contributed to Pixie’s failure to thrive.)