Little Baby, Big Worry

When Baby's Too Small


Holly's got a little question: She says, everywhere she goes, people comment on how small her belly is at 33 weeks pregnant. This is her second pregnancy and she's a healthy woman with a healthy lifestyle. She observes all the don'ts: don't smoke, drink, do drugs. She also observes all the do's: Do exercise, eat right and see your doctor. When she mentioned to her doctor about everyone's concerns, she was sent for an ultrasound. Sure enough, the ultrasound indicated a smaller than usual baby—about 3 lbs. Holly wants to know why her baby is so small and if she should be worried about her baby's health.

Let me first ask this question: Why do people say things to pregnant women that are obviously going to stress them out? Why do they feel compelled to talk about how bad things can be, how painful labor will be, how she should or shouldn't be doing this or that? How she should be bigger than she is. I know everyone wants to share their story and experiences but not everyone has enough common sense to frame it in a positive light.

I get questions all the time based on dumb stuff friends and family say that freak pregnant women out. Let's remember this statement: If you don't have something nice to say, don't say anything. C'mon guys, leave these poor mothers alone. They've got enough going on without adding your junk. If she's getting good prenatal care, let her doctor be the one to voice concerns. You voice support. Tell her she's lovely. Tell her you remember what a wonderful baby she was. Tell her you just know she's going to be the best mother on earth. Tell her you remember what a worry-filled time pregnancy can be but that in the end, everything will be just fine. Then tell her again how lovely she is. Now that's helpful information.

Holly's been going to her doctor's appointments and apparently getting good prenatal care. Her doctor, I assume has been monitoring fetal growth all along and felt, up until Holly stated her concerns that everything was progressing well. Now, she's got something to worry about that may or may not be a real problem.

At 33 weeks and 3 lbs, Holly's baby is certainly measuring smaller than average. We'd expect her little one to be closer to 4 lbs at this point. However, a single ultrasound doesn't always indicate accurate size and growth patterns. Observing growth over time will be important. Will the baby start catching up on the growth chart and reassure everyone or will he/she turn out to have Intrauterine Growth Retardation (IUGR)? IUGR indicates a baby who's not growing well inside. It's usually caused by a lack of nutrition or oxygen getting through the placenta to the baby. Sometimes that's caused by smoking, poor nutrition, drug abuse, diabetes, or other medical diagnoses. Something is affecting the placenta. Sometimes it's the effect of pre-eclampsia, high blood pressure or other circulatory conditions preventing adequate blood flow to and from the placenta. Sometimes, IUGR is caused by genetic anomalies. Those certainly don't seem to be any of Holly's issues. A lot of the time, we don't know why IUGR happens.

I expect what will happen next is that Holly's doctor will repeat ultrasounds frequently and start monitoring baby's wellbeing with nonstress tests. That means she'll have regular sessions with a fetal heart monitor, either in her doctor's office or at the labor and delivery unit of her hospital. They'll look for specific heart patterns that indicate good fetal circulation and oxygenation. She may have other tests done as well, like blood work to rule out serious blood pressure issues. If all of these tests turn out reassuring, Holly's doctor will probably just wait and see what happens. If tests start indicating that baby's in trouble, they'll start talking about contingency plans like bed rest to reduce circulatory stress and check-ups with a perinatologist (who specializes in fetal medicine and premature babies). In the uncertain but less common scenario that Holly's baby is really not growing inside, they'll talk about the possibility of premature delivery. This doesn't happen very often. Most of the time, baby is growing well enough inside Mom that they leaver him/her there. When baby is born, they'll keep a close eye on him/her to make sure all systems work well. Most of the time, they're fine. Little but fine.

That's a whole lot to worry about but most of the time smaller than usual babies are just that&mdash:little ones. Maybe baby's little because Mom's little. That's why they invented petite sizes. Maybe Holly's not as far along as previously thought and this baby is normal for a 31-weeker. Maybe he/she's just about to hit a growth spurt and will be right where he's supposed to be in another week or so.

Holly honey, you sound like you're doing all the right things and your doctor's on top of the situation. If I can offer one useful piece of advice it's this: When people offer you unwanted comments or advice on your pregnancy, stick your fingers in your ears and sing, "LALALALALA! I can't hear you!" If that's not your style, try saying, "Thanks but I've got a great doctor who's taking good care of me. I'm fine." My advice to all you well-intentioned but clueless people out there who feel they owe the world their pregnancy, labor and birth saga, their advice, opinions and the story of their best-friends niece—write it in a nice journal and keep it to yourself. Then tell her she's lovely instead.

Got a question for Jeanne? E-mail it to and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.