Small Babies: Understanding the Implications, Care, and Birth Options

Understanding Small Babies: Implications and Your Care Options

When you hear the term “small baby” during pregnancy, it can trigger a lot of worry and concern. However, it’s important to keep in mind that being “small” doesn’t always mean there’s a problem. In fact, many small babies are born healthy and well, and the decision-making process around small babies is nuanced. Understanding the implications of a small baby, the care available to you, and how to make informed decisions is crucial for a positive pregnancy and birth experience.

In this blog, we’ll cover the factors that contribute to small babies, the possible implications, what the latest evidence says (including NICE and RCM guidelines), and the care options available to you. Our goal is to empower you with information to make confident decisions for your birth plan, and, as always, to support you through every step of your journey.

What Does It Mean to Have a Small Baby?

A small baby is often referred to as a "Small for Gestational Age" (SGA) baby. This means the baby’s size is smaller than expected for the number of weeks of pregnancy (gestation). It's usually detected via:

• Growth scans: These measure the baby’s growth by checking the size of the baby, including their head, abdomen, and femur. However, these scans have a margin of error (usually around 10-15%).

• Fundal height measurements: This involves your midwife measuring the distance from your pubic bone to the top of your uterus. Again, this can be affected by different factors like bloating, time of day, or the position of the baby.

It’s important to note that small babies can sometimes grow perfectly well despite being below average for their gestational age, and some babies are simply smaller by nature.

What Causes Small Babies?

There are various reasons why a baby might be small, including:

1. Placental problems: Issues with the placenta can restrict the nutrients and oxygen that reach the baby, potentially causing growth restrictions.

2. Genetics: If parents or close family members were smaller babies themselves, this can often be a contributing factor.

3. Maternal health: Conditions such as high blood pressure, diabetes, or pre-eclampsia can sometimes cause growth restrictions.

4. Infections or chronic illness: Certain health conditions during pregnancy may also impact a baby’s growth.

   
   

It’s essential to remember that just because your baby is small, it doesn’t necessarily mean that there’s an immediate problem. In many cases, small babies are healthy and can thrive after birth with no complications.

The Implications of Small Babies: What You Need to Know

Being small for gestational age can sometimes indicate that the baby may face certain challenges. However, each baby is different, and many small babies grow up healthy. Some potential implications of a small baby include:

• Increased risk of low birth weight (LBW): Babies born under 2.5kg (5lb 8oz) are considered low birth weight, which can sometimes lead to health complications at birth.

• Preterm birth: Small babies may be born earlier than their due date.

• Placental insufficiency: In cases where the placenta is not functioning properly, babies may not be receiving enough oxygen and nutrients.

• Neonatal complications: In rare cases, small babies may require more monitoring at birth due to issues such as hypoglycemia (low blood sugar) or trouble feeding.

However, the latest evidence from the Royal College of Midwives (RCM) and NICE guidelines show that many small babies are born healthy with no complications. Babies who are small for their gestational age can often go on to thrive without medical intervention.

What Care Options Are Available?

If your baby is diagnosed as small, your healthcare provider will likely recommend additional monitoring and checkups. There are several care options available to you:

1. More frequent growth scans: These will help track your baby’s growth and make sure they’re developing as expected. However, keep in mind that scans can have a margin of error of up to 15%.

2. Induction of labour: If there are concerns that your baby’s growth is restricted, induction of labour might be considered. However, NICE guidelines stress that induction should only be offered if there’s clear evidence that it benefits both you and your baby.

3. C-sections: In some cases, a C-section may be suggested if your healthcare team believes it's the best option for the safety of you and your baby. But as always, this decision should be made in partnership with your healthcare team, ensuring you are fully informed.

4. Continuous monitoring during labour: If your baby is small, your healthcare provider may recommend continuous monitoring during labour to track the baby’s heart rate and well-being.

   
   

The NICE guidelines on small for gestational age babies highlight the importance of offering choices and working collaboratively with your healthcare team to ensure the best care for you and your baby.

Making Informed Choices for Your Birth Plan

Making decisions around a small baby can be daunting, but using the BRAIN method can help you feel more in control of your choices. The BRAIN method is a tool that can be applied when considering any decision about your care:

• Benefits: What are the benefits of this choice?

• Risks: What are the risks involved?

• Alternatives: Are there any alternatives to this approach?

• Instinct: What does your gut tell you?

• Nothing: What happens if you do nothing or wait?

👉 Our free video, Taking Control of Your Birth, talks you through how to use BRAIN in real-life scenarios. It's a great starting point if you’re facing decisions about suspected small babies!

How Can Beyond the Bump Support You?

Inside The Birth & Baby Academy, we have a full module on navigating birth choices, decision-making, and understanding scan results so you can approach your labour feeling calm, confident, and empowered.