Pregnancy After 40

Fetal Growth Restriction (IUGR)

Written by Michelle Johnson

Intrauterine Growth Restriction

At 31 weeks pregnant we had an appointment with our Fetal Maternal Specialist anticipating good news regarding the growth of our unborn son – or more specifically the size of his stomach.

If you recall from my “Second Trimester” Article, our visit with the specialist during week 29, the doctor informed us that the baby had a growth restriction, also called Asymmetric or Secondary Intrauterine Growth Restriction (IUGR), despite the fact that his weight was normal at 2 lbs. and 9 ounces.

What is Growth Restriction?

According to, our type of IUGR “is characterized by the head and brain being normal in size, but the abdomen is smaller. Typically this is not evident until the third trimester.”

With this particular growth restriction, the doctor informed us that the baby’s head was normal in size but it appeared that the baby was conserving energy, likely from a lack of proper nutrition, and that his belly was in the 5th percentile and was too small for his gestational age.

I was told that I would have to see the specialist every week now until delivery to keep an eye out on the baby for growth, stress, placenta productivity, etc.

Obviously I freaked out a little, but remained calm.

Causes of Asymmetric Intrauterine Growth Restriction

After some research, our IUGR could be attributed to malnutrition, placenta or umbilical cord abnormalties, or gestational diabetes (which I had not been diagnosed). In addition to being pregnant over the age of 40. In my head, the placenta and/or umbilical cord abnormality could have been connected to my age.

As a side note though, when I was 8 months pregnant with my daughter almost 16 years ago, I remember the doctor telling me that she was underweight. At that time my first stop was to Outback Steak House where I ordered my favorite chicken entrée and pretty much ate significantly more until delivery – she was a healthy 6 lbs. and 15 oz. at birth.

Reversing Growth Restriction

Anyway, this time I was basically advised to eat healthy, including a lot of protein and vegetables every 2 hours or so.

Now to be honest, prior to my 26th week visit I was not eating that frequently, albiet relatively healthy, because I didn’t want to gain a lot of weight since I was already heavier than I should have been prior to getting pregnant. After that visit, my husband and I made our way to the nearest café and consumed a nice breakfast. Additionally, I set an alarm on my phone to go off every 2 hours so I could eat something, whether it was a small bag of baby carrots, yogurt, a mozzarella cheese stick or apple, in between smaller portioned meals.

Increased Baby Movement 

I immediately felt an increase in the baby’s activity to more general moving around and sporadic intense kicks. I was confident that eating more was the trick and couldn’t wait to see his progress in stomach growth 2 weeks later, which was the 31 week visit.

At 31 weeks, we were told that the baby weighed approximately 3 lbs. and 5 oz. which is relatively normal, however, his stomach is still somewhat small.

We had another visit with the specialist again at 32 weeks and had another ultrasound. Overall, the baby and blood flow in the umbilical cord appeared healthy, albeit, his stomach still appeared to be approximately 2 weeks behind in size.

Delivering a Baby Diagnosed with Growth Restriction 

With this news, I went on my research binge and discovered that this “small stomach” issue was very prevalent amongst the pregnancy community. My mind was somewhat eased when most of the outcomes were deliveries of healthy babies despite them have smaller than normal stomachs while in utero.

Doing What’s Best for Your Baby 

I continually felt the baby move throughout the day, which again is very comforting. At the end of the day, the best thing for me to do is to avoid stress and eat well. Freaking out over this will only lead to the baby stressing so I decided to just relax and continue to pray for the health and well-being of our baby.

Admittedly though, trying not to stress is easier said than done, right? We as women and mothers tend to blame ourselves about everything when it comes to our children – both born and unborn.

Growing and Getting Out of the Woods

At 35 weeks pregnant, the fetal maternal specialist ultrasound technician did provide with some good news – the baby, weighing 5 lbs. 5 oz., was now in the 12% percentile range in terms of size and was no longer considering small. My visits to the specialists would have ended then, except for the fact that I was over 40 years old and pregnant – with that being the case I still had to continue visiting the specialist every week until I delivered. The visits were to monitor the placenta and umbilical cord blood flow and amount of amniotic fluid surrounding the baby. Again, being over 40, there’s an increased chance of placental problems which affects the baby receiving proper nutrition.

My husband and I were finally able to relax regarding our unborn son’s size, although we would’ve preferred that his percentile be somewhat higher. Well, we got what we hoped for – at our 38th week visit, our baby was weighing 6 lbs. 13 oz. and was now in the 33% percentile of babies during this stage of pregnancy. And boy did I feel the increased growth!

The Homestretch

From my 38th week until I delivered, I was increasingly uncomfortable as the baby was “exponentially” bigger and is getting more cramped in my belly. At this point, my former concern, stress and worry has turned into anxiousness. Yes, we were ready to welcome this bundle of joy but I also decided to take the final days of pregnancy as a time to relax, read, write, watch tv and tie up some business and personal tasks, which is virtually impossible.

Induction and Delivery

At 39 weeks and 6 days, my husband and 16 year daughter accompanied me to my OB for a “quick” ultrasound and checkup. I met with one of the doctors who informed that our baby was measuring small AGAIN and strongly suggested that I go straight to labor and delivery and get induced as the risks for the baby increases daily and not to wait until my scheduled induction which was 3 days later (40 weeks and 2 days). The fear was that my placenta would start to deteriorate thereby depriving my son of necessary nutrients and oxygen if I waited. So, we decided to go forward with the induction that day.

I’ll spare you the super extensive details of the delivery in this article, but I was given cytotec to ripen my cervix. My water broke about 30 minutes later and the wretched contractions started a few minutes after that. Labor for the first 5 hours was horrible and I cried several times damning Eve for eating the apple, or fig, as my daughter politely pointed out during a contraction – let’s just say that I arranged for her to go to her friend’s house right after that!

Anyway, after about 5 hours I received an epidural. After being given the epidural, my blood pressure dipped too low and as a result it was putting the baby in distress. I was never given Pitocin, as the doctor was waiting to see if I would dilate on my own. I did, albeit 10 hours later. At the end of the day though, my son, Levi, was born the next morning at 5:15 am weighing a healthy 7 lbs 2 oz.

For the first year of his life, Levi remained in the 20th percentile or lower for weight and at 2 years old he was in the 50th percentile for boys his age. Overall, Levi is a very, very, very active and energetic boy and I thank God for his continued health of as well as for myself and his little brother that I delivered less than 2 years later at the age of 43 (who had to be induced a week early because he was too big). Hope this keeps you encouraged…

Disclaimer: The content in this article is merely the writer's opinion and information - not advice. If you have questions, you should always seek the advice of a doctor or another appropriate medical professional.