Labor in fetal growth restriction — management of delivery at Genesis Dnepr

What are deliveries for fetal growth restriction — childbirth managed with the knowledge that the fetus has been diagnosed with slowed intrauterine growth (intrauterine growth restriction, IUGR) and therefore requires intensified monitoring of its condition.

This approach may be appropriate for pregnant people with confirmed fetal growth restriction and when combined with other risk factors.

Be sure to discuss with your physician and obstetrician the monitoring options (ultrasound, cardiotocography/CTG), the possible mode of delivery, the analgesia/pain-management plan, and the criteria for emergency interventions.

The decision is made individually based on the condition of the mother and fetus and the monitoring results, and it may change during labor in the interest of safety.

What the delivery plan means in cases of fetal growth restriction

This delivery plan involves managing the birth with consideration of detected intrauterine fetal growth restriction (FGR). It is focused on closer surveillance of the fetus and readiness to change the birth plan if necessary. Decisions are made individually based on examinations and the condition of the mother and fetus.

Enhanced monitoring of the fetus before and during delivery.
A delivery plan that can be modified with respect to timing or mode of delivery.
Regular examinations (ultrasound, cardiotocography) to assess growth and fetal blood flow.
Readiness to change tactics emergently if signs of fetal deterioration appear.
Discuss delivery criteria and limitations in advance with your doctor and obstetrician.
Limitation: vaginal delivery may not always be possible; the choice depends on monitoring data.

Discuss any questions in advance with your doctor and obstetrician. Maternal and fetal safety remain the top priority, and the plan may change during labor.

Who this childbirth approach may suit

Labor and delivery in cases of fetal growth restriction often require more careful planning and closer monitoring of the fetus. This approach may be appropriate not only for medical indications but also when a woman wishes to discuss the delivery scenario in advance. It is important to talk over expectations with your doctor and midwife/obstetrician, the partner’s role, and pain-relief options. The final decision is individualized and may change during labor.

A desire to discuss the birth plan and possible criteria for changing it in advance with the doctor and midwife/obstetrician.
Partner presence may be allowed if organizational and medical requirements of the maternity ward are met.
Discussing pain-relief options in advance with an anesthesiologist to plan a safe approach.
A wish to remain active during labor and choose comfortable positions, provided there are no contraindications.
Taking previous birth experience into account when discussing tactics and possible delivery scenarios.
A pregnancy without serious complications, when a more predictable plan can be discussed in advance.
A need for a calm, clear, and documented birth plan to reduce uncertainty.

Discuss your option with the maternity team in advance; the safety of the mother and fetus remains the priority, and the plan may change.

When this birth format may not be suitable

The chosen format cannot always be maintained until the end — sometimes observation and labor require changing the plan. With fetal growth restriction, indications for more active intervention may appear in the interests of safety. Decisions are made by the doctor and the midwife based on current monitoring data and the mother’s condition.

Obstetric complications requiring urgent intervention and a change of approach.
Signs of fetal deterioration on monitoring (CTG, ultrasound).
The need for emergency operative delivery for the safety of the mother and baby.
Contraindications to a particular type of analgesia identified before or during labor.
Infectious or organizational restrictions that may limit the partner’s presence.
The mother’s severe general condition, when the priority is immediate medical care.
Unstable dynamics of fetal growth restriction requiring reassessment of the delivery plan.

Such limitations are a normal part of clinical care and are intended to protect the mother and fetus. The doctor and midwife will adjust the plan as new information becomes available.

Who decides the mode of delivery

The decision on the mode of delivery is made jointly and is based on clinical data, not only on the patient's wishes. In cases of fetal growth restriction, the choice of management depends especially on the current condition of the fetus and the results of examinations. The discussion involves you, the physician and the obstetrician; if necessary — an anesthesiologist and a neonatologist. The plan is discussed in advance, but it may be adjusted during labor for medical indications.

The patient stating her preferences regarding labor management and partner involvement.
Assessment by the physician and obstetrician of the pregnancy, tests, ultrasound, and fetal condition.
Consideration of monitoring data (CTG — cardiotocography, Doppler) and the trajectory of intrauterine growth.
Involvement of an anesthesiologist when discussing pain relief methods and contraindications.
Consultation with a neonatologist if there is an increased risk to the newborn.
Joint development of a plan with clear criteria for possible changes in approach.
Review of the plan during labor if indications arise for the safety of the mother and child.

The decision is documented and discussed with you; your wishes are taken into account, but priority is safety. The team will explain the reasons for any changes and propose the next safe step.

What to discuss with your doctor and obstetrician before delivery

Before delivery, when there is fetal growth restriction, it is helpful to discuss key issues with your doctor and obstetrician in advance so you understand the monitoring plan and possible scenarios. Below are practical questions for the consultation that will help structure the conversation and prepare for hospitalization. Write down the answers and bring your test results to the appointment.

What type of delivery do you recommend given the fetal growth restriction?
Is partner presence allowed, and are there any organizational or medical restrictions?
What pain relief options are being considered, and is a consultation with an anesthesiologist necessary?
How will previous deliveries, cesarean section, or complications affect the choice of management?
Do I have any chronic conditions that should be taken into account before delivery?
Which ultrasound findings and laboratory results are important for assessing fetal growth and condition?
What is the plan of action if the condition of the fetus or mother worsens during labor?
When is it best to go to the clinic if contractions start or worrying symptoms appear?
What should I bring with me and which documents should I prepare for hospitalization and identification?
What are the postpartum accommodations and the expected timing for discharge?

Write down the answers you receive and bring copies of important test results to the consultation; decisions may be adjusted during labor in the interest of safety.

How preparation for delivery proceeds with fetal growth restriction

Preparation is a step‑by‑step assessment of the fetus’s condition and coordination of the delivery plan with the team. The process includes repeat examinations, discussion of the criteria for changing the approach, and arranging practical details of hospitalization. It is important to discuss expectations in advance with your doctor and obstetrician and clarify the roles of your partner and the anesthesiologist. Preparation does not guarantee that the initial plan will be kept, but it makes decisions more informed.

Consultation with the doctor and obstetrician to assess the current status of the pregnancy.
Review of the prenatal records and discussion of the results of recent examinations.
Repeat ultrasounds and monitoring of fetal growth and blood flow as indicated.
Discussion of the delivery plan, including criteria for changing tactics.
If necessary, consultation with the anesthesiologist about pain relief options.
Familiarization with the required documents and the hospital admission procedure.
Preparing the partner for their role and the unit’s organizational requirements.
Packing a basic list of items for the maternity hospital and recommendations on when to arrive.

Discuss any questions in advance and write down key agreements; the team will explain any changes to the plan during labor.

How labor typically proceeds with fetal growth restriction

When managing labor in cases of fetal growth restriction, the team pays extra attention to monitoring and to being prepared to change the management plan. The process is similar to routine labor but includes additional checkups and clear criteria for decision-making. Below is a simplified sequence of steps that is explained to the patient in the maternity ward.

Admission to the clinic: registration, maternity record (medical file) and initial examination.
Examination by the obstetrician and midwife to assess the condition of the mother and fetus.
Assessment of contractions and labor progress, determination of the stage of labor.
Fetal monitoring (CTG) and, if necessary, repeat ultrasounds.
Adjustment of the birth plan depending on monitoring results and progress.
Discussion of pain relief and consultation with an anesthesiologist, if relevant.
Support from the midwife and doctor, assistance in choosing comfortable positions.
The second stage (pushing) under team supervision, with readiness to take necessary measures.
Birth of the baby and initial assessment by a neonatologist, evaluation of the newborn’s adaptation.
The first hours after birth: monitoring of mother and baby, and planning further actions.

The team will explain the reasons for any changes to the plan in detail; the priority remains the safety of the mother and baby.

Pain management during labor with fetal growth restriction

The question of pain relief is discussed in advance as part of birth planning, especially if enhanced fetal monitoring is required. During the consultation, indications and possible limitations are assessed, and an anesthesiologist is involved if necessary. The decision is made individually and the option to adjust it during labor is preserved.

Discuss pain relief options in advance at a planning consultation.
Consult an anesthesiologist if needed to assess indications and risks.
Epidural anesthesia may be offered if there are no contraindications.
The choice of method depends on the mother's condition, fetal status, and stage of labor.
The decision can be changed during labor if the clinical situation requires adjustment.
Contraindications to pain-relief methods (for example, coagulation disorders or local infection).
Organizational factors and specialist availability affect implementation of the chosen method.

Discuss all questions about pain relief with your physician, obstetrician, and anesthesiologist in advance; the team will explain possible options and limitations. No one can guarantee complete absence of pain — the priority remains the safety of the mother and baby.

Monitoring and safety during labor with fetal growth restriction

Management of labor in cases of fetal growth restriction involves systematic monitoring of the mother and fetus to detect changes in time and make decisions. This is a routine part of obstetric care, not a sign of an inevitable problem. The team follows a pre-agreed plan and is ready to adjust tactics if necessary. Any changes are explained and discussed with you.

Regular assessment of the mother's condition by the team (physician and midwife).
Monitoring of the fetal heart rate; cardiotocography (CTG) is performed if indicated.
Monitoring the progress of labor and uterine activity.
Repeat examinations (ultrasound, Doppler) as needed to assess the fetus.
The team is prepared to change tactics or perform emergency intervention.
Involvement of an anesthesiologist and neonatologist if the risk is increased.
Documenting decisions and explaining the reasons to the patient and partner.

The monitoring is aimed at early detection of changes and ensuring the safety of both mother and baby. The team will explain any steps and the reasons for adjustments to the plan in detail.

What happens if delivery doesn't go according to plan

The birth plan for fetal growth restriction (FGR) is advisory and may be adjusted as new information becomes available. If the situation changes, the team will adapt management to ensure the safety of the mother and baby. Such changes are a normal part of clinical care and not a sign of "failure."

Limiting the partner’s presence for medical or organizational reasons.
Changing from an upright position to a horizontal (lying) position when more intensive monitoring is needed.
Using labor augmentation/stimulation or deciding on a cesarean section when indicated.
Cancellation or inability to provide epidural anesthesia if contraindications are identified.
Shifting from a minimal-intervention plan to a more active approach for safety.
Involving additional specialists: anesthesiologist, neonatologist, or a relevant surgeon.
Transferring the birth to the operating room or to intensive monitoring if the condition worsens.
Ongoing communication with the patient about the reasons for changes and possible alternatives.

Plan changes are aimed at the safety of the mother and baby; the team will explain the reasons and propose the next safe step.

Potential risks and limitations

Any mode of delivery has its limitations, and this is especially important in cases of fetal growth restriction. Decisions depend on the mother's condition, fetal dynamics, and test results, so the plan may change during labor. Discuss potential limitations in advance with your physician and midwife to understand possible scenarios.

Limitations of the chosen approach if the condition of the fetus or mother deteriorates.
Risks depend on the condition of the mother, the fetus, and the course of the pregnancy.
The need for medical intervention may arise during labor.
Contraindications to certain methods of analgesia for a specific patient.
Organizational or infection-control reasons may limit the partner's presence.
You cannot rely solely on other people's experiences and birth stories.
The safety of the mother and baby takes priority over a preselected plan.

Discuss with the team the criteria for modifying the plan; they will help guide decisions when new information emerges.

What happens immediately after birth

Immediately after birth, the team provides initial contact, assesses the baby’s condition, and monitors the mother. In the clinic, CTG is performed during labor and a mandatory newborn examination by a neonatologist is carried out to quickly assess adaptation. In the first hours it is important to maintain calm, help with the first latch-on, and monitor the progress of both mother and baby.

First skin-to-skin contact and an attempt at the first latch to the breast.
Mandatory newborn examination by a neonatologist to assess adaptation.
Monitoring the mother’s condition (well-being, bleeding, vital signs).
Continued monitoring of uterine contractions and overall recovery.
Assistance from the obstetrician and medical staff with the first feeding and care.
Transfer to the maternity ward when the mother and baby are stable.
Documentation of the birth and discussion of the further plan for monitoring and feeding.

The process may vary slightly depending on the situation, but the team will always explain the next steps and support you in the first hours after delivery.

Role of the physician and the birthing team

The team manages labor together; each specialist performs their role to ensure the safety of the mother and baby. The physician and midwife assess risks, monitor the progress of labor and make decisions if the situation changes. If necessary, an anesthesiologist, neonatologist and operating team are involved to quickly address arising issues.

Risk assessment and development of a delivery plan.
Monitoring of labor progress and the mother’s condition by the physician and midwife.
Monitoring fetal condition and interpreting CTG (cardiotocography) and ultrasound data.
Supporting the patient during labor: instructions, help with choosing positions, and facilitating contact with the baby.
Involving the anesthesiologist when discussing and providing pain relief.
Calling the neonatologist for initial examination and care of the newborn.
Organizing emergency operative delivery by the operating/surgical team if needed.
Documenting decisions and explaining the reasons for any plan changes to the patient and her partner.

The team works to explain and involve you in decision-making, but the priority remains the safety of the mother and baby.

How this format benefits the patient

In labour with fetal growth restriction, this format helps to build a plan in advance and define criteria for decision-making. It allows discussion of expectations, the partner’s role, and monitoring options before hospitalization. Such pre-agreed steps reduce uncertainty and help you feel better prepared, although the final decision depends on the situation.

A clear birth plan with criteria for steps and possible changes.
The opportunity to discuss your preferences for management and the partner’s involvement in advance.
Less uncertainty thanks to clear monitoring and control algorithms.
The option to choose and agree on the presence of a specific doctor upon admission.
Discussion of pain-relief options and their availability if there are no contraindications.
Continuous monitoring of the mother and fetus with regular assessment of parameters.
Team readiness to quickly switch to another scenario for safety.

These advantages help you be informed and more confident during the birthing process. Priority remains the safety of the mother and baby, so the plan may change if new information emerges.

How a pre-labor consultation goes

When fetal growth restriction is suspected before delivery, a consultation is a structured review of your situation, documents, and test results. The meeting helps align expectations, discuss possible limitations, and outline a safe plan of action. Often several rounds of communication and repeat examinations are required, so not everything is resolved in a single visit.

Taking medical history: chronic conditions, previous deliveries, and current well‑being.
Reviewing the maternity record and notes from previous appointments.
Reviewing and discussing ultrasound, CTG (cardiotocography), and lab results.
Discussing your preferences for labor management and partner involvement.
Explaining possible limitations and the criteria for changing the plan.
Assistance from the doctor and midwife in choosing a safe mode of delivery.
Explaining when it’s best to go to the clinic once signs of labor begin.
Answering questions and documenting agreements for hospitalization.

Come to the consultation with your maternity record and a list of questions; decisions may be refined as more data accumulate and during ongoing monitoring.

Please note that online consultations are available for patients from other cities. We often receive requests from Zaporizhzhia, Pavlohrad, Kamenskoye (Dniprodzerzhinsk), Novomoskovsk (Samar), Kryvyi Rih, Nikopol, Marganets, Sinelnikovo, Pokrov, Zhovti Vody, and other cities.

Preparation for admission for delivery

When delivering with fetal growth restriction, preparation helps reduce registration time and allows monitoring to begin sooner. Gather the essential documents and test results so the team can promptly assess the situation. Discuss medications, timing of arrival, and partner participation with your doctor and midwife in advance.

Identification documents and any existing medical records.
Maternity record (antenatal care card) with notes on pregnancy management and recommendations.
Up‑to‑date ultrasound reports, lab results, and conclusions from recent examinations.
A list of regularly taken medications and a note indicating which must be continued.
A set of items for the mother for a short stay in the maternity ward.
A basic set of items for the newborn and related supplies.
Partner’s items and confirmation of arrangements for their presence during the birth.

Clarify the specific list and any questions with your doctor and midwife before hospitalization. This will help start monitoring more quickly and reduce uncertainty on admission.

Conditions of the maternity ward and organization of care

The maternity ward is organized to ensure safe management of labor and timely care for the mother and baby, including in cases of fetal growth restriction. The team follows monitoring protocols and is prepared to respond quickly to changes in condition. Below are key organizational and clinical points to know in advance.

Labor rooms are equipped for monitoring and performing standard obstetric procedures.
Postpartum recovery rooms with the option for mother-and-baby rooming-in.
Continuous access to a neonatologist for initial examination and, if necessary, emergency care.
Availability of an anesthesiologist and provision of pain relief/anesthesia when there are no contraindications.
Possibility of partner-supported births provided organizational and medical requirements are met.
Individual support by a physician and a midwife, with documentation of the birth plan.
Arrangements for rapid transfer to the operating room or to a higher level of monitoring if necessary.

Clarify specific conditions and rules for your stay during your scheduled consultation; the team will explain the procedures and the ward’s requirements.

When to seek urgent medical attention

If you are in labor with fetal growth restriction, it is important to immediately notify the maternity hospital or go to the emergency department if worrying symptoms appear. Do not delay the visit because of doubts — the medical team will assess the situation and advise on next steps.

Blood‑tinged discharge or heavy vaginal bleeding that is different from your usual discharge.
Your water has broken or you notice significant leakage of amniotic fluid, regardless of contractions.
Regular contractions that increase in intensity and have intervals consistent with the onset of labor.
Severe or persistent abdominal or lower abdominal pain.
Decreased or absent fetal movements compared with the baby’s usual activity.
Very high blood pressure or a sudden rise in blood pressure accompanied by feeling unwell.
Severe headache that does not improve with rest or represents a marked worsening.
Visual disturbances: blurring, spots, flashes of light, or partial loss of vision.
Marked weakness, loss of coordination, or confusion that interferes with your ability to act.
Fever, especially with chills or signs of infection.
Any sudden or sharp change in how you feel that causes serious concern.
Seizures, loss of consciousness, or other acute neurological symptoms.

If in doubt — seek care: the maternity team will evaluate your condition and promptly decide on the next steps.

Frequently Asked Questions

Question: Can the timing or mode of delivery be chosen in advance in cases of fetal growth restriction? Answer: You can discuss and outline a preferred plan in advance, but the final decision depends on the assessment of the mother and fetus and may change according to clinical indications.

Question: Is this type of delivery suitable for everyone? Answer: No, the appropriateness of the approach is determined individually based on examinations and the pregnancy status; some patients will require different strategies.

Question: Can the plan be changed during labor? Answer: Yes, the plan is often adjusted during labor in the interests of the mother’s and baby’s safety; the team will explain the reasons for any changes.

Question: Can the mode of delivery be discussed before labor begins? Answer: Yes, discussing it at a consultation helps prepare and agree on criteria for possible changes in strategy.

Question: Can I give birth with my partner present? Answer: Yes, partner presence is possible if the organizational and medical requirements of the unit are met; it’s best to clarify conditions in advance.

Question: What pain relief options are available? Is epidural anesthesia possible? Answer: Options are discussed with the anesthesiologist; epidural anesthesia may be offered if there are no contraindications and if a specialist is available.

Question: Who decides about pain relief? Answer: The decision is made jointly by you, the obstetrician, and the anesthesiologist, taking into account indications, contraindications, and the current situation in labor.

Question: What happens if the chosen method of pain relief is not suitable during labor? Answer: The team will offer alternatives or adjust the approach; in some cases the chosen method may be discontinued for medical reasons.

Question: When should I go to the hospital — what signs require immediate attention? Answer: You should go to the maternity hospital immediately if your waters break, there is bloody vaginal discharge, you have regular contractions, decreased fetal movements, severe pain, or a sudden deterioration in your condition.

Question: What should I bring to the maternity hospital? Answer: Bring your identification and medical documents, maternity record, results of recent examinations, a list of regularly taken medications, and basic personal items; check the exact list at your consultation.

Question: Do I need my maternity record and test results? Answer: Yes, the maternity record and up-to-date test results speed up admission and help the team assess the situation.

Question: Can I come with already completed tests and ultrasounds? Answer: Yes, bring all current reports and ultrasound scans — this will facilitate decision-making and birth planning.

Question: What happens if a cesarean section is needed? Answer: If indicated, the team will recommend operative delivery, explain the reason and next steps, and arrange transfer to the operating room.

Question: How long is the usual hospital stay after delivery? Answer: Length of stay depends on the course of labor and the condition of the mother and baby; the exact duration will be clarified after delivery and assessment of recovery.

Question: What happens immediately after the baby is born? Answer: Initial contact is provided, the newborn is examined by a neonatologist and the mother is monitored; in our clinic cardiotocography (CTG) and a newborn examination are always performed to assess adaptation.

Question: Can I meet the doctor in advance and discuss the birth plan? Answer: Yes, schedule a consultation — the doctor and midwife will discuss test results, your preferences, and possible scenarios.

Question: How can I prepare my partner for the birth? Answer: Discuss their role in advance, the unit’s organizational requirements, possible restrictions, and simple ways to provide support during labor; the team will give practical recommendations at the consultation.

Question: Can I get a second opinion if I disagree with the proposed approach? Answer: Yes, you can request a second opinion or an additional consultation; please inform the team in advance so they can arrange the meeting.