Jul 182011
 

“Your amniotic fluid is low so we will induce you on Monday if the baby hasn’t come by then. Also the baby is having a hard time gaining weight, so I think she will just do better out than in.” – OB to mother at a prenatal at 37w 2d weeks.

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 July 18, 2011  induction, OB, prenatal  Add comments

  29 Responses to “"Your Amniotic Fluid Is Low…"”

  1. Oh I hope a second opinion was sought :(

  2. I’m of two minds here. First, if the mom really had oligohydramniosis, then yeah, maybe the baby needed to be out. And if the baby had stopped growing and was really small for dates, yes. Out is better than in.

    But if the doctor looks at one middling number on the ultrasound and is taking on the “trouble gaining weight” in order to convince the mom something is wrong, well….

    • No it doesn’t. Oligohydramnios is a crap ‘diagnosis’ that they pull out their arses and NO literature endorses induction or much of anything other than the mom to up her self care.

      • That’s not always true. Yes, sometimes they use the “low amniotic fluid” bit when the numbers are still in the normal range but my cousin has seriously low amniotic fluid and was on bed rest for several weeks, drinking like a gallon of water a day or something like that to keep her fluid level up. She was finally induced at 34 weeks and her placenta was already calcifying and had been causing all kinds of problems with the fluid levels, etc. It DOES happen.

        • Oligohydramnios/low fluid may ‘happen’ but as one OB with an under 10% section rate said, tis a“’pseudo-issue’ that is used to expedite delivery, although evidence does not show benefit of induction.” Calcification of the placenta is not evidence of a timely induction either. Bed rest is problematic, too. The mind and the body are not separate and mechanistic interventions are rarely the solution. A supported mother can go the distance w/o heroic charges. We just don’t know that anymore.

          • My son died of oligohydramnios. Well, he died of renal agenesis, but the oligo was the sign that something was wrong. I was there at the ultrasound, I have his autopsy report, it was a very real issue with a very real outcome.

            I don’t think you should categorically declare it to be a pseudo issue, though I would dearly love for that to be the case.

            Assuming that the baby’s AFI is 10 or above, the mother should be WATCHED, not immediately induced. Even below that can be watched for at least a day or two. Did this doctor even bother to check if it was leaking membranes? Because then antibiotics and bedrest can keep the baby baking longer. Many babies are fine being born at 37 weeks, but why not keep the baby in longer?

      • Babies with kidney blockages will often present with oligohydramniosis which, after further investigation, requires early delivery and surgery to remove the blockage.

      • Another person who knew someone with true oligo. They replaced her fluid, though, instead of taking baby out, feeling that baby would do better in rather than out.

  3. I’m with Jane. If this information is true then yes, induce. Chances are since it’s on this site this is a case of (dangerously early) failure to wait. Wonder if the chart says “Mother requested induction”.

    I had an interesting conversation this weekend with a friend (who isn’t a Mom yet) why everyone doesn’t just induce at 37 weeks since the baby is considered at “term”. After mentioning that dates can be wrong, inductions are dangerous, and that statistically viable doesn’t mean your baby won’t end up in the NICU (or worse) she then asked why bother saying 37 is term after all. Obviously this Doc needed that chat too.

    • If I remember correctly, 37 weeks is four and a half weeks less than average gestation time for normal first pregnancy. Which makes me wonder, if 4.5 weeks less than average time is considered “term”, why isn’t 4.5 weeks more? When does “post dates” start – 42 weeks? That’s four days longer than average.

      I suspect OBs have managed to find the cloud that goes with the silver lining of much-improved neonatal care for preemies. They can do miracles these days with early babies, but it seems one result is that doctors cause premature birth without a care in the world. You didn’t see this “all babies are better off born slightly premature” attitude a few decades ago; then the emphasis was on gestating the baby long enough, not “getting the baby out of there” as soon as physically possible.

      • For a couple of years now I’ve been sayint this same thing. OB’s have lost their fear and respect for premature infants because NICU do such a wonderful job. If OB had improved as much as NICU had improved how safe would birth be. But they haven’t because there is no press on them to do so. The only pressure is to avoid a law suit. No pressure to deliver the healthiest possible baby because the NICU will fix their screw-ups!

      • If 41 weeks is average, and mothers are being induced early very often, isn’t this number skewed low? Meaning, if they let nature take it’s course, wouldn’t the average be even later than 41 weeks? All my babies have been born spontaneous at 42. I know that’s just an anecdote, but still, I wonder…

  4. First of all, amniotic fluid index measurements are very difficult to perform with accuracy. It’s been commpared to trying to figure out how much water is in a clear bathtub with a full grown person inside, by looking through the bottom of it.

    Secondly, recent research suggests that induction for low fluid is not helpful.

    • My doctor said the same thing. I’m 30 weeks long and had an ultrasound yesterday. My amniotic fluid level was 10.8, still in normal range but lower side. According to my OB, it’s really difficult to get an accurate result because of the way baby position itself.
      But, my OB is still going to do an another ultrasound next week to make sure.

  5. I also wonder in these situations why it is that if baby needs out, that the induction isn’t going on NOW! If it’s such an urgent thing, why are we scheduling for the future?

  6. And to clarify, if we can wait, it must not be such an urgent situation as doctor says. Holiday coming up maybe? Docs not on call this weekend?

  7. Yeahhh…if the induction can wait til Monday, then why not just wait til Monday and recheck then? Have mom up water and caloric intake, ‘problem’ (if there actually was one to begin with) might be gone by then!

  8. You all do realize that there is very little research on low amniotic fluid. The best explaination is that low fluid is a sign of some other problem and not the cause of the problem. Low amniotic fluid occurs along with other problems and is only an indicator. Any doctor who doesn’t send you to drink gallons of water and retest is doing knee jerk defensive medicine not patient care. If one low amniotic fluid is the only negative it isn’t enough to support any action. I would want to review the chart and see the number before I risks delivering a preemie for no reason.

  9. Sounds similar to the last one from DoulaMama. If it is, this doc seriously needs to lose his license.

  10. I would really like to hear the rest of how the pregnancy went. I hope someone can pink this link.

  11. See, I have accepted multiple ultrasounds this pregnancy to keep an eye on a kidney abnormality detected at 20 weeks.

    Part of me agrees with my husband, that since they can’t actually treat anything, that going every 4 weeks might be not strictly necessary. On the other hand, knowing how the issue is progressing, or not progressing, helps me cope and prepare for any potential treatment that could still be necessary after birth.

    Anyhow, each time, we have been able to track his growth, which has been “on track” with each scan. The fluid levels are important, because kidney issues can cause low fluid levels. The fluid levels have been perfect, which is a great sign.

    Now, if I were to go for my final scan next month and they said “His growth pattern is extremely different this time, and seems to have slowed. The fluid levels appear to be much lower than last time” THAT would be concerning to me. Because they have a history to compare it to. I also know that the MFM doc is committed to natural birth and midwifery models of care. So, he’s not going to be jumping to intervene at the slightest thing.

    Based on how rapidly what little room is left in there seems to be shrinking even further, I highly doubt we will find any issues with his growth.

    This case, however, looks more like a doctor who was looking for an excuse to start the cascade of interventions rolling ASAP. I really hope the mother got a second opinion!

  12. Or we can check again on Monday and in the meantime, I’ll keep myself well-hydrated and then we can talk about ways to keep this pregnancy going until at least REAL full-term if there still seems to be a problem. The difference between 37 and 39 weeks is too great to take a chance on one scan, sorry.

    And since I had a friend just give birth at 41 weeks to a baby with IUGR, naturally, no induction, not even knowing he HAD IUGR, I’m not even as scared of that as I used to be. I question a lot more the more I get exposed to pregnancies not micromanaged by OBs.

  13. This one is mine, it was said to one of my doula clients. This was mom’s second baby and no second opinion was sought. The fluid levels were on the lower end of normal and was told the baby was measuring around 5-5 1/2lbs and not gaining any more weight and would thus do better outside since she could be given formula to gain weight :/. She went ahead with the induction at 37+5.

    The baby was thankfully a healthy 6 1/2 lbs baby girl and also had a very healthy placenta..no signs of calcification or other issues whatsoever.

  14. I had the OB in my 1st pg say these exact words to me. Luckily I was educated enough to push back and ask how we could confirm whether an induction was truly necessary. OB seemed surprised I wasn’t jumping at the chance to induce at 38 weeks (eyeroll) but agreed to send me to a specialist who did a more-advanced ultrasound and stress tests to determine that baby was doing just fine. That doc said, “yes this baby is small – because of genetics! You and your husband are small too. There is no evidence of failure to thrive here.” So we waited and had our healthy 6.3 lb baby at exactly 40 weeks with spontaneous natural labor.

    It makes me crazy how many excuses can be found to suggest early induction – fluid too low or too high, baby too big or too small, blood pressure too high or too low. And the NICUs are full.

    Elizabeth, your mama was very lucky.

  15. Oh, Doctor?… Horse hockey.

    *sigh*

    The things they expect us to believe…

  16. I had two very early babies-the first one was an induction at exactly 34 weeks (they were determined my dates and the early scans were wrong, as he was ‘big for dates’) and the second a C-section at 32+3 (or 32+4 depending on if you went by my dates or theirs). Both ended up with complications, which thankfully turned out okay in the end. My 32 weeker was originally due to be ‘rescued’ on the Friday, but there was no room in SCBU/NICU for her, so they delayed the op…I was frantic, having been told on the Thursday evening that we were headed for ‘an empty nest’ (I was carrying twins, and my son had already died, I was told he could ‘poison’ his twin). On the monday morning the OB told me we were well past the 32 week point, I’d had the hormone injections (very painful, but I thought worth it, as I was told they almost guaranteed a baby would survive if they got past 32 weeks), so we had the scheduled c-section that afternoon. My OB stayed long enough to make some nasty comments about birth control etc, but left within half an hour. My daughter couldn’t feed properly, her temperature started to fall, the heater didn’t seem to be helping so she was stripped to just her little socks (way too big for her), and placed skin to skin with me, but still her temperature dropped. As I held her in my arms, examining the amazing tiny features my daughter had, I noticed how far in her chest heaved when she was breathing. The midwives had bleeped and phoned SCBU/NICU several times, but they were over full, and had apparently warned my OB not to give me the C-section (this I found out a few weeks later), when a doctor finally arrived my daughter had stopped her squirming and was peacefully asleep. The doctor picked her up, her little sock fell off, I looked from the sock on the floor, to the doctor’s face, he went pale and grabbing my daughter to his chest he screamed for assistance, yelling for the midwives to notify SCBU he was on his way, and then ran out of the doors with my daughter. All babies must be moved around in their ‘cribs’, there are no exceptions-parents, midwives, porters, doctors, nurses, OBs, all of them *must* put the baby in the goldfish bowl style crib, and push them to where ever they are going. I knew this. I knew the doctor wouldn’t have broken that rule under normal circumstances, I’d seen his face when he looked at her, I heard the urgency, verging on panic in his voice. The stillness I had thought was my daughter settling to sleep, was actually more like her dying, and when the doctor took her she’d stopped breathing. I am thankful that the doctor turned up then, and not 20 minutes later…I’m reasonably sure that she would have passed away in my arms without me realising, and all the possible help outside my room, would have been far too late. The doctor’s words, a week or so later made me realise that doctors, although specialising is wonderful and needed, really need to take time out regularly to work in other departments, especially those linked to their own speciality. He told me my daughter was colder than he’d expected, her lips were blue and she just wasn’t breathing, he had to apologise for breaking hospital protocol and ‘leaving the room without placing [my daughter] in her crib’, I naturally told him I was glad he’d run with her straight to where she was revived and put on a respirator. He then said ‘you know the trouble with these OB’s? They just care about getting the baby out alive…they have no idea or concern about how hard it is for us to keep them that way’…and that was as close as he would go to saying it was my OBs fault for such an early c-section. But he was right. The hormone injections may help, but they don’t guarantee anything. Getting past 32 weeks helped, but again, no guarantee. Having a bed in Special Care also helps, but sadly is no guarantee, as I’m sure far too many parents can testify. Going fully to term, and giving birth the way we were designed to doesn’t even guarantee a perfect outcome (although the odds are more in favour), so why do OBs think they can just interfere and get a good outcome? I think the doctor was right, they don’t care past the point of birth…the Post Traumatic Stress, the side effects of the drugs and procedures, the problems with conceiving, carrying or giving birth to the next baby, the feeding or bonding problems and all the other problems we see day after day on this site, are nothing to the OBs, because they get to wash their hands of us as soon as our baby is delivered (and on their terms if they can talk/force us into it). What a shame so many of us are brought up to believe that these OBs are always right, and that so few OBs are forced to take responsibility for the damage their actions (or inactions) cause.

  17. This post scares me as last thursday, the doctor noticed my AFI is high, at 23. At 36 weeks. The baby only is weighing 4 1/2 lbs, in the 16% for her size. So i go this thursday when i’ll be 37w2d for an ultrasound and stress test and if she hasn’t gained weight my doctor said she’ll have to induce me.

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