Low Amniotic Fluid? Preventable?

[amymckinney]

It's been 6 months since I had my first baby, Victoria, via "emergency" section. It was due to low fluid -- they were going to try to do a version and turn Victoria head down (at 36w1d). They couldn't do the version and said I needed to have a section immediately. My MW said it was "normal" in older moms (I conceived at 35) and it was nothing I did. They also didn't want to try hydrating me really well to see if my fluid would increase and then trying to turn the baby -- frankly, I was so alarmed at the time that I agreed to the section.

But I'm hesitant to believe it was all just nature/maturity. My FH started measuring a week behind at 35 weeks, and two weeks behind at 36 weeks. This was all after a wonderful, textbook pregancy. My MW says it's normal in late pregnancy to start measuring smaller due to the baby dropping. But Victoria never dropped. And I wonder if she might have been unable to turn head-down and drop after 34 weeks because of low fluid (hence my FH measurement being off). If they had known I was losing fluid earlier, maybe we could have done something....??

I'm writing all this because I need to know if it's much more likely that I could have prevented the section. If it's likely I could have prevented it, I want to know. My MW and her OB, of course, said "no, no, you did nothing wrong." But if I'm going to have another baby, I want to feel confident that I'm doing everything I can to prevent it happening again.

See, I'm afraid maybe I didn't drink enough water and/or had too much caffeine when pregnant. Since my pregnancy was going so well, my MW didn't really put restrictions on me with regards to eats/drinks (except big ones like caffeinated coffee or alchohol). She said it was ok to drink sodas as long as I don't "overdo" it, because sodas and tea has much lower caffeine levels. But honestly, when you're finally over morning sickness and you're craving a burger, fries, and a coke, do you really pay that much attention? And frankly, that's where I fell down. I didn't keep track and I drank probably a lot more caffeinated sodas and tea than I thought I did. I loved sodas -- I craved them badly. But I never kept track. And water -- ugh -- the whole first trimester I had trouble drinking water because it grossed me out for some reason.

Does anyone else out there think it's likely that I dehydrated myself and caused the section to be necessary? Or, perhaps, does it look like my midwife could have done more?

I would love to have a VBAC (possibly at home?) for a second pregnancy, but I'm afraid I've done myself in for another section by allowing the first one.

Sorry for the long post folks...

Thanks in advance for any advice or insight or experience...

-Amy

[MsBlack]

Well, what I can say as a midwife are 2 things:
1. I tend to discourage drinking soda for a variety of reasons: because it is empty calories, because it is high sugar (unless you drink diet soda, but even that has it's issues), because the composition of soda interferes with nutritional balance of various minerals, because of caffiene. It is one thing to drink soda a time or 2 a week, quite another to drink it more than that. If you add caffienated tea to the weekly mix of beverages, it can get to be a lot of caffiene along with other substances and effects on your body that are never so desirable but least of all when pregnant or nursing a baby.

2. If it seems to me that a mom's amniotic fluid levels are dropping too much in the final weeks (some decrease in fluid is normal for many), among the first things I'll ask is about such things as caffiene, soda, how much water mom is drinking. Even decaffienated coffee/tea, or soda seems to me to irritate/over-stimulate the kidneys, causing a woman to lose too much fluid from her body generally and from her uterus specifically.

The craving for soda or sweets of any kind may mask a protein deficiency, for one thing. So if I had a mom who spoke of such cravings, I would talk to her in depth about her diet--but I speak to moms in depth about their diets anyway, at intake and in the first few visits. *Some* 'empty calories' seems to be fine for most women--pregnancy utilizes a great deal of energy and even empty calories provide some of that energy. But it is a matter of balance for sure. No one need have a 'perfect diet'....just 'good enough', and I think you did not know last time just what was good enough for you and your baby.

Anyway--it does seem possible that you unwittingly contributed to your low amniotic fluid levels in your last pregnancy. Apparently your care providers did not realize how they might have advised you on this--but I have seen that such things as eliminating caffiene and soda generally, drinking more water, and even soaking regularly in a bath can help improve amniotic fluid levels.

I don't think you are bound to suffer the same issue again with your next pregnancy. Live and learn, right? One thing to be aware of is that hospital-based care providers are seldom very involved in such matters as nutrition. You might receive general nutritional advice--but I have never known a med care provider to work on nutrition with a mom experiencing pregnancy issues. One told me that 'the majority of moms just ignore it anyway--and we don't worry about it because we have so many medical ways to control problems that arise'....such as giving someone a csec in your situation. Just saying that if you are going to choose hospital birth again, you might want to be sure to get nutritional advice; whether by visiting a nutritionist or just reading up on pregnancy nutrition and following the advice you receive.

good luck!

[jeminijad]

This is purely anecdotal, and based on a tiny sample size (1 woman, 2 pregnancies.)

With one pregnancy, my fluid was completely "normal." I drank some soda and juice (certainly not daily) and water to thirst... probably around 40-50oz a day.

With the second pregnancy, I guzzled water. It was keeping my skin clear, so I wasn't doing it for any real pregnancy reason, but I ended up with borderline polyhydraminos- not problematic in any way, just a very high level of amniotic fluid.

So in my limited experience, yes, the amount of H20 you put into your body influences the amount of H20 in the uterine "tank."

[tessie]

Am I right in thinking that low fluid can be caused by the placenta not functioning as it should? So if the placenta was showing signs of post maturity, such as calcification (even if you're not at your EDD), this would indicate that it was a placenta problem and not a hydration problem?

So, did they identify any placental problems?

[amymckinney]

Thanks for the responses, ladies!

You know, I didn't get any information back on the state of my placenta. I didn't even think to ask in the blush of new motherhood because I was just so happy to have a healthy baby. I should contact my midwife about it; she might be able to shed some light on it.

-Amy

[organicpapayamama]

wanted to add my 2 cents. Im very bad about drinking water When I was pregnant with DS I was still not on top of drinking water... just drinking to thirst. I started drinking soda in the second and third trimester. We are talking maybe a small soda almost every day.... i know I know.... and my fluids were fine. same thing is going on this time around and so far so good.

[rlmueller]

Can I jump in with more amniotic questions

I was induced at 42 +3 for dropping amniotic levels. At the time--I didn't know what a normal level was.

Can someone tell me during an NST sono measurement of levels--what is being looked for? Pockets of how much fluid?

I just want to avoid a repeat--the the birth went pretty well by induction standards.

[MsBlack]

Originally Posted by tessie

Am I right in thinking that low fluid can be caused by the placenta not functioning as it should? So if the placenta was showing signs of post maturity, such as calcification (even if you're not at your EDD), this would indicate that it was a placenta problem and not a hydration problem?

So, did they identify any placental problems?

This is becoming a popular theory but I really don't know as there is any real evidence to uphold it. With true Intrauterine Growth Retardation (IUGR), you see 3 things together: very small baby for dates (usually with 'off' proportions of baby's head/body), poorly functioning placenta, and very low (nearly nonexistent) amniotic fluid. I am thinking that because of these findings with true IUGR (which is fairly rare in otherwise normally healthy pregnancies), now the docs are inferring that 'low fluid probably equals poorly functioning placenta'....and it goes from a theory with shakey connections in the first place--shakey, because in a healthy baby, all conditions including placenta are just *different* than in an IUGR baby--to becoming a 'probability' or even gets stated as 'fact'. But this is not a fact by any means!

So this is to say, Tessie, that we really don't know if low fluid occurs in an otherwise healthy pregnancy because of poor placental functioning! There are theories and inferences only. Nowadays, 'low amniotic fluid' has become quite the trendy reason for Drs to induce labor or otherwise begin the fear mongering and interventions. But there is really no evidence that u/s is even able to accurately measure amniotic fluid, and no evidence that low fluid in late pregnancy is problematic for babies.

I do want to distinguish 'low fluid' from 'no fluid (or nearly none)'. This can be felt fairly clearly on palpation of mama's baby belly--baby gets that 'shrink wrapped' feeling to the palpating hands because there is no fluid to buffer/blur/soften the feeling of the baby's parts. One does not need u/s to sense this, and u/s is notoriously bad and estimating Amn. Fluid anyway--but unfortunately, most med maternity providers don't much use palpation anymore, instead relying overmuch on u/s for info. 'No fluid' is associated with perinatal problems--but even with this situation (with otherwise healthy, well grown baby), there is time to wait for labor for another couple of days. Days in which a mother does best to try what she can to improve fluid levels!

But maybe med HCPs just don't know there are natural ways to improve fluid levels. They are, after all, the experts in illness and pathology, not in health.

By the way, another reason for very low amniotic fluid is dysfunctional or non-functional baby kidneys. But that is a whole nother thing, and also fairly rare--and if that issue was not raised for the OP then it's safe to say that her HCPs did not see any evidence of this.

[annekh23]

Sometimes things are beyond our control, I think if I were to ever have another baby fluid levels would be one of those things I don't think I can have much influence on.

My first baby was IUGR, with normal fluid levels when you'd expect, as MsBlack said, low fluid.

My second had severe low fluid, which went undiagnosed as based on my history everyone was on the look out for a small baby, so my normal bump was interpreted as normal sized baby normal amount of fluid, turned out to be big baby, almost no fluid, there likely had been a cord incident due to the presence of old meconium when she was born at 39+3. There can't have been low fluid for long as her lungs were fine. Her water was broken artificially after 2hrs at full dilation, none of the stuff they had ready to catch it and clean up was necessary, it just trickled onto the pad they had under me.

Guess what happened 3rd time around? Too much amniotic fluid, I didn't do anything different and it wasn't severe polyhydramnios, only just outside normal range, but that was a dramatic difference compared to my previous pregnancy when I'd always been able to sense exactly where she was, not by self palpation just feeling it. This time doctors and midwives were struggling and there wasn't any excess fat to complicate it.

We can do our best to look after ourselves and our growing babies and respond to situations as they develop, but unless there was some major change that I've not spotted I've had 3 pregnancies and 3 very different fluid situations, somethings are just random!

[MsBlack]

Annekh23--

I like what you say on this topic No, we ultimately cannot control pregnancy/birth, and a big degree of surrender and trust is needed for our own sanity!

I also appreciate your pointing out that IUGR can occur even with NORMAL fluid levels. Really, there is just so little about amniotic fluid levels that is cut and dried, black-and-white clear. There are trends and associations with both high and low fluid levels, but no particular amount of fluid tells us any particular thing for *all* women and babies. And many different amounts of amniotic fluid are healthy for most babies.

When it comes to the OP's story and question, it bears mentioning that we do know of some associations between fluid levels and such things as amount of maternal fluid intake, and substances such soda and caffeine, some herbs and meds. If I had a diagnosis of low fluid, I'd want to know if there's anything I could do to possibly improve that. And it also bears confirming that we really don't have much by way of real control over fluid in many cases.