Scared about low fluid and failed BPP

[ILoveSweetpea]

I was just diagnosed with pre-eclampsia (mild - only 420 protein in urine and bps around 150/90). I had this last pregnancy, so it wasn't a total surprise.

But I'm scared now because the baby failed the BPP today. She wasn't moving at all - so they couldn't get tone or reflexes. Also her amniotic fluid was very low - I think 2 1/2 or 3 cm.

The doctor was having a hard time deciding if I needed to deliver today or if we could try to wait until I am 37 weeks (I'm 36 +2 now). She consulted with another doctor and they decided to send me home. But I have to do kick counts and call if she fails kick counts. I also have to drink a TON of water. Tomorrow morning I am going in for another BPP. I suspect if she failed it again, I'll be delivering tomorrow (via c-section). If she passes, we'll try to get to 37 weeks.

I'm feeling so nervous about all of this. But I am very close to full term. I am nervous that she hasn't been moving and that my fluid is so low... and what those things might imply.

Is the low fluid related to pre-e?? Can the low fluid harm her?? Please share your experiences. Thanks!

[umsami]

:

I will keep you and your little one in my thoughts and prayers. I've had other issues in my pregnancies, but not this.

I'm pretty sure there is a link between pre-e and low amniotic fluid... but whether or not that is the cause in your particular case, I don't think anybody can say. I believe that less than 5 cms is considered low.

How was her heartbeat?

Were you seeing a perinatologist/Maternal Fetal Medicine specialist or a "regular" OB? If you didn't see a peri, I would make sure that I saw one tomorrow. That's their specialty.

You know, as much as Mamas on MDC don't generally like c-sections, yours sounds like a case when it's very much in the best interest of you and your baby. So, you might want to check on the birth and beyond threads for some ideas/requests on what you can do to make the experience as positive as possible should you need one tomorrow. Hopefully, your little one can cook until 37 weeks, but if not, it may just be her time to come out right now.

[mischievium]

*

[umsami]

Originally Posted by mischievium

Can I ask, is it that she wouldn't move during the BPP and has moved since then, or that she's not moving at all? If you have any concerns at all between now and your BPP tomorrow, I wouldn't hesitate to go in.

Yes, I meant to add this. Honestly mama, follow your instincts. Even if you just think things might not be O.K., I'd go in. Definitely a better safe than sorry thing.

Here's some experiences from the pre-e board
http://www.preeclampsia.org/forum/to...TOPIC_ID=38220

There are many threads on it, though... so do a search.

[stephbrownthinks]

I don't have any suggestions, but wanted to send you a

[MI_Dawn]

I don't want to scare you either... because everything COULD be fine.

But now that I've fallen off the other side of the "should I/shouldn't I?" fence after delivering a stillborn son at 39 weeks... and this is coming from a woman who was a doula, taught Birthing From Within classes, etc...

FOLLOW YOUR INTUITION.

I ignored mine, and it was the worst thing I could have done. I might be planning a first birthday party right now instead of a memorial/remembrance.

It just makes my heart beat faster when I read posts like yours, because while I know that 99% of the time, birth IS natural and things ARE fine... being in that other 1% sucks. You don't want to cross over to that dark side of motherhood. Trust me on this, it's pretty awful.

So my advice, since you're asking, would be to trust your instincts. Don't ignore that little voice in your head. You might regret going in and all the interventions that may follow... but you will regret the worst-possible-outcome even more.

<--stepping off soapbox...

[ILoveSweetpea]

Thanks you guys. I've just been crying like crazy since I posted. I'm an emotional wreck, and the hormones are only making things worse. My husband is being less than supportive... I'm sure he is a bit scared too, but he is also totally put out because he's been stressed out over getting a big project done before our daughter arrives. So he's being short with me and not exactly the pillar of support I was hoping for. So thanks for your hugs, because I really need them.

The doctor I was seeing was just a regular OB. I had a consult with a high-risk specialist at the beginning of the pregnancy (due to pre-e in previous pregnancy) but that was it.

Her movements have been greatly reduced in the last two weeks. She has moved since the BPP, and she moved before it too -- just not much. I guess the low fluid is to blame?

The more I've read on low fluid, the more surprised I am that they sent me home. I mean, being less than 3 cm is apparently very low. You are right, umsami, that 5 cm is the cutoff for low.

The doctor did say I'd be lucky to make it to 37 weeks - but I'm not sure what she is basing that on. Are we expecting something catastrophic to happen in the next five days or so? If so, why wait?

I hope I can sleep tonight. I'm so nervous about the BPP tomorrow morning. I did a kick count and she passed in about 55 minutes. (10 moves in 55 minutes). I'll do another couple of kick counts before going to bed tonight and I will call if she fails.

I just wonder how much water can make a difference... How much fluid is required for me to not deliver tomorrow? I don't know. I just hope we are doing the right thing.

OK. I gotta stop crying over here. Crying is bad for the blood pressure and for hydration. Hormones, hormones, hormones... I'm never weepy like this!

If you are so inclined, prayers are most welcome and appreciated. I just want my little girl to be safe.

[RedOakMomma]

If you are scared, go back to the hospital and ask to be monitored overnight. You shouldn't have to wait at home, terrified, until tomorrow's BPP.

[ILoveSweetpea]

MI_Dawn I'm so sorry for your heartbreaking loss. As scary as that is to read (and as hard as I imagine it must be for you to type), I do very much appreciate your perspective.

I just feel so confused right now. I don't know what is intuition, what is fear, and what is rational. My husband is so annoyed with all of this, I know he'd be pissed if I had to go into L&D tonight... but I'd rather tick him off than lose my child.

I just don't feel tapped into my mother's intuition right now. I feel too emotional. Sometimes I think it'll be fine, but I am so worried about the "what ifs".

How do you know if something is fear versus intuition? I'm not usually this emotional and I can't quite think straight right now.

[mrsfru]

Originally Posted by ILoveSweetpea

I was just diagnosed with pre-eclampsia (mild - only 420 protein in urine and bps around 150/90). I had this last pregnancy, so it wasn't a total surprise.

But I'm scared now because the baby failed the BPP today. She wasn't moving at all - so they couldn't get tone or reflexes. Also her amniotic fluid was very low - I think 2 1/2 or 3 cm.

The doctor was having a hard time deciding if I needed to deliver today or if we could try to wait until I am 37 weeks (I'm 36 +2 now). She consulted with another doctor and they decided to send me home. But I have to do kick counts and call if she fails kick counts. I also have to drink a TON of water. Tomorrow morning I am going in for another BPP. I suspect if she failed it again, I'll be delivering tomorrow (via c-section). If she passes, we'll try to get to 37 weeks.

I'm feeling so nervous about all of this. But I am very close to full term. I am nervous that she hasn't been moving and that my fluid is so low... and what those things might imply.

Is the low fluid related to pre-e?? Can the low fluid harm her?? Please share your experiences. Thanks!

I'm sorry to sound negative, but I went through this in 2008--5 wks of bedrest, 2 in the hospital, baby born at 35 weeks--and YES, fluid that low can harm her. 2.5-3 cms isn't "a little low", and it's not the kind of "low fluid" that docs dx at the end of pregnancy as part of the placenta "aging out". They should have checked you into the high risk pregnancy unit and scheduled your delivery. This isn't really that gray of an area.

FWIW, I fought to keep my baby in till 35 weeks. The high risk docs wanted to get him out at 34 wks. In hindsight, I wish I had agreed. DS2 would have probably fared better coming out at 34 weeks, while my fluid was still around a 4-5 cms. At 35 wks, it hit a 2 (barely!), he was born w/pneumonia, the skin on his legs was totally dry and cracked, and his muscle tone was not that good. He struggled w/feeding, and spent 5 days in the NICU for the pneumonia.

I don't want to scare you, but I think your docs are doing you and your baby a HUGE disservice that could be a colossal mistake. When I really hunted for the real info about severe oligohydramnios, the risks of losing my baby were as high as 15% (and I'm not a fear mongerer--I planned homebirth w/my first!). My old posts from when I was in the hospital and first put on bedrest are on here--they are from July and August of 2008 and my user name was the same (mrsfru).

And yes, the pre-e can cause the oligo.. Low fluid can be a result of a faulty or failing placenta, just like pre-e.

I promise I don't want you to feel bad or to frighten you, but I do think absolutely that you should be in the hospital right now and delivering your baby ASAP.

Best wishes to you!

mrsfru

Adding: all the water in the world isn't going to do anything at this point, unless they are going to do an amnioinfusion and put it in your amniotic sac, which isn't worth it at this point, b/c you might as well deliver now to be safe.
An IV in the hospital would be prudent however.

[mrsfru]

Sweetpea,

My husband even just read this and my response....and was shocked by your doctor's treatment plan.

Please go to the hospital and ask to see the MFM. I'm almost positive that they would not send you home. I really think your doc has lost her mind, seriously. Don't sit around all night feeling terrified. Call your doc, tell her you've decided to go to the hospital, and go from there. You won't regret having erred on the side of caution.

Obviously, there is a chance they measured wrong, obviously, there is a good chance everything will be reasonably okay...but at 36 wks your child can survive outside the womb and thrive. Yes, she may be a slightly crankier baby for a few weeks, she *may* have a minor bit of trouble w/nursing at first that you will overcome w/just a little support, she may need a little breathing help due to the c-section...but she's coming out via c-section anyway b/c she now needs to (fluid that low increases the risk of cord compression by a LOT and really reduces her chances of a safe vaginal birth anyhow). The longer the fluid is that low the more the chance that her lungs won't function as well, b/c she needs that fluid to help them develop and work right.

Trust your gut and please go in ASAP.

Hugs and prayers!!!!!!!!!!!!!!!

mrsfru

Links to my old posts:
http://www.mothering.com/discussions...ligohydramnios

[mrsfru]

More links in this thread:

http://www.mothering.com/discussions...ligohydramnios

mrsfru

[umsami]

I'm going to second the call to go in and speak with an MFM. It worries me that your OB made this call on her own... when the more I read, it sounds like you qualify with severe low amniotic fluid. At minimum, give a call to the hospital and ask to speak to the MFM on-call. I don't think you should spend tonight worrying, when you could be monitored quite well in the hospital should you need an immediate c-section. Forget about annoying your DH. No doubt, if he realizes that this is serious, he'll get over it. Any annoyance he expresses probably has to do with fear about you and the baby, then real annoyance anyways. If there's a concern about lung development at this stage, no doubt they could be giving you steroids tonight anyways rather than you're sitting at home. Go in... or at least call. Please.

[kitkatkaddoodle]

Originally Posted by RedOakMomma

If you are scared, go back to the hospital and ask to be monitored overnight. You shouldn't have to wait at home, terrified, until tomorrow's BPP.

I am an L&D nurse who teaches fetal monitoring, and I'm also a mamma who attempted a homebirth for my son (I only went in for mec and got a vacuum extract due to a knot in his cord tightening) and am going to do as non-interventional a birth as I can at a birth center this time. I would go in, and I'd consider delivery right now as a very possible valid option for me even now, at 32 weeks if my midwife, found what your doctor seems to have found.

I definitely think you should go in to get re-evaluated. If she's not moving much, then your kick counts are obviously not getting completed, and that along with the other info you know would make me want to be closely monitored. Even if she needs to come out now, they could attempt an induction, but a c/s in this case might not be unwarranted.

If you go in and she's doing fine, you can be reassured, and if not, you're where you'd need to be.

I don't want to be alarmist, but I think you (and I) would feel better if you get checked out again. Let us know how it turns out!

edited: at this point, they will not use steroids in all likelihood. At 36 weeks, the benefits are outweighed by the negatives, and they're not as useful as in earlier in the pregnancy.

[mischievium]

Originally Posted by ILoveSweetpea

MI_Dawn I'm so sorry for your heartbreaking loss. As scary as that is to read (and as hard as I imagine it must be for you to type), I do very much appreciate your perspective.

I just feel so confused right now. I don't know what is intuition, what is fear, and what is rational. My husband is so annoyed with all of this, I know he'd be pissed if I had to go into L&D tonight... but I'd rather tick him off than lose my child.

I just don't feel tapped into my mother's intuition right now. I feel too emotional. Sometimes I think it'll be fine, but I am so worried about the "what ifs".

How do you know if something is fear versus intuition? I'm not usually this emotional and I can't quite think straight right now.

, I say this as someone with the gift (curse?) of hindsight-- in this moment, you can't be expected to sort out what of your feelings might be intuition versus what might be fear. Really. Let yourself off of that hook. And the way I would think about it is this-- HCPs are there to reassure you, that's why you pay them the big bucks. If you are scared to the point that you're crying and upset, then they haven't done their job and it's okay to make them do their job. I would consider going in tonight-- at the very least, you will get another opinion and have the chance to have your questions answered to the point that *you* feel okay with the plan of care (because I don't get the sense that you are currently okay with the plan of care). Depending on the hospital, they may either have an MFM in-house at all times, or they may call one in to consult on your case, or you may get another OB who feels like your case is so clear cut one way or another that it's not necessary to bring in an MFM (although, absolutely don't feel bad about asking to have the MFM on-call paged if you aren't happy or reassured by the OB who's on).

Sending you love and strength .

[MacKinnon]

No advice Mama, but wanted to send you love. Best wishes for a healthy, happy baby!

[ILoveSweetpea]

Thank for all the support. Your responses, of course, made me cry... but not in a bad way. It felt good to have my feelings validated. I haven't had a chance to read the other mothering links, but I will... and I'll share some of the info with my DH and hopefully he'll sort of "get" why I'm so worried.

I did a kick count and my doctor said I needed 10 kicks in an hour or to call in. I got 7 kicks (well... barely perceptible movements... but I'll take it). So I called the doctor to report what I thought was a failed kick count. She said "really, 10 kicks in 2 hours is ok." Er... ok.... (???) so I counted for the next hour and she did indeed reach 10 kicks in two hours (plus a few to spare.)

So I asked the doctor what would prompt a delivery at this point. I have that BPP tomorrow morning at 10:30. She said a failed kick count, a spike in my bp, or if the fluid is still low tomorrow morning would all be reason to delivery. Basically... a light breeze could prompt delivery. She seemed to think that after tomorrow's BPP I will either be delivering, or I will be going to the hospital for monitoring until delivery. Again, I hate being in the hospital.... but I don't get why I was sent home rather than to the hospital today. It's just confusing to me.

I asked how often I needed to do kick counts - and she said basically throughout the night until the BPP. Ug... how am i supposed to sleep if I have to be constantly vigilant about her movements? I really want to rest up. I'm so exhausted from all these emotions and I want to be well rested if I will be having a c-section soon.

So, I am frustrated. And your responses just justify my confusion and frustration.

In good news.... (a) I'm not a crying mess anymore. I think I got that out of my system for now. (b) My DH is being a bit more sympathetic than he was earlier today - maybe he's sort of accepted that his project must be put on hold. (c) Most importantly, the baby is moving! Not huge movements, but she has been passing her kick counts.

I'm just still surprised about how this is all playing out. Knowing how laid back this board tends to be, and low-intervention by nature, it really gets my attention that everyone here seems to be on the same page that delivery needs to happen right now. I guess all I can do is keep track of these kicks and if she fails a kick count, I'm driving to L&D rather than calling the doctor first. In the meantime, I just need to prepare myself mentally for the likely c-section tomorrow and what this all may mean for my daughter.

OK. I am rambling and not making much sense.

Thanks again, everyone... you've all really touched me by taking the time to write with both support and information. Thank you!!!

[umsami]

Your OB is not my favorite person right now. She should have had you come in... at least you might be able to get some sleep (although not a lot) in the hospital.

If you can, take a bath, relax.... and visualize everything going well. Visualize your little one swimming around in plenty of fluid... happy... healthy... etc.

I'm sorry it's going to be a tough night. But hopefully you'll be holding your healthy, happy little one soon.

Check out this thread too Natural Family Living Cesarean Resources
http://www.mothering.com/discussions...d.php?t=401645

[RedOakMomma]

Something feels very wrong about this. If your OB is having you stay up all night to monitor your baby, then why aren't you in a hospital where someone and something more reliable could be monitoring your baby? And where you might be able to get some rest?

If your OB is so concerned that she has you monitoring your baby ALL NIGHT, and if delivery is all but certain tomorrow, then you should not be at home. Was an afternoon or evening labor or c-section somehow inconvenient to them today? I don't get why this level of monitoring was placed on your shoulders, especially in an overnight shift. It seems unsafe and unreasonable.

I'm worried about you. I'm worried about their shifting ideas of what qualifies as "okay" for kick-counts. This does not feel right. You're the one actually hearing what they're saying and experiencing the situation. Does it feel right to you?

If it doesn't. If it doesn't AT ALL...go in. Tonight. So what if it's inconvenient...for them especially. It's their job to keep you and the baby safe.

[mrsfru]

Just checking in on you.....

I'm w/the others in that you should be in the hospital....please go in if you feel uncomfortable at all.

You would be able to *sleep* in the hospital--they will give you an IV that will help get some fluids in you and give you some strength, plus they will put baby on the monitor and the *nurses* will monitor the baby through the night while you rest.

GL Mama--I anxiously awaiting good news of your babe's safe delivery.

Hugs

henrietta