how bad is "low amniotic fluid"?

[lillymonster]

I have been reading a lot on this, and it seems controversial. I am almost 40, and I know there is an increased risk of stillborn. But from what I have read, they don't know why. My "medwife" is now saying it's because of low amniotic fluid. So I asked what the protocol was for low fluid. IV, then if that doesn't work (how long do they give for it to work?) then possibly a c-section or being induced. I already had a c-section, so I am trying for a vbac. Another c-section and having a baby prematurely seems crazy for a 5% (what she said) risk of a stillborn. And being induced brings a high risk of uterine rupture.

I am having trouble wrapping my head around this? Which is worse, having low fluid (which wasn't an issue with my first, I never had as many ultrasounds or even mention they were looking for it, and I was 36) But so far with my medwife I have had 4 ultrasounds with 2 more scheduled to check for fluid levels. Is this something new? By they way, all my ultrasounds have been "perfect" according to the OB who oversees them.

[tracymom1]

Are you dehydrated at all?  You can try taking in extra fluid and see if that helps.  How low was your fluid?  There is a lot of debate over what exactly to do in a situation where the baby is near or almost fully mature and the fluid is on the low side.  It really shouldn't affect your trial of labor unless the fluid is dangerously low.  I would try to boost fluids and see where that gets you in the next week or two.  

[Aliy]

i had low fulid with my first so i was put on modified bed rest... ( mainly cause I can't just stay in bed all day and told my doc that)

make sure you are resting putting you feet up over your heat so yes you have to do some fun pillow work but it is possible and drink lots of fuild.... juices and water.  and fulid levels change so i really don't know how much wieght they really hold as things cycle through and levels do go up and down...

[BusyMumof5]

I had this problem with my first, unfortunately I knew no different (being a first time Mama) and agreed to the caesarean.

However there is plenty you can do to help yourself and then there is things they can do to help too.

1) Increase your fluid water intake, It is dangerous to drink too much, but certainly increase what you are drinking, to water.

2) If all else fails, I can't remember where I saw this (perhaps, Google it?)... They can do a procedure, breaking your waters (When you're in labour) and actually infusing liquid up into you - I'm not sure how common this is used and if it carries risks itself, but to avoid a caesarean it's well worth looking into ( I wish I had known!) 

Best of Luck x

(P.s, Have they actually told you the biggest amount pool of fluid they've found?)

[lillymonster]

Originally Posted by tracymom1 

Are you dehydrated at all?  You can try taking in extra fluid and see if that helps.  How low was your fluid?  There is a lot of debate over what exactly to do in a situation where the baby is near or almost fully mature and the fluid is on the low side.  It really shouldn't affect your trial of labor unless the fluid is dangerously low.  I would try to boost fluids and see where that gets you in the next week or two.  

I have had no low fluid levels myself. In fact, after 4 ultrasounds they say I am fine, that is why I don't understand they want 2 more, and are assuming I WILL have low fluid.  I just prefer not to have 6 ultrasounds to test for something that hasn't been a concern at all during my pregnancy. With my first OB, I had 2, with my midwife, they want 6?? And I am in better health than I was 4 years ago. My levels were fine, just 2 weeks ago at 32 weeks and they want another ultrasound at 36 weeks to check for fluids again. and then again at 39-40 weeks.
 

[tracymom1]

Well in that case I would just refuse.  Nobody can make you have an ultrasound.  Maybe you should just tell them you will have one at 41 weeks if you go post dates and that there is no real reason or indication to do one before then. 

[gemasita]

Here's an article on low amniotic fluid:  http://www.themidwifenextdoor.com/?p=1141

Her suggestions are oral hydration and immersion in water because they have both been studied and found to be particularly effective.  She sites the studies.  She also cites studies that report how induction does not improve outcomes.

[lillymonster]

Originally Posted by gemasita 

Here's an article on low amniotic fluid:  http://www.themidwifenextdoor.com/?p=1141

Her suggestions are oral hydration and immersion in water because they have both been studied and found to be particularly effective.  She sites the studies.  She also cites studies that report how induction does not improve outcomes.

Yes I think that is what I read - and my midwife is now suggesting c-section because I am a vbac. I met with a homebirth midwife today, I justed want to cover my bases. Sometimes I question my trust in myself because of all the interventions I am told I HAVE to have.

[tracymom1]

I had my VBAC at home.  It was the very best thing I could have done for myself and my family.  IMHO, the hospital just sets you up for failure when trying for a VBAC.  Give the homebirth option a lot of thought... it really is worth it :)

[Mamatoabunch]

Originally Posted by tracymom1 

I had my VBAC at home.  It was the very best thing I could have done for myself and my family.  IMHO, the hospital just sets you up for failure when trying for a VBAC.  Give the homebirth option a lot of thought... it really is worth it :)

ITA. All 8 of VBACs happened at home and my first VBAC was unlikely to have happened had I been in the hospital.

[BusyMumof5]

Originally Posted by tracymom1 

I had my VBAC at home.  It was the very best thing I could have done for myself and my family.  IMHO, the hospital just sets you up for failure when trying for a VBAC.  Give the homebirth option a lot of thought... it really is worth it :)

I couldn't agree more with this statement. 

[Mommaof2angels]

Hi,
I can tell you from personal experience that low amniotic fluid is never a good thing. With my 2 year old son, my amniotic fluid was leaking. I kept going into early labor as early as 7 months, what amniotic fluid I did have left was stained with meconium during labor and his heart rate dropped to 19. We came very close to losing him but thankfully, they did an emergency c-section and he turned out ok. My 7 month old daughter was unusually small and once again, my amniotic fluid was decreasing rapidly and the specialists couldn't figure out why. They ended up having to do my c- section a week early because the specialist said if they kept her in any longer, she would definitely be stillborn and even taking her when they did, they couldn't promise she wouldn't die after birth. Thankfully, she was alive. But, she has suffered continuously since her birth, starting with staying in the NICU for almost a month due to her weight, undeveloped lungs and severe pneumonia. They believe it all was attributed to not having enough amniotic fluid in the womb but they still cannot figure out why my fluid has always been extremely low. Needless to say, I just found out unexpectedly that I'm pregnant with our third child yesterday and I am extremely scared fir the well fare of this baby. Hoping for the best and then, I can get my tubes tied. Good luck.

Mother of Trey(2) and Genesis(7months) and expecting baby number three....5 weeks preggers due August 18th

[mamamille]

Taking long (over 30 min) baths increases amniotic fluid.  And if your levels are fine then I wouldn't even worry about it.  It sounds like they already have a plan for you and are "breaking" you in gently.  Looking into other alternatives sounds like a smart move, if you don't want to be a stubborn bull the whole time.  They can't force you to do anything, and if you are good at tuning out the BS, then labor at home, and just show up for the birth. 

[geekgolightly]

It depends on the issue but low amniotic fluid can point to very serious issues (baby in renal failure, ruptured membranes) or it can be as simple as dehydration. It's taken seriously because it can result in death, as a PP has mentioned. Amniotic fluid is mostly urine from the baby and is an indicator of how well the baby is doing in the womb environment.

[RoseRedHoofbeats]

It depends on how low. Ask what your amniotic fluid index is. Normal is 8-18. Lower than 6 is a problem, especially if the kidneys or bladder look bad on ultrasound. But some doctors freak out around 9-11 AFI, even though that's not low enough to increase the chance of stillbirth.

Drink a lot of water, reduce things in your diet that are dehydrating (caffiene, soda, salt), and take it easy on yourself.

Good luck!

~Rose

[gemasita]

Originally Posted by Mommaof2angels 

Hi,
I can tell you from personal experience that low amniotic fluid is never a good thing. With my 2 year old son, my amniotic fluid was leaking. I kept going into early labor as early as 7 months, what amniotic fluid I did have left was stained with meconium during labor and his heart rate dropped to 19. We came very close to losing him but thankfully, they did an emergency c-section and he turned out ok. My 7 month old daughter was unusually small and once again, my amniotic fluid was decreasing rapidly and the specialists couldn't figure out why. They ended up having to do my c- section a week early because the specialist said if they kept her in any longer, she would definitely be stillborn and even taking her when they did, they couldn't promise she wouldn't die after birth. Thankfully, she was alive. But, she has suffered continuously since her birth, starting with staying in the NICU for almost a month due to her weight, undeveloped lungs and severe pneumonia. They believe it all was attributed to not having enough amniotic fluid in the womb but they still cannot figure out why my fluid has always been extremely low. Needless to say, I just found out unexpectedly that I'm pregnant with our third child yesterday and I am extremely scared fir the well fare of this baby. Hoping for the best and then, I can get my tubes tied. Good luck.

Mother of Trey(2) and Genesis(7months) and expecting baby number three....5 weeks preggers due August 18th

I think leaking fluid at 7 months or very low amniotic fluid at 7 months, along with preterm labor, meconium staining, and IUGR is a very different situation than slightly low amniotic fluid at the very end of pregnancy that DOES resolve with hydration or submersion.  Your situation was obviously very serious and there were several signs that your babies were showing that they weren't doing ok.

[lillymonster]

Originally Posted by gemasita 

Originally Posted by Mommaof2angels 

Hi,
I can tell you from personal experience that low amniotic fluid is never a good thing. With my 2 year old son, my amniotic fluid was leaking. I kept going into early labor as early as 7 months, what amniotic fluid I did have left was stained with meconium during labor and his heart rate dropped to 19. We came very close to losing him but thankfully, they did an emergency c-section and he turned out ok. My 7 month old daughter was unusually small and once again, my amniotic fluid was decreasing rapidly and the specialists couldn't figure out why. They ended up having to do my c- section a week early because the specialist said if they kept her in any longer, she would definitely be stillborn and even taking her when they did, they couldn't promise she wouldn't die after birth. Thankfully, she was alive. But, she has suffered continuously since her birth, starting with staying in the NICU for almost a month due to her weight, undeveloped lungs and severe pneumonia. They believe it all was attributed to not having enough amniotic fluid in the womb but they still cannot figure out why my fluid has always been extremely low. Needless to say, I just found out unexpectedly that I'm pregnant with our third child yesterday and I am extremely scared fir the well fare of this baby. Hoping for the best and then, I can get my tubes tied. Good luck.

Mother of Trey(2) and Genesis(7months) and expecting baby number three....5 weeks preggers due August 18th

I think leaking fluid at 7 months or very low amniotic fluid at 7 months, along with preterm labor, meconium staining, and IUGR is a very different situation than slightly low amniotic fluid at the very end of pregnancy that DOES resolve with hydration or submersion.  Your situation was obviously very serious and there were several signs that your babies were showing that they weren't doing ok.

I wanted to stress too that I have had no issues during this pregnancy, and my 32 week u/s was "perfect" in the words of the high risk Ob who scanned it - so the request of  bi-weekly u/s after 36 weeks from the midwife baffles me. I am not leaking fluid because I was tested at one point during the pregnancy because I had pretty severe cramping and I also made a trip to L&D at 35 weeks due to limited baby movement and everything checked out fine. My First baby was 8 pounds, and this one is measuring even bigger so far.

On a side note, I did not get the 36 week u/s,  I have decided to switch practices and will meet a new midwife on Monday. I have no problem consenting to one more close to my due date, but one every 2 weeks at 36 weeks seems excessive.

[gemasita]

Here's some more good information about low amniotic fluid levels at the end of pregnancy by themselves vs. low amniotic fluid levels in the presence of other issues.

http://www.glorialemay.com/blog/?p=306

[jwoodbri]

I had low amniotic fluid with my last pregnancy. My doctor was starting to get concerned with the size of my daughter until she saw the low amniotic fluid then suddenly she much more concerned about that. I ended up being monitored in addition by a maternal fetal medicine specialist. I did not want my daughter delivered early so I drank water by the ton and I might have tried bathing too but nothing helped. I think in my case they were concerned that for some reason my placenta wasn't functioning properly (if I am remembering correctly) since I had low amniotic fluid and my daughter was pretty small. Something about not having enough space to grow and/or not getting enough nutrients from me. Again I'm fuzzy on the details now as so much has happened in my own medical history since then I think I threw some of these details out the window so to speak.

She ended up being born by c-section at 37wks 6days. She was 5lbs 10oz and very healthy. My boys were 7 1/2lbs an 8 1/2 lbs both born about a 39 weeks. Both were c-sections too (first was breech, second I didn't know better and should have vbac-ed.) I had actually looked into trying to vba2c but couldn't find anyone locally that would allow it and she was actually breech and with low amniotic fluid so I suppose even if I had it probably would have ended in a c-section after all. I didn't like them taking her a week early but they were truly concerned about her safety and had what seemed like valid reasons at the time. And thankfully everything turned out ok.

Good luck to you!

[msmiranda]

Just to clarify, the OP says that she has not experienced low amniotic fluid at all -- her midwife is asking her to have numerous ultrasounds to CHECK for low fluid solely because of her age (40) and an increased risk of stillbirth in older moms that they believe is correlated with low fluid levels.  In other words, they are being very (perhaps too) vigilant about potential stillbirth.  My understanding was that the risk of stillbirth is elevated at 40 but not elevated that much compared to the average person (6 in 1000 chance of stillbirth in the general population, so maybe an 8-10/1000 chance for a 40 year old mom).  In the absence of another risk factor, such as diabetes or hypertension, I would think that having a mom pay careful attention to fetal movement would be enough. It sounds like they are concerned about being sued in the event of an adverse outcome, which doesn't augur well for a VBAC, unfortunately.  It's not so much that the ultrasounds themselves are disturbing -- I might be okay with having them if I felt that I was at increased risk for a stillbirth -- but what this whole extra-intensive medical management regime says about their ability to be supportive of VBAC that is the issue.  It seems like the OP has picked up on that and is checking into other options.  Best of luck to you in dealing with your providers, lillymonster!

ETA: I just went back and read your previous post about having been to the L&D for limited fetal movement at 35 weeks.  That might have spooked them even though everything checked out fine at the time.  Hell, it would have spooked me too.  Have you talked to them about your concerns about what they are requesting?