PLEASE HELP low amniotic fluid - fear induction

[bradleybrat]

PLEASE HELP advise my sister!

She is 39 weeks (first pregnancy), and has been measuring small for dates, so has had 3 ultrasounds in the last month. Today's showed the baby to be about 5 1/2 pounds, and her amniotic fluid to be LOW, 5.7 - 6.1 cc (?). My sister is slim but has gained 25 lbs. She is dilated 2 cm and 50% effaced but not having contractions. Her blood pressure, the baby's heart rate, and the non-stress test were all good. They could see that the baby's kidneys were functioning.

The are going to do another ultrasound and stress test on Friday and plan to induce if her fluid is below 5 cc.

Please advise; should she be trying natural induction methods??? Her doctor prescribed oral evening primrose, I believe 9 capsule/day. What else should she be doing?

How much concern should that low fluid be? Is it a reason to induce on its own?

Her husband is a Dr. and insisted on a hospital birth and I am concerned about a cascade of interventions. I had a natural home birth and want to help in any way I can.

THANKS!!!

[pamamidwife]

Here's some info that even her MD dh might find interesting:
http://www.obgyn.net/newsheadlines/w...0030306-34.asp

In a study presented at the annual meeting of the Society for Maternal-Fetal Medicine in San Francisco, researchers showed that babies born under such conditions at 37 weeks' gestation fared similarly to those born to women whose wombs held normal amounts of amniotic fluid. No significant differences were found in the babies' birth weights, levels of acid in the umbilical cord blood, or lengths of stay in the hospital.

Typically, doctors have been concerned about women with low amniotic fluid during the third trimester - a condition called oligohydramnios - because too little fluid can be associated with incomplete development of the lungs, poor fetal growth and complications with delivery. Amniotic fluid is measured by depth in centimeters. Normal amounts range from 5-25 cm; any amount less than 5 cm is considered low.

"These study results are very surprising - they go against the conventional wisdom," said Ernest M. Graham, MD, senior author of the study and assistant professor of gynecology and obstetrics. "Amniotic fluid stems from the baby's urine, and the urine results from good blood flow, so if we see low fluid we assume there probably is not good blood flow and the fetus is compromised. This study shows the fluid test is not as good as we thought, and there is most likely no reason to deliver the baby early if other tests are normal."

here's more: http://www.sma.org/smj1999/augsmj99/magann.pdf


If the standard is >5cm for diagnosing low AF, then your sis is doing JUST FINE.

and more: http://www.mothering.com/discussions.../t-137396.html

[Stacymom]

My story sounds similar to hers. I went in for a nst at about 37 weeks or so because 24 hours had gone by with no movement. They measured my fluid level at a 6, gave me the same spiel about inducing for 5 or less, then told me to come back in three days and "prepare to be induced, because when you're fluid levels are that low, they won't go back up." The next time I went, I was at 11. They wanted to see me in four days. That time, I was back down to a 7. Once again, they told me, come back in three days and prepare to be induced. Came back and was at a 15. Baby was born healthy (and fast!) three days after her due date.

Moral of the story? As my wonderful Dr said, AFI is an unrelaible marker for what's really going on. Tell her to trust her body, drink lots of fluids and take it easy!

[bradleybrat]

Thanks!!!

Thanks very much for your replies! That research is great. I will keep you posted on her progress.

Robin

[Nosy]

I was induced because of low amniotic fluid, and not too happy about it. I was having weekly non-stress tests because I had refused the 3 hour GTT and they thought I might have GD. He was 6 lbs 7 oz when born at 39 weeks so he wasn't exactly too big. I could have gone against medical advice, but was afraid and ended up having a 3 day induction. After the fact, I read the soaking in water and drinking lots of water (gallons) might have helped me. Best of luck to her- I know how scary it is to have pressure put on you for induction. My baby was born fine after 3 days of contracting- started with cervadil and progressed to pitocin on the 3rd day- but I wouldn't want to repeat it like this. We tried EPO, nipple stimulation, sex, & even pineapple, but nothing helped me go into labor. He just wasn't ready to be born yet!

[ctdoula]

I was at a birth in the spring of a friend. It was her 3rd child, and she'd been in & out of the hospital for months for PTL & low fluid. She was going to be induced, and went into labor naturally by coincidence. When the baby came out (a surprise sunny side up, LOL) fluid was everywhere & the doctor said "oh, well, so much for that low fluid bit". She was very surprised.

I would suggest also having your sister lay on her left side as much as possible to increase blood flow & drink lots of fluid, etc.

Good luck!!

[yequanamama]

Just drinking lots of water can change the low fluid levels.

[its_our_family]

Any news??? Did they end up inducing??

[Bethla]

I was induced because my contractions (on and off) for several days were actually causing pressure on the umbilical cord and my baby's oxygen level was lowering.

[bradleybrat]

Update

They did not induce last week -- they've just been doing ultrasounds and stress tests every couple of days, and she's been taking evening primrose capsules. They did strip her membranes last week, but it did not start labor.

My sister went in for an induction at 7 a.m. today, but they did not start Pitocin. Instead, they've done three rounds (so far) of prostaglandin gel and she is having mild contractions.

They said she might go home tonight (if things don't progress). I think they are afraid to start Pitocin because they think the baby might not respond well to those strong contractions -- they are worried that the baby might not tolerate natural labor well anyway. I'm getting all this third-hand from my mom, so I don't have all the details, which is frustrating. Hopefully nothing is "really" wrong and she will still have a natural birth and a healthy baby. I just don't know what I would do in her situation -- probably I wouldn't have all the information she has because I wouldn't have had so many tests, and I wouldn't have people scaring me.

Hopefully I'll be posting a happy ending soon!
Robin

[its_our_family]

Man, I hpoe things go well...or better than expected. They sound pretty negative about the whole thing. to her

[bradleybrat]

C-section

Well, she had a c-section at 3:30 p.m. today. I'm not sure of all the details or the sequence of events, but they did go home last night, then went in this morning to start the pitocin. At some point they broke her water, the cord was compressed (crimped???) and the baby's heart rate went down to 80. So they did the c-section. Baby swallowed a lot of meconium, but she is O.K. now. She was small, only 5'9". When I talked to my mom, it was 7 p.m. and baby still hadn't nursed yet -- she had been in the nursery but they were supposed to be bringing her to my sister to nurse soon. AAARGH!!! I am so sad -- and angry! I just wish she had had different caregivers that I could feel did everything possible to avoid unnecessary interventions.

Thanks again for your advice and stories.

Robin

[pamamidwife]

I'm so sorry, Robin. I know that it must be hard to hear about things like that.

[Galatea]

I'm so sorry to hear about the c-section. Did they nurse yet?

I was induced for low fluid. It went okay b/c he was ready to come, but in retrospect, I shouldn't have done it and won't ever again.

[bradleybrat]

Nursing!

They had a good day today. She finally got to nurse at 9 p.m. yesterday, and her baby girl latched on great right away, and loves to nurse. She roomed in all night -- with my brother-in-law sleeping there and bringing her the baby to nurse. My mom was with her most of the day and will be there with her tonight. She said the baby had lots of poopy diapers and the last one already had some yellow in it! And she had one big spit up and burps a lot. She is very wide-eyed and alert.

My sister got her IV and catheter out today and will go home tomorrow or Monday.

Thanks again.

Robin

[its_our_family]

i'm glad things are "better" today. It sucks about the c/b...