Need Some Serious Advice!!

[katie9143]

Ok - so I am 41w4d - i went in today for an NST and a biophysical - the biophysical came back that the amniotic fluid was low - it was actually 4.1cm. Everything that I had read before going said that in order to get the 2pts alloted to that portion of the test for fluid vol the level had to be greater than to equal to 2cms. The told me that the cut off point for them at this hospital was 5cm - and that would be the bare min for the levels to be considered normal.

So they sent me up to have the NST. When I got there I talked to a MW from the birthcenter (which is across the rd - and i had originally been going there before I decided to go with the homebirth). She told me that with the low fluid levels that they would recommend that I stay and be admitted and start with the cervical gel - but that first they should do the NST because if that was perfectly normal and the baby looked healthy, that would give me more options and they would be more open to giving me the gel and then letting me go home rather than admitting me (hopefully then i would go into labor and have my baby at home). So we have the NST (at this pt my hb mw was there helping hold the monitor on the baby) - well the NST results were perfect, not one instance where it was bad and several times where the heartbeat sped up with her movement. So I expected that we could talk about the gel or going home, etc like she promised. Well this wasnt the case. The mw comes back in and said that they were still recommending that I be admitted and that regardless of whether i wanted to be admitted tonight or tomorrow, they really thought that I should have my baby at the hospital. She started talking about how with the low fluid levels that could contribute to increase cord prolapse problems (although my mw could feel her head at the cervix yesterday and we told them that) and also that since the levels were low that that pointed toward there being meconium.... WTF?? Why would that have anything to do with meconium and how could that have anything to do with the lower fluid level anyway.

Well, to make an already long story as short as I can - we convinced them to let me go home and try to drink a ton of water tonight and repeat the biophysical tomorrow morning at 830 and see if maybe we could get it up above there 5cm cut of level.

I need advice - what does anyone who knows about this stuff think? What levels have you ladies ever know as being normal for the afv? What does that have to do with the cord and meconium??

Thanks :

[alegna]

This is exactly why I will never consent to testing of this sort unless *I* think there is something to worry about. Nearly always they find something *wrong*

What do I think? What does your intuition say? Does that little voice say that everything is fine? If it does, I say forget them and have your homebirth.

Thing is that things like fluid levels are subjective. It's not a measuring cup that they're reading the markings on, ya know?

-Angela

[katie9143]

My intuition is telling me 100% that everything is fine with her! I am just afraid that now my mw is scared and will tell me she doesnt feel comfortable attending my birth. If this was not my first baby i would just do it myself, I have total confidence in being about to birth this baby naturally and at home - but she was really nervous and said that she really wanted the repeat bpp tomorrow morning that shows the levels atleast are a 5.

I dont know what to do - I will go back in the morning, but even if they are still under, I dont want to be pressured to be admitted and induced, but I think that is exactly what will happen.

[sebarnes]

I think that Angela is right in saying you need to listen to your intuition and what you are feeling right now. If, as you say, you know everything is fine, I would still go with the homebirth. I have a feeling that if you go back to the hospital you will end up being pressured until you agree to induce. Have you talked to your hb mw about her feelings on the subject? That way you would at least know if she is still comfortable with attending you. You could be worrying on that account for nothing, and stress is never good for anybody!

[katie9143]

If I had not agreed to go back in the morning for the repeat bpp then my mw would have told me to stay and be admitted The repeat test was her way of bargaining with me so I could go home tonight and avoid the imediate induction.

[Full Heart]

With a BPP if they push in with the u/s wand it can displace the fluid and make it appear low when in reality it isn't. How does the fluid feel when you play with the baby? Does it feel low to you?

If there isn't enough fluid the cord can get compressed, but I can't see how it would increase prolapse. And if the head is firmly applied to the cervix there is no way a cord is gonna get around that. Not that any of thise is gonna be a problem since you aren't consenting to AROM .

Hows the kick counts? Baby still moving well?

http://www.midwiferytoday.com/articles/biophysical.asp Thats an article by Gloria Lemay about low fluid in BPP.

http://www.gynob.com/biopamfl.htm That one has an interesting paragraph:

On the other hand, a low AFI (oligohydramnios) at or near term may be an indication for delivery, either by induction or C-section. If there were to turn out to be a normal amount of fluid with rupture of membranes during an induction, then the low AFI that prompted the induction was either temporary or wrong. It happens, but ultrasound's the best thing we have to go by, even with its inherent error.

Ultimatly I hope you go into labor tonight and have your baby uneventfully at home. If tomorrow comes without labor I hope your bpp turns out beautifully. I've faced transfer before due to post dates and its so stressful. You feel abandoned. You trusted someone and they turned at the very last second. I hope your mw will come through and attend you at home.

[dinah]

have you considered doing something to encourage labor to start naturally (acupuncture, EPO, castor oil, etc). It might not be ideal but probably better than a hospital induction or ask your midwife if she would be willing to support you in that and staying home.

[katie9143]

I have been taking epo for a few weeks - i had accupuncture on weds, but I almost passed out and she didnt have the needles in very long. I was going to attempt to go back tomorrow afternoon - but now i probably wont get that opportunity unless the bpp comes back better.

I have been thinking about going and getting the castor oil at the drug store and taking it in a little while. I keep thinking that that is all i have left to do really. I am thinking though that it might increase my risk of having meconium and then if I end up in the hospital having my baby that would just be one more thing that they can say they were right about - the meconium that is. I just dont know what to do.

[georgannemomof6]

at 41 wks, or thereafter, the med community always seems to find *some* sort of "complication" and "reason" for induction, kwim??
Follow your gut, keep track of kicks, have some "fun" w/dh, and baby will be here before ya know it

fwiw, prolapse cord occurs more frequently with POLYhydramnios

[Emilie]

what does your mw think?
I would not listen to their crap personally unless you think there is something wrong.
I would not go back but that is me.
Remember they believe you and your baby are in grave danger for going past your 40weeks and they are going to con you into birthing at the hospital no matter what. IMO.

[sarahmck]

Oh my God -- deja vu. Please be very wary of fluid tests. I had a very similar situation. I will try to keep it somewhat short for everyone's sanity, but please feel free to ask for more details or PM me.

I planned a homebirth all along, but had a back-up OB, just so that we would know the doctor in the event of a hospital transfer. Because of a condition that they thought I had but I didn't (this is off-topic so I won't give details here in an effort to keep in short), I was having 3x weekly NSTs and fluid indices. Aargh. What a stupid waste of time. Live and learn. Everything was always fine, but my fluid was always a bit on the low end, say 9ish.

One day, my fluid measured 3 at the OBs office on his crap ultrasound machine. I don't know if you've paid much attention to how they calculate your fluid level, but it is obvious to any thinking person that it is a completely ridiculous inaccurate test. The gist of it is that they add up the vertical height, in centimeters, of the four corners of your uterus where there's empty space. If that's above a certain number, you're in the clear. However, because they're using a fuzzy, two dimensional model of a three dimensional entity and because everything is shifting around in there, there is a huge margin of error.

Anyway, I was told that my baby was in grave danger and that if I didn't go to Stanford Hospital immediately, my baby might die. I was further told that labor would probably be induced that evening. My husband asked the OB if the fluid could possibly rectify itself from this low level and was told that a minor fluctuation may occur, but a safe level could not be reached from this very low level.

I went to hospital in the late afternoon, but the ultrasound department had gone home for the day, so my OB's findings couldn't be verified that day. Instead, I was put on 24 hour monitoring, so that they could see how the baby was coping. The heartbeat was normal and stayed that way throughout the night.

In the morning, I was whisked downstairs for an ultrasound and what do you know? I was informed that my placental fluid was at a normal level (10) and that there was nothing at all to be concerned about. They said that my OB had probably obtained an incorrect reading from inferior equipment, as the hospital's ultrasound machine was much more advanced.

My OB was quite put out at the suggestion he had made an incorrect measurement and insisted he had enough experience under his belt that this was not possible. He maintained this stance, even though this then forced him to concede that my fluid level must somehow have managed to rectify itself, in spite of having claimed this to be impossible not 24 hours earlier.

So, I came quite close to an induction at 35.5 weeks and was needlessly frightened out of my mind, thanks to primitive equipment, error-prone obstetrical technique and the negative orientation of the medical community, which treats pregnancy as an illness requiring medication and intervention.

This wasn't the last panic-stricken attempt by my OB to get me to give birth in hospital, but I'll spare you further details. After the next farcical diagnosis of impending doom, I dismissed him as my physician, having lost all faith in his judgment and motive.

In the end, I gave birth at home to a full-term, healthy baby girl.

All of the above happened in the Bay Area of California in 2005. Happily, I now live in Amsterdam, The Netherlands, where home-birth is much more the norm.

So, while it's entirely possible that you do have a low level of placental fluid, it's also entirely possible that there's nothing wrong at all.

[katie9143]

I just feel like now unless i want to have a UC - if i either dont go back or the test comes back that it is still low that i will be forced to have my baby in the hosp. My mw will not attend me i dont think at home with the low level and waiting to see if i will go into labor on my own.

This hosp sucks too because although they supposedly have these very nice birthing suits and jacuzzi tubs, they make you get out of the water once the pushing starts and the birth is eminent.

I just want to cry (again).

[koru]

oh katie! i'm so sorry you're going through this! i have no words of wisdom (except keep drinking your water!) and i'll be thinking & praying for you & Baby. tonight's the night...tonight's the night...tonight's the night!

hey, do you have a breast pump? this is another great way to induce labor. try pumping for 10 minutes every hour.

[crittersmom]

I had a similar experience to PP's birth and induction scare except I was alone at the time and uninformed so I believed the Dr and dutifully went in for the induction.Its been 2 years and I'm still bitter about it.Luckily for us both DS just needed a nudge since he was all ready and I was trying to keep him in so that my support system could get there.
If you do have to have an induction and I really, really hope it doesn't happen labor in the bathroom and let your DH or Doula run interfernece with the nurses until you are ready to push or even after. Don't let them force you into bed unless you feel you need to lie down.
I hope that you have a safe happy birth.

[MommytoTwo]

I also had low fluid levels at 41w4d, but my bpp wasnt all that great. In speaking w/ my mw this time she said I probably would have gone into labor that night or the next day.

[momto l&a]

I was talking to a mw yesterday that I may go with telling her of my history of going 'late'. She said she 'requires' a u/s done to check fluid levels.

Been trying to get information about the accuracy of that.

She backed down after I told her I don't do u/s unless there was some really good reason.

[momto l&a]

Looking more into the Amniotic Fluid Index.

http://pregnancy.about.com/cs/amnioticfluid/a/aaafv.htm

The most recent studies say that the AFI is not a great predictor of the Amniotic fluid volume (actual amount of fluid).

Some more info http://www.findarticles.com/p/articl...39/ai_n8581168

I am really wondering why the mw I am considering would even want to have this 'test' done as its obviously not accurate . I wonder if she just trying to cover herself in case something went wrong?

[Emilie]

we really need some reliable links on here about all these tests to help moms sort thru this junk.
A mw is now wanting these tests done?
I am confused./

[katie9143]

Thanks for the links - i keep sending my mw emails containing everyones info along with info that I am collecting on my own. They are very much appreciated!

[Emilie]

Thinking of you.
Did she know the position of your baby when she did check you?
Getting on my hands and knees helped dd get into place.

Hope you go into labor soon.
EM