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Two women I know were induced for having "low water." One of these babies, a newborn, has respiratory difficulties, IMHO from being induced early (four days, but who really knows when he actually would have been born had he been allowed to decide himself). I'm wondering a few things about this. Is having "low water" actually a concern? How likely is it that a baby would die from it? Are the risks of induction greater or less than the risks of "low water?" (I keep putting "low water" in quotes because it sounds like a BS diagnosis to me.) How can a doctor tell water levels from an ultrasound anyway? I'm a little concerned because I'm going to the same doctor/midwife team as the first woman I know who went through this.
 

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Babies typically will have lower fluid levels at the very end of pregnancy - and it's highly subjective (as has been mentioned) - hard to find and measure pockets of fluid with a full term baby in there.

The only time I'd worry about low amniotic fluid is before term.
 

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I think high levels of fluid are more worriesome, as certain birth defects can cause that. During my last pregnancy I had one u/s and it was to to look at fluid levels. I was measuring super-big (something like 56cms at 32 weeks, and my O date/conception were solid so dates could have been a few dates off, but not much more). The u/s showed that the odd measurements were somehow wrong, even though two very experienced people, one a MW, one a FP doc who does homebirths, confirmed. I've always measured "big" and it gets worse with each pg. Still, we felt that was enough of a variation from the norm that we would look. I don't do routine u/s, but will use it it is the best diagnostic tool for the job when something arises.

K
 

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I'd add to the above that many women get sent in for induction with "low AFI" when it is not really clinically "low", even by OB standards.

Interesting article on the unreliability of AFI from the "green journal"

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Conclusion: There was no difference between AFI and single deepest pocket techniques for identifying truly abnormal AF volumes. Both techniques were unreliable for identifying true AF volumes.

Quote:
The important consideration for the clinician is the relationship between the ultrasound estimate of AF volume and ultimate pregnancy outcome. Many investigators have already questioned whether there is any relationship between identified abnormal ultrasound estimates of AF and pregnancy outcomes.15-18
 

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This seems to be the latest craze. I hear it a lot but have never seen a baby born any less than perfect after this was diagnosed.
 

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There is a practice in this area that claims that they are okay with moms going to 42 weeks, but the moms are sent for a BPP at 41 weeks. Amazingly enough, EVERY SINGLE MOM is diagnosed with low AFI and sent for immediate induction at 41 weeks. What a coincidence!
: :puke

I had a client at a different practice get an ultrasound done somewhere between 40 and 41 weeks. The OB got a reading of 4.5, and instead of sending her immediately for an induction, actually referred her to a more experienced radiologist for a more accurate reading. That tech got an AFI of 13. BIG DIFFERENCE!!! The mom was relieved and the doc did not push for induction. I was truly amazed that the doc admitted that measuring AFI via ultrasound was very subjective, and needed a truly experienced operator to find all the pockets of fluid.

Sweetpea
 

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Here is an article about not inducing for low AFI based on a study by an High Risk OB at Johns Hopkins. I cannot find the link to the article but here is the full text from Healthscout News.

Low Level of Amniotic Fluid No Reason to Induce Labor
source: Health Scout News
By Janice Billingsley
HealthScoutNews Reporter
A low level of amniotic fluid in the last trimester of a pregnancy, often thought to be sufficient cause to induce delivery, is not reason enough to do so.
Johns Hopkins researchers who studied the health of more than 250 babies born at 37 weeks of gestation say they found that babies whose mothers had low levels of amniotic fluid were of normal size. And the babies had no greater risk for health problems than babies whose mothers had normal levels of amniotic fluid.
"This study indicates that we don't want to intervene because of a Amniotic Fluid Index (AFI) of less than five if everything else is normal," says study author Dr. Ernest M. Graham, an assistant professor of gynecology and obstetrics at Johns Hopkins University.
Graham presented the results of his study on Feb. 7 at the annual meeting of the Society for Maternal-Fetal Medicine in San Francisco.
Amniotic fluid is a clear, slightly yellowish liquid that surrounds the fetus during pregnancy; it is contained in the amniotic sac. Normal levels of fluid indicate proper functioning of the developing fetus, while low levels can be associated with incomplete lung development and poor fetal growth. Measured by depths in centimeters, normal amounts range from five to 25 centimeters; below that is considered low.
The American College of Obstetrics and Gynecology recommends the Amniotic Fluid Index should be only one measure of assessing fetal health. Heart monitors and sonograms are others.
However, doctors often induce delivery -- especially at 37 weeks -- based largely on a low AFI, says Dr. Siobhan Dolan, assistant medical director of the March of Dimes.
Normal gestation lasts approximately 37 to 40 weeks, according to the March of Dimes, which last week launched a $75 million campaign to address the high incidence of premature babies born before 37 weeks.
"In general, there's a tendency, at 37 weeks, to deliver the baby," Dolan says. "But this is a good study because it gives people reassurance to manage the pregnancy with careful monitoring and observation. You don't have to go immediately to the labor room."
For the study, Graham and his colleagues studied 262 women who gave birth at Johns Hopkins Hospital from 1999 to 2002, comparing the babies' health at birth. One hundred thirty-one women had had a low AFI during their third trimester, a condition called oligohydramnios. The other 131 women had normal amounts of amniotic fluid at the end of their pregnancies.
Women with low AFI levels had their labor induced sooner due to their condition, but were less likely to have Caesarean sections, Graham says. The babies born to these women were normal size, and were at no increased risk for respiratory problems, immature intestines or brain disorders, he says.
"We've always thought that AFI was correlated with blood flow in the fetus, that a low AFI meant there wasn't a good blood flow, but we found that AFI is a very poor indicator of that," Graham says. The finding should give doctors pause before using AFI test results as a reason to induce delivery, he adds.
"If a low AFI is the only thing determining an early intervention in a pregnancy, that is not a reason to do so," he says.
 

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I am still very bitter about my induction due to "low fluid levels".DS was so firmly engaged I couldn't sit up straight.I was still frightened into it because of cord prolapse.I asked the DR if he was sure,he said yes and I was lucky enough to have my baby without a c section but he was born 9 days before his "due date".My fliud levels were at 7 at the time and DS was kicking and breathing and looked plenty healthy.Hind sight is 20/20 and I have tried to learn the info before I do anything rather than blindly follow and trust.
This is a big factor in any of my future relations with any other health care professionals since I am the one who has my best interests in mind.
 

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Inducing for low fluids seems totally counterintuitive to me. Even if there was actually so little amniotic fluid that there was a danger, wouldn't this be an instance where a c-section would be called for? I mean, if the levels are really that low, the baby's not going to have been able to turn into a good position, the cervix will be totally unready--all the classic indications that an induction will fail, and fail painfully.

Not that I'm suggesting that low fluid levels are an indication for c-section, since it doesn't seem like they're ever properly diagnosed, I'm saying that if other factors indicated problems as well.
 
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