Thursday, July 7, 2011

Low Amniotic Fluid

This is a story about low amniotic fluid and how a normal check up can potentially turn major intervention in a matter of hours.

I got a call this afternoon from a client saying that she was being sent to Kaiser Riverside to do a non-stress test on her baby because of low amniotic fluid. She had gone to her regular 38 week appointment and the doctor was having trouble locating the baby's heartbeat from the hand-held doppler so she decided to use the ultrasound machine. Her doctor quickly found the baby's heartbeat but then commented that she had low amniotic fluid. A score of 4.7cms. Normal levels range from 5-25 centimeters although it's common to be in those lower ranges at the end of pregnancy. The concern with low amniotic fluid is that it can sometimes indicate that the placenta is not functioning as optimally as it once was (aka it's "getting old") and that could be compromising the baby. Other reasons for lower fluid levels are dehydration or simply that the mom's fluid levels are lower. What may indicate a problem for one mother, may be normal for another. That's why it is so important to check things out and look holistically at mom's and baby's health.

I do agree that non-stress tests in these situations can be helpful to rule out the concern that the baby is compromised. It is also important to note that the fluid must be measured in the deepest pocket to get an accurate reading. In this mom's case, the technician was unable to find other pockets because the umbilical cord was in the way.

After drinking two bottles of Gatorade before going into Kaiser Riverside, her levels were at a 4.9 but her baby looked great. The technician called the supervising OB and stated the fluid level but also mentioned that the baby looked really good. Despite this, my client was told to check into labor and delivery to possibly be induced. It is important to note these two facts: #1 Induction of labor in first time moms leads to a 44% cesarean rate versus an 8% rate for mothers who go into labor spontaneously. And #2 Low levels of amniotic fluid are no risk to normal birth provided that other tests are normal.  

When the induction was recommended, my client asked if she could just continue to be monitored twice a week to make sure the baby was doing well. Her doctor was not comfortable with that and stated that she didn't want her coming back in a few days with a dead baby. 

The dead baby card. For anyone who has wondered about the dead baby card, that's what it looks like. It is incredibly difficult to think not to mention make rational decisions when you've been handed this card. It's terrifying and it speaks to the soul. It's amazing how an average 38 week check up can snowball into  an induction of labor in a matter of hours, even for a healthy mom and baby.

The problem here is risk. What is the risk of low amniotic fluid provided all other health vitals are normal? According to research, not much at all. What is the risk of induction of labor on a 38 week pregnancy? Essentially taking a perfectly happy baby and stressing him out with hours of pitocin and stressing the mother's body out as well, leaving her with a high chance of failure to progress, fetal distress, or any number of induction-related risks?

She and her husband decided to decline the induction (which means they had to sign the Against Medical Advice form) but agreed to come back every two days to have the baby monitored. This seems fair to me. Despite handing out the dead baby card, her doctor did ultimately say it was her choice and supported her in their new plan of action. And incidentally, right before she left her doctor decided to do one more ultrasound and announced that her levels were a 6.


JNowell said...

Eww to the "dead baby card"!!!! I got that card in other words but either way not fun or fair! Seems like it worked out for your client :)

Jamie said...

The dead baby card is by far the worst one. She's also currently getting the brain damaged baby card. This isn't over for her by far. The pressure is on very hard and even though her baby is doing well, all of these scary seeds have been planted. Please pray for her and baby. It's hard being a mom! (and dad) I'm hoping she goes into labor very soon but realistically she's probably got at least a full week.

Laurel said...

I really admire her for trying to do what's best for her baby. It is so hard to stand up to a medical professional especially when they tell you that you are harming your baby. Even if you know you are doing the right thing its hard not to have little nagging doubts. I just want to give this mom a big hug! Prayer was essential to me when I was in a similar situation.

I just realized that this post was days ago, so she might have had her baby by now, I hope things did/will work out!

SlapItHigh said...

Had the dead baby card played on me once and it sucked. And then they coerced me into signing an Against Medical Advice waiver stating that I had been advised that I was putting my baby at risk for death by not agreeing to the induction.

That said, that dude's stats are way off. Induced FTMs don't have a 44% c-section rate, not even close. I don't think we need to inflate the numbers to make our points. The true stats are bad enough on their own.

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