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.

Why a good childbirth class is so important

I'm on a bit of a high after hearing the news of two babies born this week, Lucca and Rebecca. Lucca's mom Josephine was told at 30 weeks that she should schedule a c-section because her baby was measuring big. She continued to question this advice, and when again at 38 weeks she was advised to schedule her cesarean for 39 weeks she did what most won't do; she sought a second opinion and switched doctors. She went into labor 3 days past her due date and vaginally delivered her 9lbs+ baby boy in an uncomplicated birth. Rebecca's mom Crystal had a little bit of a different story. She was never offered a cesarean, but she also did what most won't do; she stayed pregnant for 42 weeks and 1 day past her due date. She went into labor 15 days past her due date and delivered her little girl 7lbs 10oz in an uncomplicated birth.

I know that Crystal went drug-free, but don't know yet about Josephine. But the point that I'm always trying to help people understand is that a good childbirth class is about so much more than the epidural! In both of these cases, these mothers could have easily had births with very different outcomes. Few women would know to question a doctor's opinion that a cesarean was necessary. If not for Josephine's knowledge and self-advocacy, she would not have experienced labor much less birth. As for Crystal, few women have the confidence in their bodies to go so far past an estimated due date. But she knew that inducing a labor before the baby is ready can cause a long difficult labor and she knew based on non-stress tests that she and her baby were healthy. Her waiting was an act of advocacy and I'm so proud of her for that.

I also need to mention the husbands here. It is not easy being a dad whose only concern is that his wife and baby are safe. But they had knowledge too, and their knowledge helped them to be supportive when their wife was facing these decisions.

I am proud that the Bradley Method is a comprehensive childbirth class that helps women and their partners not only know how to handle actual childbirth, but know how to handle all of the CHOICES that present themselves so that they can truly make informed decisions for their health and the health of their babies.

Iris's birth story

(Iris sent this to me awhile ago and I forgot to post it. So here it is! It's a great story.)

Saturday January 24th, I was expressing my concerns to G about our induction, scheduled for January 31st, 2009. Expressing them the same way, I've been writing about them. G kept telling me to relax and not worry.

I took a nap and while I did that, G called Labor and Delivery at the hospital to ask them some for information to calm my fears. Questions like "What weight is considered is 'too big' to deliver natural?", "What if we don't want to be induced at 41 weeks? What are the risks?" The nurse's answers to G's questions didn't please him. They confirmed that I had valid reasons for being concerned. We both felt like they had turned their backs on us, as far as our desires for delivering when the baby was ready, not when they say he is. G told me that he would be attending the Dr's appointment with me! G decided to go with me to my last Dr's appointment to ask some questions and share some concerns about our scheduled induction for Saturday, January 31st. I was so pleased because I hated feeling like I was "fighting" the hospital and their policies, alone. G said to me, "I am taking you walking tomorrow and you better be ready because we are walking a whole lot."

Sophie's Birth- written by Laurel on Dec 3

The following is an excellent birth story that demonstrates how to follow your own instincts and strongly advocate for yourself if you need to. 

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I’M NOT EXACTLY SURE HOW TO SHARE THIS STORY, I’M STILL TRYING TO SORT OUT MY FEELINGS ABOUT THE WHOLE EXPERIENCE.  THERE WERE A LOT OF UPS AND DOWNS.  I WENT THROUGH THE ENTIRE SPECTRUM OF EMOTIONS PROBABLY MORE THAN ONCE.  HOWEVER, THE END RESULT IS WONDERFUL BECAUSE WE HAVE A HEALTHY LITTLE BABY GIRL AND SHE IS DEFINITELY WORTH ALL THE TURMOIL, THE WORK AND THE PAIN.

I THINK I SHOULD START MY STORY ON TUESDAY NOVEMBER 9TH, THE DAY I TURNED 36 WEEKS.  THAT WAS THE DAY THAT I LOST MY MUCUS PLUG.