First, amnniotic fluid volume is not fixed because it is continually being absorbed and secreted. Second, amniotic fluid volume measurements are at best not terribly accurate "guesstimates" because the baby is an extremely complex shape, and the baby is moving. Third, I have no idea what your doctor means by "a pocket" that has no fluid. "Pockets" would obviously come and go as the baby shifted position. There is also a recent study (see below) concluding that when low amniotic fluid volume is the only symptom, inducing labor does not improve outcomes, but it increases cesarean surgery and instrumental vaginal delivery rates, including cesarean and instrumental vaginal delivery rates for nonreassuring fetal heart rate. It makes sense that you would see more surgical and instrumental deliveries for nonreassuring status with induction. If low amniotic fluid volume indicates the baby is somewhat stressed, the baby would be less able to tolerate the increased stress of induced contractions. (Despite their own results, though, the investigators recommended inducing labor anyway. Go figure.)

As I was writing this, the thought occurred that perhaps you have other concerning symptoms that led your doctor to order an amniotic fluid volume evaluation. It certainly isn't usual to do so at 33 wks. If something else is going on, the results of that study do not apply, although you would still want to weigh the risks of induction versus awaiting labor for you and your baby. If your doctor did it as a matter of routine, while this doctor may have been your best option with the twins, you may wish to consider whether he is your best option with this pregnancy. Have you, for example, considered having your baby with a midwife in the hospital, in an out-of-hospital birth center, if one is in your area, or at home? 

 -- Henci

Manzanares S, Carrillo MP, Gonzalez-Peran E, et al. Isolated oligohydramnios in term pregnancy as an indication for induction of labor. J Matern Fetal Neonatal Med 2007;20(3):221-4.

You're welcome. When I read posts like yours I feel sad and angry. It shouldn't be this hard. Women should not have to fight, struggle, and connive to get safe, effective care for themselves and their babies.

-- Henci

Henci,

I am an independent childbirth educator in India. Over the past several months, I have been hearing an increased diagnosis of either decreased amniotic fluid or increased amniotic fluid in otherwise healthy, low-risk expectant moms. Mostly, it is the decrease in fluid levels that are being diagnosed (?) and as a result the C-section rates which are anyway through the roof, are tending to go even higher, with inductions being scheduled left, right and center. When I questioned one of the OB/GYNs about this, she said (verbatim) "I don't know - maybe the reason is something in the environment" - and, I was shocked.

In India, in most hospitals, moms are subjected to Ultrasound scans almost at every prenatal visit, and this means weekly US towards the end of their pregnancy. Do you have any research which points out the accuracy or inaccuracy of ultrasound predictions of lichre levels as the pregnancy advances? On another note, I have already shared FDA advisory regarding unneccessary use of US in pregnancy with our OB/GYN.

Thank you in advance .. I think your efforts in bringing evidence-based practice to moms and dads are just wonderful.

VIjaya