To begin with, the unfortunate fact is that you cannot assume that by choosing a midwife, you have chosen someone who automatically practices a different model of care. She may have the same approach as the typical ob, or she may be constrained by practices and policies by the doctor she works for or who backs her up or the hospital where she has privileges. I cannot give you medical advice, but I can tell you this: amniotic fluid levels vary according to fluid intake, the estimates are not exact--how could they be when you are estimating a complex three-dimensional volume from a two-dimensional image?--and the research says that there are no benefits to inducing for low amniotic fluid in the absence of other signs of problems. Here are some other sources of info:
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.
OBJECTIVE: To evaluate the outcome of active induction of labor for isolated oligohydramnios [low amniotic fluid volume] in low-risk term gestation. METHODS: This retrospective study analyzed the obstetric and perinatal outcome of 412 singleton term pregnancies with cephalic presentation and no maternal risk factors or fetal abnormalities. Two groups were compared: 206 deliveries after induced labor for isolated oligohydramnios, and 206 deliveries matched for gestational age following spontaneous labor with normal amniotic fluid index. RESULTS: The overall rate of cesarean deliveries and cesarean deliveries for nonreassuring fetal status, and operative vaginal delivery rates and those for nonreassuring fetal status were higher in the oligohydramnios group than in the control group. There were no differences between groups in neonatal outcome or perinatal morbidity or mortality. CONCLUSION: Active induction of labor in term low risk gestations with isolated oligohydramnios translated into higher labor induction, operative vaginal delivery and cesarean section rates. This led to increased maternal risk and an increase in costs with no differences in neonatal outcome.
On the other hand, as a first-time mother, especially one not on the verge of going into labor on her own (the Cervidil is to "ripen" the cervix), inducing labor doubles your likelihood of a cesarean section. It isn't something you want to do without a clear indication that your baby is better off out than in.
-- Henci |