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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Archived User
    I am currently 33 wks expecting and just had a ultrasound.  The doctor saw a pocket where there was no amniotic fluid.  The doctor wants to perform a Amnio Fluid Index in two weeks.  He said that if the number is "4" or below, baby has to come.  I have been distraught with this.  I want a vaginal normal birth and inducing early could very likely lead to a "C".  I have been trying to take it easy, drink tons of water, and get back to high protein.  I have been quite vigorous keeping busy (I have twins) and have been feeling pretty dehydrated.  So I am trying to hopefully reverse this condition.  Do you think this can be reversed to where the pocket would be gone on the next test?  What can I do to help that?  Since the doctor is having me come in two weeks, perhaps this is not as bad as it seems?  I hope so.  I am 44 and the doctor is already biased against older women such as thinking that disfunctional uterus is pretty common with older women and they needing help for labor.  I just had twins two years ago with this doctor.  They were delivered vaginally and the second breech.  I defied some of his pre-conceived ideas.  I was thankful that he was willing to deliver baby B breech.  Most OB's don't here.  So I am hoping that this pregnancy will go well.  I appreciate any comments you may have. 
    Henci Goer

    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.

    Archived User
    Thank you so much Henci for your response.  I would love to have a midwife compared to conventional doctor.  My second birth with my daughter I was going to have a homebirth which ended up in the hospital due to having a partial water leak which went beyond 24 hrs.  The protocal was to go to the hospital after the 24 hrs.  I had to be induced which I hated.  I think things could have turned out differently.  As a result of that, my husband is negative towards another home birth situation.  It is hard to find a midwife who does hospital births in our area.  So I feel like I have to jump through hoops to have a natural birth with a doctor.   Sometimes I think about going to Tennesee Farm to birth!  We will see how it goes over here.  So far baby is good weight (est. 4 1/2 lb), my weight gain is good, and I am huge!   So hopefully I will be able to jump through the hoops for a natural birth.  It is so hard these days when everyone wants to intervene!
    Henci Goer

    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

    Archived User

    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

    Henci Goer

    I am sorry to hear that obstetrics is practiced this way in India. This is not, repeat, not either safe or effective care, and the consequences of these unnecessary cesareans can be dire for mothers and babies and the babies of future pregnancies. I know I should feel shocked too, but blaming everything but their own actions when confronted with the harm they do is unfortunately so common a response by obstetricians that it has lost its shock value. Sad to say, I am rather more surprised when an obstetrician doesn't.

    If you mean amniotic fluid volume when you wrote "lichre levels," I haven't researched this issue, other than the study mentioned in the thread, but here is a summary (abstract) from a Cochrane systematic review:

    Amniotic fluid index versus single deepest vertical pocket as a screening test for preventing adverse pregnancy outcome   In this one, one type of measurement resulted in more inductions and c/sections without improving outcomes, but there is no control group that did not have the screening. Without that, we do not know if having either type of fluid volume measurement improved newborn outcomes, although it's a safe bet that having any type would increase inductions and cesareans. In any case, the study cited above in this thread says that it doesn't matter how accurate the diagnosis, low fluid volume in the absence of other symptoms is benign.

    -- Henci

    Archived User

    Henci,

    Thank you for your reply. I did read the review you mentioned in the thread. I just wish that the obstetricians here would let go of their Ultrasound machines. I am sure natural birth outcomes for women would automatically improve.

    On a positive note, I got a call from one of my expectant moms who is almost at 39 weeks + 2 days today. Normally, she would have been given a date, and told that she would have to be induced if she did not go into labor by then. Good news is, she was told "as long as everything is ok with the baby, you can come back next week". Mom was thrilled, and so was I. I would like to think that we are making a difference one parent and one obstetrician at a time.

    Thanks again.

    Vijaya

     

     

    Henci Goer

    We need to cherish and support the progressive obstetricians. I do not know if women can choose their care provider in your country, but if they can, I would spread the word on this doctor. Idea: In some places, normal birth activists have put together guides to local hospitals and to care providers who practice mother-friendly care.

    -- Henci


    All Times America/New_York

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