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Low amniotic fluid?

Posted by on Jan. 4, 2013 at 8:17 PM
  • 7 Replies

This is an article about the wrong diagnosis of low amniotic fluid being a  reason for induction. Very interesting! I remember the doctor being concerned about that with my "overdue" pregnancies. There were more comments and such that I did not copy, so here's the webpage if you want to read further:

http://www.glorialemay.com/blog/?p=60

Low Amniotic Fluid. . . I don’t think so

What will it take to stop the inductions for too little amniotic fluid?  This is largely a wrong diagnosis based on ultrasound.  Women are having their births wrecked by midwives and doctors who believe that Biophysical Profile is a valid testing method.  We need to go back to clinical palpation skills and stop depending on sound wave fuzzy pictures to assess the amount of fluid at full term.

Leopold's manoeuvres Here is where the problem begins:

Many North American women are being told at the very end of their pregnancies to go to an ultrasound clinic and have a biophysical profile done. Most are impressed by the thoroughness of their practitioner and have no idea what this test involves or what sort of harm could follow from consenting to this diagnostic procedure. They will probably not be told that there is no scientific basis for having faith in the test results and that no improvement in health has been proved from large numbers of fetuses being “profiled.” Certainly, no one will mention that the only benefits of the procedure are: 1) the ultrasound clinic will earn $275; and 2) the medical practitioner will be able to cover themselves legally in the very rare instance that a baby might die in utero.Until recently, physicians and midwives would tell women who were carrying their babies beyond 41 weeks gestational age to do “kick counts.” If the baby has 10 distinct movements between the hours of 9 a.m. and 3 p.m., it is widely accepted that the baby is thriving under the mother’s heart. In a culture that loves technology and with the push to expand the commercial use of ultrasound, it was inevitable that someone would come up with a more complex strategy to provide reassurance of the baby’s wellbeing in late pregnancy. Thus the biophysical profile (BPP) was born. Here is the content of the testing, as it appears on the Family Practice Notebook Web site (www.fpnotebook.com/OB44.htm):

  1. Cost: $275
  2. Criteria (2 points for each)
    1. Fetal Breathing
      1. Thirty seconds sustained breathing in 30 minutes
    2. Fetal Tone
      1. Episode extremity extension and flexion
    3. Body Movement
      1. Three episodes body movement over 30 minutes
    4. Amniotic Fluid Volume
      1. More than 1 pocket amniotic fluid 2 cm in depth
    5. Non-Stress Test
      1. Reactive
  3. Scoring
    1. Give 2 points for each positive above
  4. Interpretation
    1. Biophysical Profile: 8-10
      1. Low risk or Normal result
      2. Repeat Biophysical Profile weekly
      3. Indications to repeat Biophysical Profile biweekly
        1. Gestational Diabetes
        2. Gestational age 42 weeks
    2. Biophysical Profile: 8
      1. Delivery Indications: Oligohydramnios
    3. Biophysical Profile: 6
      1. Suspect asphyxia
      2. Repeat Biophysical Profile in 24 hours
      3. Delivery Indications
        1. Repeat Biophysical Profile less than or equal to 6
    4. Biophysical Profile: 4
      1. Suspect asphyxia
      2. Delivery Indications
        1. Gestational age 36 weeks
        2. Lung Maturity Tests positive (L/S Ratio 2)
    5. Biophysical Profile: 0-2
      1. Likely asphyxia
      2. Continue monitoring for 2 hours
      3. Delivery Indications
        1. Biophysical Profile ‹ 4

“Breathing” above refers to movements in the lungs that show activity of the lungs in preparation for life outside the womb. The baby’s oxygen supply in utero comes via the placenta and umbilical cord while in the mother’s womb.

In the past year, I have had a number of letters and phone calls from doulas, midwives and childbirth educators about a flaw in this testing method. An unusually large number of diagnoses seem to be made that “there is not enough amniotic fluid.” This seems to be the factor in this outline that is most often used as an excuse for induction. It is important for parents to know that this is likely an inaccurate assessment. What the ultrasound technician is doing could be compared to viewing an adult in a see-through plexiglass bathtub from below the tub. In such a scenario, it would be difficult to assess how much water is in the tub above the body that is resting on the bottom of the tub. You might be able to get an idea of the water volume by measuring how much water was showing below the elbows and around the knees, but if the elbows were down at the bottom of the tub, too, you might think there was very little water. This is what the technician is trying to do in late pregnancy—find pockets of amniotic fluid in little spaces around the relatively large body of an 8 lb. baby who is stuffed tightly into an organ that is about the size of a watermelon (the uterus). If most of the amniotic fluid is near the side of the uterus closest to the woman’s spine, it can not be seen or measured. This diagnosis of low amniotic fluid frightens the parents-to-be into acquiescing to an induction of labour. Even though the official BPP guidelines do not require immediate induction for a finding of low amniotic fluid, in practise, the parents are pressured to induce. Stories abound of mothers who are induced for this indication and then report having abundant fluid when the membranes released in the birth process. The risks of induction, which can be catastrophic, and the resulting increase in the need for pain relief medication and cesarean section are usually not discussed with the parents prior to embarking on induction of the birth. Be warned that this latest suspect diagnosis using ultrasound is increasing in frequency and causing increased harm to mothers and unborn babies through aggressive use of induction.

After I published the above explanation in Midwifery Today Magazine in 2004, I received  posts from women who had experienced being induced for this diagnosis.

by on Jan. 4, 2013 at 8:17 PM
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Replies (1-7):
tabi_cat1023
by Group Mod - Tabitha on Jan. 4, 2013 at 8:27 PM

Thanks for sharing

ballerina.2006
by on Jan. 4, 2013 at 8:28 PM
Bump to read later :)
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Ichthus
by Member on Jan. 5, 2013 at 11:21 AM

BUMP!

Mrs.Salz
by Platinum Member on Jan. 5, 2013 at 12:18 PM
1 mom liked this

Gloria Lemay is awesome!

I read this article yesterday too, another good one on the same subject. http://mamabirth.blogspot.com/2011/07/obstetric-lie-90-your-fluid-levels.html

Peera
by on Jan. 5, 2013 at 7:57 PM

I sent this on to my best friend since BOTH of her children were induced for this very reason. 

peaches_04
by Platinum Member on Jan. 7, 2013 at 4:27 AM
I was palpated low and u/s proved not saving me from an induction
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polkaspots
by Bronze Member on Jan. 7, 2013 at 4:52 AM
My mom lost almost all of her fluid during her sixth month so she was on bed rest for the rest and my sister was born very underdeveloped. An induction wouldn't have helped that at all. She was born full term but her lungs and muscles were in terrible shape. She started school early and was in speech therapy, occupational, and physical therapy until middle school. Induction just puts at risk babies into more danger by taking them out of the place where they have the best chance of continuing to develop.
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