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. Here’s an example:

Thanks for writing this article, Gloria.  It was the one that made me fully realize that my induction (at 41w1d – due to “low” amniotic fluid) & subsequent c/s due to failed induction were almost certainly unnecessary when I first read it in 2004.  Everything you wrote happened to me.  The BPP was perfect besides the fluid measurements.  And then I did have “abundant fluid when the membranes released in the birth process”.

Cathleen in MA

——————

DS 5/03

DD 2/06 (HBAC!)

Here are some medical studies that confirm my alarm over using Amniotic Fluid Index as the reason to do an induction:

Low Levels of Amniotic Fluid No Risk To Normal Birth (2004)

Doctors may not have to deliver a baby early if it has low levels of amniotic fluid surrounding it, Johns Hopkins obstetricians report.

In a study to be presented Feb. 7 at the annual meeting of the Society for Maternal-Fetal Medicine in San Francisco, researchers show that babies born under such conditions fared similarly to those born to women whose wombs held normal amounts of amniotic fluid. No significant differences were found in the babies’ birth weights, levels of acid in the umbilical cord blood, or lengths of stay in the hospital.

Typically, doctors have been concerned about women with low levels of amniotic fluid during the third trimester – a condition called oligohydramnios – because too little fluid can be associated with incomplete development of the lungs, poor fetal growth and complications with delivery. Amniotic fluid is measured by depth in centimeters. Normal amounts range from 5 to 25 centimeters; any amount less than 5 centimeters is considered low.

“These study results are very surprising – they go against the conventional wisdom,” says Ernest M. Graham, M.D., senior author of the study and assistant professor of gynecology and obstetrics. “Amniotic fluid stems from the baby’s urine, and the urine results from good blood flow, so if we see low fluid we assume there probably is not good blood flow and the fetus is compromised. This study shows the fluid test is not as good as we thought, and there is most likely no reason to deliver the baby early if other tests are normal.”

The researchers studied 262 women (131 with oligohydramnios and 131 with normal amounts of amniotic fluid) who gave birth at The Johns Hopkins Hospital between November 1999 and July 2002, comparing the babies’ health at birth. Patients with oligohydramnios were delivered sooner, but were less likely to need Caesarian sections. Babies born to moms with isolated low amniotic fluid were normal size and were at no increased risk of respiratory problems, immature intestines or brain disorders.

Study co-authors were Rita Driggers, Karin Blakemore and Cynthia Holcroft.

Abstract # 318: Driggers, R. et al,

“Are Neonatal Outcomes Worse in Deliveries Prompted by Oligohydramnios?”

Related Web sites: Related Web sites:

http://www.nature.com/jp/journal/v24/n2/abs/7211034a.html
Journal of Perinatology (2004) 24, 72–76. doi:10.1038/sj.jp.7211034 Published online 22 January 2004

An Amniotic Fluid Index 5 cm Within 7 Days of Delivery in the Third Trimester Is Not Associated with Decreasing Umbilical Arterial pH and Base Excess

Rita W Driggers MD1, Cynthia J Holcroft MD1, Karin J Blakemore MD1 and Ernest M Graham MD1
1Division of Maternal-Fetal Medicine, Department of Gyn-Ob, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Correspondence: Ernest M. Graham, MD, Johns Hopkins Hospital, Department of Gyn-Ob, Phipps 228, 600 N. Wolfe Street, Baltimore, MD 21287-1228, USA.


Added Sep 7, 2012. Blog post on this subject by “Science & Sensibility” http://www.scienceandsensibility.org/?p=5294

Related blog post
: http://www.glorialemay.com/blog/?p=306

About gloria

I live and work in Vancouver BC Canada. I've been in the childbirth business for 30 years. I teach midwifery and doula courses both online and in person.
This entry was posted in Holistic midwifery & doula education, Homebirth, Ultrasound dangers. Bookmark the permalink.

70 Responses to Low Amniotic Fluid. . . I don’t think so

  1. Jennifairy says:

    Thank goddess we dont (yet) have this test as standard here in Australia (at least not where I am).
    Just another situation where the term “If it works, dont fix it” doesn’t get enough airplay.

  2. Ninja Mom says:

    This is a really good article. I will be sending it to all of my friends.

    I am curious if you have written anything about polyhydramnios, and how the condition relates to the labor and delivery process.

  3. kim says:

    I wish I read your article one year and 9 months ago when I was diagnosed with (SLIGHT) oligohydramnios at 31.6 weeks. The tech doing the ultrasound spend A LOT of extra time on me saying my baby was small for dates, 1-2 weeks delayed. She ordered me to rest for 10 days and epeat the ultrasound. I completely panicked. I can´t tell you how afraid I was at this news. Now I am much more informed but back then, I was very sensitive being pregnant. I cried so much I couldn´t even get on the metro to go home. I spent countless hours worrying myself on the internet reading horror stories. I repeated the ultrasound and went to MODERATE OLIGO HYDRAMNIOS, then again 2 weeks later back to LIGHT. I asked if I should drinks tons of liquids, they said nO it won´t help, but I did anyway and I was back to LIGHT. We did 2 non-stress tests. I had a natural water birth planned but I was starting to rethink it. Doc talked to me about possible programmed induction. In the end,after a second opinion at another clinic where she wrote AMNIOTIC LIQUID NORMAL I went ahead with the natural water birth and my baby was born on her due date at 7 pounds. We had an amazing birth experience. I have since been plagued by all this. Did my baby just catch up somewhere along the way or was she really small for dates. I wish they wouldn´t scare us so much. I nearly derailed my plans for a natural birth and I had so much added stress and crying at the end of my pregnancy.

  4. catherine says:

    i am currently 37 weeks pregnant and just had an ultrasound and the technician terrified me when he said my amniotic fluid was low and i will be needing a non-stress test can someone please give me some advice /infirmation on what happens from here.
    everything ive read so far has terrified me any help would be appreciated.

    thanks

  5. Gloria,
    Thank you SO much for this. I’m a labor and postpartum doula in New York, and this has been much discussed with the new york doulas that I know.
    Terrific explanation of an increasingly common phenomena.
    In the doula spirit,
    Tess

  6. Lia says:

    Amen to this entire article! I was induced by my midwives at 41 weeks 2 days, and I wish I had not been. Even after induction, he was born at 41 weeks 3 days (pushing 4, as it was almost midnight). I trusted them, but I am now disappointed that they were not up on their research, as I was told by several other midwives and our hypnobirthing teacher that there were studies advising against induction for this reason. We went a different way for our second and had a WONDERFUL homebirth in the water. Our girl was born at 41 weeks, and we would have let her stay in however long she wanted!

    Catherine, I don’t know if you’ve already had your baby, but I would recommend finding a doula or other support person to help you assert your wishes. If you don’t have trust in your practitioner, think about switching (unless it would be too stressful at this point). What I was told by several practitioners I trust is that, if low amniotic fluid is the only “negative indication,” it’s not enough of a reason to induce. Bottom line, trust your own instincts, your own body, and surround yourself with people who support you and your wishes. Happy birthing to you!

  7. Mary says:

    Good information, thank you.

    There are times when the fluid really is low, however. With my 4th baby I could tell something was different – the baby “bumped” around in a way that felt different – I asked for the biophysical profile. Low fluid was the diagnosis. I had 2 HBAC’s prior, and was planning another homebirth. My instinct told me this wasn’t the safest scenario for me with this birth. I didn’t want to risk the possible cord compression and we decided on a c-section (I’m hyphenating the story here – there were extenuating emotional/physical concerns to consider, as well). When the doctor was performing the surgery I asked what the actual fluid level was – not even 1 cup! (and this after drinking gallons of water daily to try and get my fluid up) It was the safest choice with the intuition/information we had.

    I did some research post-birth and found a procedure where fluid can be introduced during labor (Amnio-infusion) through an intrauterine catheter. This added fluid helps with padding around the umbilical cord during delivery and is reported to help lower the chances of a cesarean delivery. If only I had known! I should have taken more time to research – I was already about 2 weeks past my ‘due date’.

    Just serves as another (painful) reminder that WE have to be the educated, informed ones. I can say that the c-section itself was beautiful. I negotiated to get the atmosphere I wanted and was never separated from my baby.

  8. gloria says:

    Mary, babies have been known to drown in utero with amnio-infusion so I wouldn’t recommend that anyone do that. Thanks for your comment. Gloria

  9. Gloria I am so pleased someone has put this story out. A breastfeeding client of mine at 38 weeks was told her measurement was 2cm short of the ultimate 10. Previously her obstetrician ignored the pregnancy induced rash that S complained about and then all of a sudden on the Friday(we were going away that weekend) she was told that she had been booked for induction on the Monday.Smelled a rat. When S asked Obs (woman) stated “because of the rash”) S rang me and I said refuse the induction. Next came the news of the 2cm amniotic short fall. l suggested she did not go for the appointment but S succumbed and the induction was a Caesarian. S had a VBAC next time and all was well. So to find out the cost = reason is no news to me

  10. Denise Hynd says:

    Thank you for this explanation Biophysical profile were being done on women in Western australia several years back before I left practice there and they are being used in this way here in Auckland NZ now!

  11. Denise Hynd says:

    Also I find this another example of inconsistency in the medical model of birth Management.
    1) induce when there is thought to be low liquor
    2) rupture the membranes and loose the previously precious liquor around a labouring baby at the least excuse??
    It is like they say a baby’s head was/would not fit out through the pelvis on its own but it plus salad server sized forceps will fit when in the control of a doctor!!
    Go figure!!

  12. gloria says:

    Quote:
    While error exists in simply determining the AFI, studies also show that the AFI is a poor predictor of perinatal outcome.[1,6,11] In women who have idiopathic oligohydramnios without other obstetric complications, there is no increase in adverse perinatal outcomes when compared to women who do not have oligohydramnios.[14] Although a low AFI does not reliably detect adverse pregnancy outcomes, it may lead to an increase in obstetric interventions without improving neonatal or maternal outcomes.[1,6,11-13]
    http://www.medscape.com/viewarticle/551032_5

  13. JaneM. says:

    I am 37 weeks, 4 days. At 36 weeks, 6 days, my physician became concerned about my fundus measurement, which they said was 27. They performed an ultrasound and found my fluid at 6.0. At 37 weeks, 2 days, they remeasured my fluids, finding it at 5.2. They put me on full bedrest and required me to spend the day drinking. Within 24 hours, levels are back to 6.2. They’re going to continue to watch and if fluid doesn’t rise above 8, they’ll consider induction at 39 weeks.

    At this point, I’m not sure I want to switch doctors. This is a multi-physician practice and several doctors agree with this assessment. That said, there does appear to be some ambivalence about the necessity of bedrest. I’d like to go back to work. Thoughts?

  14. Anni MW says:

    Gloria, don’t you just love it when they say “may lead to an increase in obstetric interventions without improving neonatal or maternal outcomes.” “Without improving??? What the shield is that it actually causes poorer neonatal AND maternal outcomes? Isn’t an unnecessary c/s a poor outcome? Increasing the risk of neonatal and materal mortality AND morbidity! Isn’t changing a noral labor pattern into an abnormal labor pattern thru induction a poor outcome? Isn’t increased neonatal need for NICU care a poor outcome? It really isn’t a surprise that they are disingenuous about how they state it but it is infuriating! WHy not tell the truth, say, ” may lead to an increase in obstetric intervention which can lead to worsening of neonatal or maternal outcomes.” says the truth but doesn’t play so well. It is amazing they published it at all! Thanks for this incredible article!

  15. Wow. That is exactly the birth story of my son: 40 weeks 4 days, I got a BPP; he did great on everything but the AFI measured a little low (4) and I was IMMEDIATELY induced (was escorted to L&D), got an epidural because of that wicked pitocin, and subsequently had a C/S with resulting post-partum depression. When my bag of waters spontaneously ruptured in labor, my midwife called me “Niagara Falls” because I had LOTS of fluid. Ridiculous. I can’t tell you how angry I was (and still am) because of this experience. I have since had a fantastic natural VBAC, but the bitterness surrounding the unnecessary induction and cesarean for misdiagnosed oligohydramnios with my first birth still plagues me.

    On a side note, I was diagnosed with polyhydramnios with my daughter (second baby) and I had LESS fluid when I ruptured with her than with my son! So sonograms aren’t that accurate!!!!

  16. Canoe chick says:

    Gloria,
    What do you mean about a baby drowning in utero from amnio-perfusion? How can a baby drown, if s/he isn’t actually breathing air yet? v. confused??

  17. gloria says:

    Drs have been doing amnioinfusion for some time without really knowing what the baby can tolerate since whatever they inject will never be the same as amniotic fluid. Here’s an article from 2008 which addresses the difficulty in adding a fluid to the womb that is not meant to be in there.
    http://content.karger.com/produktedb/produkte.asp?typ=pdf&file=000147168

  18. rachel whitfield says:

    hi im now 21 weeks into my pregnancy iv just had a scan they say im low fluid in which surrounds the baby and said they dont know why and the baby looks healthy but have booked me in for a scan at a big hostpital were they know more.the only other thing they have told us is it could be something to do with the babys kidneys me and my partner are so upset can you help and please give us some advise we have read lots on the net and that has made it worse thankyou r.t.whitfield xx

  19. rebecca bernardino says:

    Your post has been very helpful. I am 40 weeks and 6 days. My past two visits I have refused induction because there was no medical reason given except for that they didn’t want me to go past my due date of the 22nd of Sept. Today via ultrasound my Dr. informed me I had low amniotic fluid (a 4) and he showed where he only found two pockets. All other vitals are very good on the baby and myself. He recommended immediate induction at the hospital and continuous fetal monitoring. I am more assured after reading articles on your site and others about the validity, or lack of, for such an argument. I am thinking of again refusing induction and hydrating and scheduling another ultrasound in the next days. I am concerned however that I have not had any true contractions yet and my cervix is not dialated at all. Also the dr keeps talking about how my cervix is very far back but he won’t elaborate on how that may affect delivery. I am concerned if the baby is truly stressed or “low on reserves” does this far back cervix make for a higher risk of cesearean and or fetal distress during delivery? I so hope you get this soon and may be able to give some insight as to my situation. Thank you for providing the information on your site, you are a blessing.

  20. gloria says:

    Rebecca, has your doctor given you full information about the dangers of induction?

    At the end of pregnancy, every woman has a “very far back” cervix. As your baby gets heavier in the last months of pregnancy, the top of your uterus extends forward and that makes the cervix (the bottom most part of the uterus) go towards your sacrum. THAT IS NORMAL and it is also normal not to be dilated until you are and not to have any true contractions until you do. My personal experience is that I didn’t have any “warm up” contractions at all until the day I gave birth.

    Your body is not your biggest risk for cesarean and/or fetal distress. The way to increase your risk of cesarean is to allow the American Medical machine to induce you. THAT has been demonstrated in study after study.

    • gloria says:

      Here’s a good sample of information women can use from Janet Fraser of http://www.joyousbirth.info

      postdates primer

      When Research is Flawed: Management of Post-Term Pregnancy Henci Goer
      http://www.lamaze.org/Research/WhenR…3/Default.aspx

      To quote Menticoglou and Hall’s conclusion: “Routine induction at 41 weeks is ritual induction at term, unsupported by rational evidence of benefit. It is unacceptable, illogical and unsupportable interference with a normal physiologic situation.”
      Ageing of the Placenta Harold Fox
      http://www.pubmedcentral.nih.gov/pic…6&blobtype=pdf

      Our current knowledge of the human placenta is briefly reviewed. Particular stress is placed upon the considerable functional reserve capacity of the placenta, the unimportance of most visible abnormalities of the placenta, the lack of any evidence that the placenta ages during gestation and the lack of significance of placental weight. The effects on the placenta of infection and of maternal cigarette smoking are considered and the concept of placental insufficiency critically discussed. It is concluded that most cases of ‘placental insufficiency’ are, in reality, examples of maternal vascular insufficiency resulting from inadequate placentation during the early stages of pregnancy.
      Wings: a radio program on the magic of placentas! It’s beautiful.
      http://wings.org/ftp/2010%20shows/20…_40-64kbps.mp3

      Birthlove’s 10 month mama page – extensive references. Leilah McCracken
      http://birthlove.cyclzone.com/pages/ten_month_mama.html

      Ten month pregnancies can be tiring and eroding, but for some women- it is simply how long we are intended to gestate.

      Think of it this way: I was 11 when I got my first period; my best friend was 13. We “ripened” at different ages. People ripen prenatally at different ages, too: some women take as long as 46 weeks before their babies are ready to come out. (Women like me.)

      In healthy, well-fed women long pregnancies don’t lead to brain damaged, nutrient-starved babies! It’s actually the opposite: my own “late” babies- my 6th and 7th children- are bright, precocious, healthy, darling, uniquely gifted in language- it would have been unthinkable to steal away their precious pregnancy time for my own convenience, or to follow some ridiculous, arbitrary medical timetable. (It would have been equally unthinkable to “naturally induce”- an oxymoron if there ever was one.)

      And even though these babies were my biggest (10.8 lbs and 12.6 lbs respectively), their births were my least painful, most straightforward, and quickest: my body had lots of time to soften and prepare for birth, and when my time came, I was ready (as were my babies).
      When is that baby due? Henci Goer
      http://parenting.ivillage.com/pregnancy/0,,jb56,00.html
      When it comes to determining your due date, “things,” as the Gilbert and Sullivan ditty goes, “are seldom what they seem.” The methods of calculation are far from exact, common assumptions about the average length of pregnancy are wrong and calling it a “due date” is misleading. Understanding these uncertainties may help to curb your natural impatience to know exactly when labor will begin.

      Many obstetricians want to induce labor when you exceed your due date by a set number of days, in the belief that prolonged pregnancy increases risk. As with dating the pregnancy, the evidence for inducing labor after a certain time past the due date isn’t nearly as clear-cut as you might think, but that’s another subject.) If induction were harmless, it wouldn’t matter, but it’s not. Among other adverse effects, inducing labor increases the odds of fetal distress during labor and cesarean section in first-time mothers, and mistiming the induction can result in a premature baby.
      Suspect Diagnoses Come with Biophysical Profiling Gloria Lemay
      http://www.midwiferytoday.com/articles/biophysical.asp

      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.
      Midwifery. 1991 Mar;7(1):31-9. Related Articles, Links

      A Timely Birth Gail Hart
      http://www.midwiferytoday.com/articles/timely.asp
      The timing of birth has major consequences for a baby. Too early or too late can mean the difference between life and death. Or so we have come to believe; and it’s undoubtedly true at the extreme ends of preterm and postterm birth dates. Although few babies are born at these extremes of the normal length of pregnancy, much of our prenatal care is based on bringing babies to birth “in a timely fashion”—neither too early nor too late. But our understanding of “timely” is clouded, and some of our methods are self-defeating. By intervening in the natural timing of birth, we sometimes exacerbate the problems or create entirely new ones.

      Normal human pregnancy is approximately 280 days, with a variation of about three weeks. There may be reason for concern if labor has not begun weeks after the due date, since placental function begins to slow after some point in gestation. Placental insufficiency can lead to poor fetal growth and, eventually, damage to the baby’s organ systems or even stillbirth. This is rare, but it is not necessarily connected to the calendar. The placenta can begin to fail at any point in pregnancy, and part of good prenatal care is monitoring growth and fluid levels so we can act before the baby’s reserves are drained. We induce labor—even advise a cesarean without labor—if the baby is in trouble, regardless of due dates. It is obvious that a baby is “better off out than in” if the placenta can no longer nourish him/her or if the uterus has become a dangerous place.
      What is Normal? Marsden Wagner
      http://www.acegraphics.com.au/articles/wagner01.html

      Active management illustrates the confusion in the medical approach as to what is normal and what is pathological in birth. A WHO publication states:

      By medicalizing birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her (and some of this may occasionally be necessary), the woman’s state of mind and body is so altered that her ways of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result is that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what “non-medicalized” birth is. This is an overwhelmingly important issue.

      Almost all women in most developed countries give birth in hospitals, leaving the providers of the birth services with no genuine yardstick against which to measure their care. What is the range of length of safe labor? What is the true (i.e. absolute minimum) incidence of respiratory distress syndrome of newborn babies? What is the incidence of tears of the tissues surrounding the vaginal opening if the tissues are not first cut? What is the incidence of depression in women after “non-medicalized” birth? The answer to these, and many more questions is the same: no one knows. The entire modern obstetric and neonatology literature is essentially based on observations of medicalized birth. (WHO 1985a).

      Medicalization also results in distortions of what is abnormal or pathological birth. How can it be that when the active management protocol is applied, over 40 percent of Dublin women having their first baby have a “dysfunctional myometrium” incapable of expelling a baby without the help of doctors and drugs? Active management was devised “for the early recognition and correction of inefficient myometrial activity” (O’Herlihy 1993), but the inventors of active management had never attempted to measure myometrial activity!
      Prospective risk of unexplained stillbirth in singleton pregnancies at term: population based analysis
      http://www.pubmedcentral.nih.gov/art…gi?artid=28178

      Unexpected late fetal death is tragic but not uncommon, most such fetal deaths being unexplained. Although five times more common than sudden infant death,1 they have attracted scant public attention.

      The risk of unexplained stillbirth at
      35 weeks is 1:500
      36 weeks is 1:556
      37 weeks is 1:645
      38 weeks is 1:730
      39 weeks is 1:840
      40 weeks is 1:926
      41 weeks is 1:826
      42 weeks is 1:769
      43 weeks is 1:633
      A Doctor’s Comments on Post-Maturity
      http://www.joyousbirth.info/articles…tmaturity.html

      With the background of my experience with postmature babies, which is far more comprehensive than most other practitioners under the rule of induction at forty-two weeks or earlier, I have to assert categorically that the so-called recognized signs of postmaturity are fallacious because babies mature at different rates. Those signs are practically never due to real postmaturity, they are more likely to be due to other factors like a severe illness during pregnancy, or placental infarction well before term.

      I knew that postmaturity signs were unreliable long before I ever started attending homebirths, because I can still remember the famous and respected paediatrician Kate Campbell telling us students about postmature babies having long hair and long fingernails and other signs, and premature babies having the reverse. But once I got into general practice and was ********** babies in hospital, I noticed that those signs were most unreliable, and that some babies born before term had long fingernails and hair, and some babies born after term did not.
      Postdates: separating fact from fiction
      http://www.theunnecesarean.com/blog/…m-fiction.html

      http://pregnancy.about.com/od/induct…sinduction.htm

      5 Reasons to Avoid Induction of Labor

      1. Increased risk of abnormal fetal heart rate, shoulder dystocia and other problems with the baby in labor.

      2. Increased risk of your baby being admitted to the neonatal intensive care unit (NICU).

      3. Increased risk of forceps or vacuum extraction used for birth.

      4. Increased risk of cesarean section.

      5. Increased risks to the baby of prematurity and jaundice.
      Nice, simple article, good for sharing around. Explains a little of the five points with footnoting.

    • rebecca b says:

      Wow, thank you. No my doctor didn’t explain any risks to induction and he was aware that my birth plan is to have as little intervention as possible. I’m very thankful I had done some research and read books on how to avoid a c-section however this low amniotic fluid excuse wasn’t in any of the books I read and of course you are terrified when someone insists your baby may die and says you need to check into the hospital immediately. I am glad I decided to do more research. My doctor has tried to sneak in an induction twice already by just saying, “well you’re going to feel pressure now”. If I didn’t know what membrane scraping was or if I was a little more trusting I would have just let him do as he saw fit…which is very scary. Are you involved in any advocacy groups that I can check out? It’s been an eye opening experience to be told that home births and midwife births are illegal in my state and to see how much you really must fight- and I mean fight!- to have a “natural” experience within the existing medical/healthcare framework.

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  22. Emily Jones says:

    Low Amniotic Fluid is NOT an Emergency

    [... Gloria LeMay, in her article, "Low Amniotic Fluid....I don't think so," she describes the process like this...]

  23. Rose says:

    I am 24 weeks pregnant and my doctor diagnosed me with low amniotic fluid when I was 19 weeks along (I was at 5.42 at 19 weeks)
    She sent me to a specialist and he’s(the specialist) now saying ‘drinking more water won’t help now’ and they haven’t even put me on IVs or anything like that. They’ve just done ultrasounds and said ‘Oh, come back in 3 to 4 weeks…’ like it’s no big deal.
    They say that she’s developing fine and everything seems normal on her except that she’s really ‘skinny’…whatever that’s supposed to mean.
    I feel very frustrated and afraid that they’re not doing all they can for me and that they’re taking it way too lightly. I called my doctor and told her how upset and I was and she said she’d review my specialist visits and ‘give me a call next week’.

    What on earth am I doing wrong? If they’re not making it a big deal then should I not make it a big deal? My gut tells me that they’re not doing enough for me. HELP. I need advice. I’m so afraid.

    • rhonda graham says:

      oh hun………….the amniotic index you told us is on the lower side. all babys at 24 weeks are skinny. now saying that i am a 13 year nicu nurse with 13 years now in labor and delivery. an iv will not help your babys afi. lots of drinking is also a myth. but……follow up is very important and they are right to repeat thier testing to make sure that the fluid is not decreasing. the amniotic fluid is prodused by babys urine so therefor this baby is makeing enough pee to keep the levels ok. i have seen signifigantly less fluid and had nice big heathy babys deliver. the purpose of the fluid is for lung developement. at 24 weeks is when the baby is now viable. at 30 weeks the baby starts to produce surfactant that matures the lungs. if you and your hubby are smaller people then you will have a smaller baby. just know that you re ok. go to all the follow up appointments and dont let them kick you out of the office untill all your questions are awnsered. write them down. if your practitioner is not forthcoming with you ,then seek a new one. i believe that your eduction on what is going on will relax you and let you grow the gorgeous baby you deserve. but never be scared to ask. it is your right.

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  25. Simone says:

    Gloria,
    Thank you so much for this post. I’m currently 41+6 today. I recently was sent for a BPP ultrasound 5 days ago which came back with a result of 3.7cm liquor with deepest pocket of 2.2cm. All other indicators in the BPP were showing as normal which gave me a score of 6/8.
    I have taken great comfort & confidence from your article & others like it, in resisting the aggressive stance the hospital has taken to me resisting induction. Just today the director of the midwifery unit & an obstetrictian at the hospital ‘discussed’ the severe risks I am taking with my baby’s life. Intimating that I’m now a high risk pregnancy based on these results.
    I’m still shocked by all of the things they said to me in an effort to get me to agree to an induction. If not for the support of my husband & wonderful wonderful midwife, I may well have lost confidence & acquiesed to their bullying. The CTG result today showed perfect heartrate & movement yet I was told this is not a sufficient indicator that my baby is ok. I was even told that my strategy of tracking baby movement daily is not enough to show that my baby is ok as movements felt could actually just be fluid & the baby is already dead (for future tracking). Also that the further I went ‘overdue’, I could feel the baby move then 2 hrs later it could be dead. Any wonder women agree to inductions with such pressure.
    I’m still in shock hours later with their words running through my mind. How can they say such things?
    I am still hoping for labour to start spontaneously & am taking note of baby’s movements as I feel strongly he is doing fine in there & running to his own timetable. Daily CTG monitoring is all I have agreed to, although the hospital expect me to have twice weekly ultrasounds, whcih I will decline. I don’t need them to get anymore ‘test results’ to use to bully me.
    Thank you again.

  26. shanti says:

    This is wonderful information! I’m a Doula and will be passing this link along to all my clients. Interesting to note though that doctors treat ultrasound testing as though it is risk free, which it is not. It does carry risks for the baby, such as Autism, Mitochondrial disease, and other neurological disorders. This goes largely unmentioned and I have serious concerns about that. Thoughts anyone?

  27. Elizabeth says:

    Thank you so much, Gloria. I’m sharing this on my facebook page for readers of my book. This happened to me with baby #2 and the turn it caused for me completely changed my views about birth. Ultimately for the better, but it was certainly something I hope I could help other women avoid.

  28. Audrey says:

    I just founed your blog, and this article is really interesting.
    I’ve been induced for my first baby at 41 weeks because my Amniotique fluid index was 2 (and effectively I lost very little water during the birth process). But this induction was followed with a lot of complications due to induction and ended with a ceasarien.
    3 years later I still ask myself if I could have avoid all this whitout endanger my baby’s live?
    I couldn’t find any articles concernig the real risk for post term baby with real oligamnios like I had. What do you think about it?

    2 years later I was blessed with a beautifull VBAC (and plenty amniotic fluid). I’m now dreaming for a homebirth…

    Thank you for your answer.

  29. Hannah VW says:

    Yes! My son’s biophysical profile “confirmed” my doctor’s suspicion (based on fundal height measurements) that my son was too small. Although this term was never told to me, his medical records said IUGR when I looked at them later. Both of these were used to pressure me into scheduling an induction. I scheduled it much later than my doctor was comfortable with and managed to go into labor the night beforehand.

    When he was born he weighed 7 lbs. 11 oz (the ultrasound said about 6 lb. 11 oz, which is about what I and my other full-term siblings weighed at birth) and was in excellent health. My doctor admitted that “we’ll know for next time that you hide them well”, but by that time I had already decided I wouldn’t be going back to him next time!

    Biophysical profiles need to be used carefully.

  30. Natalie says:

    Gloria,

    I’m an American currently living abroad in Germany. I am planning a home birth with a German midwife. I did, however, get a 20-week ultrasound to make sure all looked good for a home birth. There, the genetic specialist doing the ultrasound told me my placenta was low-lying. This did not cause much concern on my part b/c it wasn’t touching the cervix and I had the same “issue” that resolved my previous pregnancy. Nonetheless, I went back in two months later (today) to check it – just to be on the safe side b/c I’m planning a home birth. I am 28-weeks, 3 days. The placenta is looking much better, however, he said my amniotic fluid was low. The baby is just over 2 kilo and is measuring fine (his head is a bit narrow – but overall head growth is fine).

    He wants me back in three weeks to monitor it and then every two weeks thereafter. He told me not to worry b/c the baby is growing fine. My midwife is going to look over his notes and see what level (or grade?) my fluid is at. She seems to think follow-up should be in 5-6 weeks, not 3. I’m concerned that he is going to be very aggressive and put me through unnecessary worry. Early in pregnancy, before I had found a midwife, I had some bleeding and his daughter who practices with him, found a hematoma on ultrasound and had me come back a few weeks later for a recheck (it was fine). The next ultrasound revealed a low lying placenta and this one low-amniotic fluid. I’ve about had it.

    I find it unbelievable all these things (two resolved) could go wrong. I had a beautiful water birth with my second child and the idea of being induced or even put on bed rest b/c of this, is beyond maddening. If I had not gone back to the specialist as my midwife suggested (she was never concerned about the placenta), I would not even know about this new issue. In fact, I didn’t have any ultrasounds past 24-weeks in my two prior pregnancies – so, if I had this issue before, I don’t know that I would have known about it unless measurements were off (they weren’t).

    My midwife will be calling to talk all this over with me later today or tomorrow – I’m sure she’ll have a more relaxed approach than the doctor, but, I’m wondering what you have to say since you’ve researched this extensively.

    Thank you,
    Natalie

  31. Michele Harshbarger- labor and delivery doula says:

    Gloria thank you for all the information surrounding Low Amniotic fluid. Women are so fearful about Childbirth because of extensive testing, and the use of interventions. Doctors still rule and the non medical model is struggling. I want to be a strong advocate for childbearing women today! Keep up the blog.

  32. Lamr says:

    I have never had this test with either of my pregnancys I’m on my third and having s home birth but also keeping my care with at the local military clinic( my husband is in the military) just in case anything should go a rye they have full knowledge of my case. Anyway they don’t require or ask for this test in the mil system unless you are high risk anyway.

  33. Monica says:

    Thank you for writing this article. I was induced by my midwife at 41 weeks because she said I might be leaking amniotic fluid. Trusting her 100%, I went ahead and drank a terrible concoction that consisted of castor oil, lemon verbena oil, almond butter and apricot nectar. Little did I know it was going to have such an effect in my small body. Within 1 hour of taking it I started contractions and was 8cm dilated in less than an hour after that. Rushed to the hospital with the midwife, there was lots of liquid coming out once my water broke, no low amniotic fluid. Long story short, I needed an epidural due to the titanic contractions I got thanks to the induction and then it all got more complicated, contractions died down so they had to inject oxitocin, my baby’s head wasn’t even engaged and was not descending, was made to push for 4 hours and then told to wait because the doctors were busy (meaning the midwife couldn’t do anything and was passing me on to a doctor). I was made to wait for 7 hours before a doctor saw me. He tried pulling the baby with his hands, etc. and then my baby’s heart rate dropped rapidly so he pulled him out with rotational forceps. Due to this I lost more than 60% of my blood and almost died. Was not given a transfusion because the nurse forgot to give the results to the doctor.
    But you know what? I survived! And my baby was really healthy :)
    This is still haunting me after 2 years. I am glad I had taken good care of my body throughout my pregnancy as it allowed me to survive such an experience. I am currently working with other moms to try and create a support group that will empower women throughout birth. Thanks again Gloria for your article.

  34. Chris says:

    In fact, there is a scientific – even mathematical – basis for rejecting the AFI (amniotic fluid index) — it uses length (depth of pockets) to measure the _volume_ of fluid! Two years ago, they were insisting on inducing my wife at 38 weeks because of this low measure. When I asked what the error range was for the measurement, they had no idea what I was talking about. Finally, I asked them to do another measurement, and that one was much higher (just hours after the earlier one), so they relaxed. Crazy.

    • Yolanda says:

      Chris you are so right! I was told the same thing and when I did my research I found that my levels were just fine. During my ultrasound I watched the tech measure the pockets and I began asking her questions … such as ” how many pockets are you going to measure and how do determine if the fluid level is low or high within the pockets: …. after that i never had anything to worry about… i did my research and began becoming very engaged and aware. Thanks for the post

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  36. Jenny says:

    Thank you for writing this. I was recently wondering what was up with all the “low fluid” issues so many women seem to be having…especially when it’s an easy fix if there truly is a problem with the fluid levels. I’m part of a due date group and quite a few had inductions and c-sections because of low fluid…it’s everywhere right now.

    I will be passing this on for sure. :)

  37. Kirina says:

    My membrane ruptured at 31 weeks and I did not give birth for another 5 days. Even though my amniotic fluid was low, there was not need to induce or do c section. If this was the case with me, I see no need for women to have their labors induced due to this test especially if it is so inaccurate. In today’s society, we are lead to believe that the doc is always right. There are many good doctors but also millions of bad ones. Always question and speak your mind when something is not right. My doc offered a c section when my water broke. No way did I let him! I gave birth to a 4 lb baby with no meds and he is very healthy. Always question the doc when it does not feel right.

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  39. Yvette Medina says:

    Hello Gloria, your article may have saved me an induction. I was told today that I measured 2.7 in amnio fluid. They did a stress test yesterday and it was declared Non-reactive because my babies heart rate was at 170 with no accelarations and two decelaration. I know that the NST has a an 80% chance of a false reading. So I did not want to base my induction on a 20% chance that they are right. So now they are pushing for an induction and pulling the dead baby card on me. I even had to sign release forms because I would not go to labor and delivery. My husband is scared more than me. Any thoughts on how to make him feel better? I don’t want to feel pressure by him too!

  40. Sam says:

    I am writing this because my 35 weeks and 4 days pregnant wife today was told that
    She has IUGR and her placenta looks like its 40 weeks old. Not sure how they can say that. The ultra sound also shows Low amniotic fluid and that the baby is only about 4 lbs estimated based on the ultrasound test. My doctor had her to a second round at another specialized facility. The reason she went for ultrasound was that she had stopped gaining weight in the past week. I do want to mention that she had caught a really bad cold last week. I supposed her fluid intake must have gone down. Until last week she had gained weight well. Between week 32-35 she had gained about 7-8 pounds and then this week none or probably lost little. She had swelling in her legs and arm in week 34 but after the cold the swelling went away. So far no protein in her urine was found but the test yesterday the doctor found a little. It was this and the weight loss that made them do an ultrasound.
    Now the doctor has advised complete bed rest with lots of fluid intake. We have to go twice a week to do ultrasound and fetal monitoring. The doctor has also said that even if everything looks good they want to do an induction in week 37.

    The baby has always been active. Wife has had no protein until today. We are also doing a 24 hour protein test. There might be chance she has pre eclampsia based on protein test but everything is confusing.

    After reading the posts above I am very confused. if the ultrasound weight estimate is inaccurate and the low amniotic fluid is not a good indication then Why the induction?

    Doctor is saying that “better out than in” to give a better chance for baby. Any comments or suggestions

    • Yolanda says:

      Hi Sam,
      My daughter is 4 weeks old and the doctor was trying to induce me at 38 weeks due to a “mature” placenta and low amniotic fluid. My husband and I were against inducing labor UNLESS there was harm to the baby or myself. The doctor began talking of inducing labor when I was just 35 weeks. So, we did our research and found out that there was no valid reason to induce labor. My fluid levels were around 11 and anything below 5 is a danger. My placenta was mature however the NST found the baby’s heartbeat was normal and was recieving enough oxygen. We did alot of research to educate ourselves on when the baby would be at risk and so we could prepare ourselves when talking to the doctor. The doctor tried everything to get us to induce and for no valid reason. I expressed to the doctor we would only induce if I or the baby was at risk.

      Please dont let them talk you into doing something that is not needed. Educate yourself and be prepared to stand your ground. My daughter was delivered at 40 weeks – naturally. The doctors will say and try to do everything to get you to induce for the sake of their selfish needs. Become engaged and understand everything that is going on.

      Good luck!

  41. Yolanda says:

    Sam ,
    Another idea is to drink plenty of water. When I asked my doctor if that would help he said “well yeah but…. “

  42. Sierra says:

    I don’t know if anyone can help me as I’m not late in my pregnancy or over due but I am very very worried. I had my 20 week ultrasound which was very blurry and ultrasound tech said the baby wasn’t in a very good position and would not let her get the measurements she really needed to get and she would most likely have to do a repeat. My doctor called me late the evening very worried after he has red the pics and said it looks like I have very low fluid and the biggest pocket was measuring at a 2.5 and he likes to see 1o. He put me on bed rest and told me to drink tons of water and ordered a repeat ultrasound to me done in a few days. He then went on to tell me he might have to send me to a big hospital a few hours away in 4 weeks to give me steroid shots and he might have to take the baby at 25 wks. Any inputs? I am worried sick! I had some bleeding earlier in my pregnancy due to a subchorionic hematoma that is now gone and he thinks this may have something to due with the low fluid……

    • gloria says:

      I would definitely get a second opinion before accepting steroids for a premature baby, Sierra. Steroids for prematurity have been shown to damage the brain.

      • Tabitha says:

        I had steroids for a preterm labor at 25 weeks and my daughter has perfectly normal brain function. Your quote “have been shown to damage the brain” is misleading. Sometimes, medical intervention is necessary. Most of the time it is not. But we don’t want to seriously freak out the new mama here.

  43. Amie Callahan says:

    When I was pregnant with my first, I had the BPP done at 37 weeks. There was an issue about breathing (or heart rate, I no longer truly remember) variability. We had an ultrasound which showed low fluid (they couldn’t find any). I was sent for the induction. 45 minutes later, the intern comes in and ruptures my membranes and a HUGE gush of fluid came out. Unfortunately, so did her cord! I ended up with an emergency c-section without anesthesia and my baby lived with no deficits, despite needing to be resuscitated. From later pregnancies and talking with my mother, it seems I tend to bake them a little longer (42-43 weeks). That made her 5 weeks early (not term!). My little girl was only just over 5 pounds. If I knew then what I know now….

  44. Juliana says:

    Thanks for this post! When my son was born 2 years ago, he was breech at 38 weeks and so my doctor had me go in for an external version to turn him. But first they had to do an ultrasound to make sure everything was good. Turns out they found I had low amniotic fluid, the doctor said it was 2cm which is apparently extremely low. He said I had to get a c-section immediately, that day, right then and there. I asked if maybe I drank a lot of water it could go back up (I had to fast since the night before for the version and it was already 3pm!) He said it wouldn’t help enough. I said well can’t I wait a few weeks, he’s only 38 weeks. The doctor said that waiting could cause still birth. So I agreed to a c-section that day.

    I regret that decision so much now that I know the facts. Luckily my son turned out just fine after about an hour in the NICU because of breathing problems. He’s now an extremely intelligent 2 year old with no health problems.

    This time around I’m going to have a home birth, and I have a wonderful midwife who knows that low amniotic fluid at the end of pregnancy is normal and usually harmless.

  45. David in Distress says:

    Im sitting in a hospital crying right now. My woman is asleep aside me with an IV drip. We were lied to but I knew something was bullshift so I investigated. It took an hour of arguing with her mother, the dr. the nurse, and the dr’s other dr friends-JUST TO GET A 24 HOUR STAY ON OUR FORCED INDUCTION. Now Im damn sure calling this whole mess off.
    I knew I was right but they push and they push, they try to make you feel stupid by using technical terms and their standing/degrees/years/babies delivered, etc. They lie and cause a stress so powerful that it consumes and boggles the mind so that you dont have time to react. I mean the “baby is in danger” or the “baby could die” really puts it home to first time mothers and fathers.

    Story.
    Went for “routine” 37 week ultrasound. Slightly low amniotic fluid at 4.2, when normal is considered 5. DR LIED AND SAID NORMAL WAS 8 AND SHE WAS “ONLY HALF THAT”….. When I asked the dr. other pointed questions she lied multiple times, first to trick us into the hospital and then many times to cover her previous lies. Unlucky for her I am able to see through people like water, understand their thought processes and facial gestures, even micro-gestures(millisecond) that most people cannot see. IQ 186 average, but I happen to look like a big tough meathead so people greatly underestimate me.

    It was supposed to be a beautiful day, her mother and I took her to the OB after lunch. We were smiling and almost crying looking at our precious baby girl on the ultrasound. Then insanity ensues. The dr comes in so matter of fact and states today is the babies birthday “so try to get used to that idea”, 3 weeks early? *with a SMILE?* BECAUSE OF (barely) LOW AMNIOTIC FLUID AND TRANSVERSE LIE(which is normal). She went white and her mother was clearly very stressed as it took us 20 minutes to drive what should have been 3 minutes because we took 4 wrong turns.

    I think the hardest part was trying to convince her mother I wasnt crazy for doubting the dr and that I alone had the babies best interests at heart. I alone will live with any mistakes or choices I make for my child and Im well aware of that and take it extremely seriously.

    Lie 1- Low amniotic fluid is grounds for immediate surgery (c-section)
    Lie 2- Transverse Lie is an additional factor for immediate surgery, combined with low fluid.
    Lie 3- We will just have you go to the hospital and get on some IV’s, then in a few hours we will recheck the Amniotic fluid level. ***In fact it takes upwards of 24-48 hours to noticeably increase Amniotic fluid level through IV. This was used to trick her into a bed where she was put on IV, which effectively forces you to stay put. Like being in Jail and punished for days until you break and finally give up on fighting.

    IMPORTANT SIDE NOTE- A STUDY PROVED THAT UNLIKE HYDRATING THE MOTHER, DRINKING LIQUIDS INCREASES AMNIOTIC FLUIDS FASTER AND BETTER THAN AN IV!!! IV rapidly increases mothers hydration but mostly bypasses the baby. 2 liters of water in 2 hours will greatly increase the Amniotic fluid level as will regularly drinking extra water.
    LIE 4-”You must have misunderstood me when I said we would recheck the fluid”After being told I know that she had misinformed us all.
    LIE 5-”your baby is in danger, she could go into distress which would be detrimental to the baby.” In fact the very act of a c-section can cause a very severe distress, along with an obvious host of additional problems.
    LIE 6 WHICH PROVES LIE 3 and was told to me as a rebuttal to us wanting to wait 24 hours to recheck- “FINE! We will keep her on fluids through the night and then retest in the morning(18 hours after last test) BUT IT WONT CHANGE”
    SHE KNEW SHE WAS LYING TO ME, THEN SHE COMPLETELY OPPOSITES HER STATEMENTS.
    Its obvious to me by the nurses statements and actions that they simply rescheduled the c-section for early morning.

    She was unbelievably told to not ingest any food or liquids even after we explained 3 times that she was likely dehydrated byworking 11 hour shifts in a building with no air conditioning because some thieves stole them, on top of that she was in the hot attic all weekend getting her room ready for the baby room overflow/extras.
    I assume this was done for 2 reasons(no liquids), both to keep her ready for immediate induction, and to try and “prove me wrong” by keeping her off fluids so that she tested the same today.

    IM GOING TO SHOW HER MOTHER AND HER THIS POST WHEN I WAKE UP BECAUSE I SIMPLY COULD NOT TALK SENSE INTO THEM NO MATTER WHAT I SAID OR THE MANY PROBABILITIES OR STATISTICS I STATED.

    Just because something is common practice does not mean its correct.
    Again thank you for this post.

    I must add this. My mother was 40 when she gave birth to twins recently. She is deathly allergic to all Cillins, as in penicillin, etc. She was wearing a bright orange band stating this, they injected her at time of labor, and again the next day, and the following day until they realized their mistake. When my mother awoke from her mild coma, all bloated like a human red balloon and unable to talk in full sentences, I asked her. Mom what happened to you, have you ever felt like this before? To which she barely replied, “when I was 6″ which we know as the story about when mom almost died from penicillin and spent weeks in the hospital.

    When the nurse came in minutes later I looked her right in the eyes and asked if anyone had given her ANY CILLINS. She looked stressed but smiled and said no, then left the room heading for the nurses station. I followed and heard the most disturbing words I have ever heard “THEY KNOW!” They had been lying to us for 4 days saying it was just toxic shock syndrome and continually advised us to leave the hospital because there was nothing we could do. Which we did, trusting them at their word. In reality though, it was just lies on top of lies to cover a DEATHLY SERIOUS MISTAKE!
    When your loved one is in the hospital watch and learn, study and search for information. It might save a life.

  46. aga says:

    Hi all.It is only me who says no to induction? I’ve reached 42+3 days. From my EDD which was 25 july. I am being pushed for induction.I am 100% sure that my scan due day was wrong and it was put back 1 week.My EDD was beginning of august .No one wants to change it.I know my LMP and the day of passion .Even that I can be wrong but most definitely I can not be pregnant before and also I had a coil which made me even more sure.
    Till my EDD I was happy, healthy mama but the way the doctors talk to me after that is really bad. I wish I recorded what and the way they talk to me about my baby gonna be dead if I carry on with pregnancy. My BP was fine during pregnancy and after the talk was very high. So now they are trying induction because my BP. I said to one doctor who nearly wanted to eat me that my BP is high because of doctors bullying me for induction and that BP is high 1 day but I am being push for induction for almost 3 weeks.My BP is fine again so they trying find another fault in my body to preventing me from continue my pregnancy.So they send me for scan .At first scan baby was doing fine everything was normal.My amino acid was 5.3 .Second scan was even higher 6.4.Then next scan show that amino acid is 3.after my scan today is even lower 2.9.And these are daily scans.So I asked midwife how this is posible she said that placenta are not working good . But should placenta work based on blood flow? In my case blood flow is normal.So what are they trying to find .I said I am not gonna be induced and they now realise it and I think they accepted it.
    What I notised in my hospital that woman are not educated about pregnancy.Lucky woman who’s EDD was put forward and if she have baby near EDD. Otherwise your nightmare will begin.Induction is like epidemic this days.When i am at hospital I can not see a woman with huge tommy any more becausethey are induce before even reaching full term.I was shock.And the sweep I found also very intimidating .I refused as well.I am being supported by my husband and he told me that my belly was much bigger with my other kids and he is sure about it.
    I would like my baby be born already but let him decide his date of birth not doctor.And how can doctor tell me that normal pregnancy last for 40 week.Maybe she should think about changing her profession.All induction are because if we woman continue pregnancy till 42or 43 imagine the cost and the extra monitoring .It will be impossible.One midwife told me that Somalian ladies do not coming for check up because they know that doctors will find something and made them worry and push for induction even before due day.
    So am still pregnant . I must say I am worried but I trust my body.I read one day that male doctor said that “pregnancy are like art, working beautifully.” Wish me luck.

  47. Rebeca says:

    This happened to me, I was 40.5 weeks with my first child, they induced me due to low fluids, had the worst labor and delivery ever, 30 hours intense contractions, way too much meds in my epidural making me sick and woozy, 3 hours of pushing, had to use vacuum assist with an episiotomy and they pulled my daughters neck so hard she required 4 months of physical therapy, and I was barely 18 and when tgey broke my waters it seemed like more than enough my dr seemed surprised? I didn’t know that they screwed me over until I had my second child 5 years later with a midwife and had a completely opposite experience, when I told them about my experience they were shocked that a dr would do that but considering I was young and poor I didn’t know any better and got screwed for it. I would make sure any first time mom would know what to look for in a dr and the warning signs that they are just out to get more money by using as many procedures as possible an put the mother and baby at risk!! My daughter is now 9 and I am pregnant with my 4th child and am glad to know that I will not let a dr push me into unnecessary procedures that may put us at risk and I hope other Mom2 be read articles like this to prevent such things especially those who target young women on state insurance to get money out of it. Thanks for this article :)

  48. Teneille says:

    Thank you for the post! I’ve had doubts about how the birth of my son went went this past February. My due date was January 25, but it came and went without any contractions. On January 30 my doctor stripped my membranes(my cervix was soft and slightly dialated). Later that day I noticed some contracting and I lost my mucus plug. I was scheduled for a routine fetal assessment for February 3 (Friday). I was told that if everything went well at the ultrasound then I would be induced on Monday morning. We drove to the ultrasound thinking it was just routine. The technician said everything thing looked great except all she could find was 1 cm of fluid and that there should be at least 2-3cm. She called someone else in to double check it and they said the same thing. We were told I would have to be induced that night. My hometown hospital doesn’t do inductions on the weekend so that meant having to stay in Winnipeg for the induction. I was very disappointed. We hadn’t brought anything with us because we weren’t expecting to stay. While waiting to be induced a girl having contractions was wheeled by screaming in agony-not what you want to hear when you are about to have your first baby. My membranes were stripped a second time(around 6 pm) no contractions. I was induced around 7 pm. Unfortunately I wasn’t able to walk around or take a shower or do any of the things I wanted to do to get my labor going. I was confined to a bed with a monitor strapped to me. By 4:30 am I was 5 cm dialated. About 15 minutes later the OB came to checked my progress she told me I would probably want an epidural. Then she checked me and said I was 8cm dialated. The baby’s heart rate went down and wasn’t coming up very fast. They flipped me on my side and when that didn’t do anything I was told I would have to have a c-section. And with that they wheeled me into the operating room. I was so close to being fully dialated! I was given a spinal (something I really didn’t want-I had wanted to have as natural a birth as possible) at 5:41am my son was born. He scored 9/10 on the Apgar test. He was beautiful and healthy. I guess my issue with the whole ordeal was whether I needed to be induced and how quickly it went to a c-section. I’ve been told since that other hospitals often get you to try more positions before sending you for a c-section. For our next baby I want to have a midwife so badly (I couldn’t get one the first time), I want to avoid as many interventions as possible.

  49. Pingback: Low Amniotic Fluid. . . I don’t think so « Lotus Midwifery • Rowen Holland, LM, CPM

  50. justinep says:

    I’m so glad you wrote this, because there is so little out there on this phenomenon, even though it’s happening every day.

    I was 8 days late when I got the low fluid diagnosis. The OB was scaring me half to death about the health of my baby. But I instinctually knew she was fine, and that “immediate induction” was not the best thing for her. Luckily I had the support of my midwife to at least wait another 24 hours. I bought myself one day, and by 6 pm that night (and the proper dosage of castor oil, which I give full credit to), I went into labor naturally. The full story is here: http://wp.me/p1MjVs-51

    I hope that this harsh end to perfect pregnancies gets nipped in the bud, soon.

  51. Pingback: The B.S. “low amnio” diagnosis is getting exposed, finally. | this is happy hour

  52. pernille says:

    Thanks for sharing this!!
    They want me in tomorrow for the ultrasound to check the level of amniotic fluid – now I feel prepared to ask THEM questions!!
    As I feel fine and my baby is fine <3 pernille

  53. jo says:

    hello I have read your article and understand a little seeing that this is my first time really doing research on this. I am 40 weeks pregnant and a day. My doctor has recommended that I come in for an induction tomorrow because I took in a amnio test that said that my fluids were low. something about sections and he will see if i need to be induced or not. so records came back and it said that my fluids are low more like 5% or something and that i need to come in right away with a finger tip dilation to be induced with only pitocin. and my bishop score is 6. I wanted a v bac done.
    how is this going to get me to deliver vaginally.

    • gloria says:

      Inducing with Pitocin increases your risk of uterine rupture in a V BAC. Most women go over 40 weeks pregnant. Inducing will not help you deliver vaginally and will increase your likelihood of having a repeat cesarean (the cesarean rate goes up hand-in-glove with the induction rate). Get a second,third,fourth, fifth and sixth opinion.

  54. Amber says:

    I had 2 c-sections due to low amniotic fluid. First, my son, in 2004 at 37 weeks they said my was 2.0. He was delivered that day at 6lbs 14oz. This past June my daughter was delivered at 35 weeks 5 days due to a level of 4.5 amniotic fluid. Saw maternal fetal dr every week with my daughter. Had gestational diabetes with both pregnancies but worse with my daughter, requiring insulin. But my blood sugar levels were great! I did everything I was supposed to! This makes me sad to read because I really wanted natural births with both of my children and felt forced to deliver them :( . And I had my tubes tied because of this low amniotic fluid “problem” with both pregnancies. Wish I had read this sooner :( . I mean I did everything! Gallons of water, protein smoothies, bed rest…..you name it, I did it and neither of my kids had any in utero issues with movement or growth or any issues after birth. My daughter was smaller at 5lbs 6oz Wow! This article has really opened my eyes!!!

  55. Crystal Sada says:

    What if…this is normal? What if…this is a signal for the baby to vacate and labor to begin? Back when I was having my babies we knew nothing of this. Ultrasound was not yet used for every little thing. And guess what? We are NOT getting better outcomes! We don’t know everything there is to know about how labor begins. Maybe this is just one of the ways it does.

  56. Pingback: Low Amniotic Fluid… I Don’t Think So | Amie Slott -- Birth Doula

  57. Pingback: Low amniotic fluid? Really …. | Ripple Effect Yoga

  58. Pingback: Oligohydramnios (low amniotic fluid) | Naveh Birth Support

  59. Valerie says:

    Thank you for this. During a post date NST, I was told my AFI levels were “dangerously low” and I needed to be induced immediately. I was obviously frightened but I was also confused as I had absolutely no other reason to believe something could be wrong. During a brief wait in the room, I found this blog using my iPhone and it gave me enough courage for pause. Much to to the doc and midwife’s chagrin, I refused the induction and requested another test after 24 hours. Operating under the assumption I hadn’t been drinking enough and the baby’s positioning was obstructing view, I drank water like it was my job. 24 hours later, the same sonographer told me my levels were excellent!

    While I am so grateful for my outcome, I am angry that the med profession believes jumping into induction is the best solution. It makes me sad to imagine how many healthy women have been forced into an unnecessary induction under similar circumstances. Thank you again, you have helped me dodge another bullet and continue on my way to my second spontaneous natural birth!

  60. Catherine says:

    I was told today that my fluid levels were low, not by much but this scared me! We have an 8 year old son, My husband and I have tried for 7 years to get pregnant and finally it happened. I have never heard of low amniotic fluid before. My doctor told me 8.6 was the cut off for the 3rd percentile. Mine was measuring at 8.3 at my 20 week ultrasound. And has scheduled another ultrasound for 4 week out. I have been a mad women looking up any and all research I could find about this and I feel better knowing the facts. Knowing that less then 5 is bad makes my .3 off seem much better and it could be due to the baby hiding the fluid. Thanks for posting this info, it truly made me feel better.

  61. Shell says:

    My doc tried to induce me yesterday and was surprised when I said “no”. I’m 43 yrs old and this is my 4th baby. My afl was 5, and he said he was very concerned. My midwife has put me on bed rest and lots of fluids and baths to get levels up by Monday. If not they want to induce. Reading this makes me second guess it all!

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