More and more I am seeing my Birth Boot Camp students and doula clients being diagnosed with low amniotic fluid levels as they near the end of pregnancy. It has gotten to the point that if they are in my class during the summer months or if they have a due date near any major holidays, I prepare them beforehand that their odds of induction are increased, and that most likely the reason will be because of low fluid levels. I always have to include the caveat, “Of course, I am not a care provider. I could always be wrong. In fact, I HOPE I am wrong. However, just be prepared to have a conversation with your care provider in case this comes up.”
What should you do if you are given a diagnosis of low amniotic fluid near the end of pregnancy?
First off, know that you are not alone. Many people experience this, and like I said before, I am seeing this more and more.
You’ll want to have a conversation with your care provider in which you both are very clear about your preferences for labor and what will be the safest route for you and your baby. If you’ve taken a quality childbirth class, you may be familiar with informed consent. An easy acronym to remember when you are being faced with any intervention is BRAIN.
- B- Benefits. What are the benefits of proposed intervention?
- R- Risks. What are the risks of proposed intervention?
- A- Alternatives. Are there any alternatives to this proposed intervention?
- I- Intuition. What is your intuition telling you?
- N- Nothing/Need time. What if we do nothing? We need time to discuss.
Helpful hint: There is a big difference between needing to get baby out NOW and having plenty of time to talk about it first. If you are able to have time to discuss things with your birth team, that is a big clue that you are not in the middle of an emergency. Doctors, midwives, and nurses are REALLY GOOD at moving quickly during an emergency. The only times that I have seen clients not given time to discuss things first were during emergencies, which thankfully have been rare.
Ask your care provider WHY you may have low fluid.
Some reasons for low fluid may be:
- It may be normal. At the end of pregnancy Baby runs out of room.
- You are within two weeks of your delivery.
- You are dehydrated. (Which tends to happen during summer months and busy holidays. Especially in Texas.)
- You may have some other health issue.
- Baby is ingesting more amniotic fluid because that’s what they do at the end of pregnancy.
- Baby may have issues with its kidneys or urinary tract.
- Baby may have some other health issue.
You will definitely want to rule out any health issues with yourself or your baby. Discuss with your care provider ways to rule out any health concerns. If everyone is healthy, then discuss your preferences for labor to begin on its own and if there is any harm in waiting.
Ask your care provider to explain what constitutes a diagnosis of low fluid.
Care providers can test for low fluid in different ways. Two of the most common ways to measure amniotic fluid, which use ultrasound, are: the Amniotic Fluid Index (AFI) method and the Single Deepest Pocket (SDP) method. The SDP method is also sometimes called the Maximum Vertical Pocket (MVP) method. Some sources say that one method is “better” than the other, so you will have to decide with your care provider which method works best for you. An AFI of less than 5cm and an SDP of less than 2cm is often considered low fluid.
Ask your care provider for ideas on how to safely increase your amniotic fluid.
There may be some ways to increase amniotic fluid, including drinking more fluids. However, it is a good idea to ask your care provider what they think are the best methods for increasing amniotic fluid and if it is safe to do so in your case.
Do some research about low amniotic fluid during pregnancy.
I always send the following articles to clients and students who tell me they have been diagnosed with low amniotic fluid.
Dr. Rebecca Decker. What is the Evidence for Induction for Low Fluid at Term in a Healthy Pregnancy?
Dr. Rachel Reed. Amniotic Fluid Volume: too much, too little, or who knows?
Dr. Elizabeth Dubil and Dr. Everett Magann. Amniotic fluid as a vital sign for fetal wellbeing.
These are merely a few articles to get you started on your research. I encourage you to check out the footnotes and sources listed throughout these articles, and even read information that does not support what you are looking for. For example, if you want to avoid induction even if you have low amniotic fluid, not only do you want to read articles that support avoiding induction, but you’ll want to read articles that conclude that inducing may be the safer route for a diagnosis of low amniotic fluid. It may be confusing, but in my opinion, it is important to consider as many angles as possible.
It is important to gather information from reliable sources. Many library websites have articles explaining how to know if a source is credible or not.
Continue to keep the lines of communication open with your care provider.
Once you have read all of the reliable information that you can, it is important to discuss things with your care provider who you hopefully trust and that shares your philosophies regarding birth. If you feel like your care provider is not a great fit, it is never too late to switch. After all, one of the most important things you can do to have the birth you want is to pick an amazing care provider.
Armed with all of the information you need and a fantastic care provider, you can still have an amazing birth, even with a diagnosis of low amniotic fluid. Good luck and best wishes on a happy birth!
Keen Doula Care 