I have a client who's OB has expressed slight concern that her amniotic fluid is a bit low. She is 40 wks today, and she and her OB are hoping she will deliver by the end of next week or they will start to discuss other options.

She asked me if I had any reading material on this and I do not have, nor can I find, anything that talks about low amniotic fluid concerns this late in gestation. Does anyone know any links or books that discuss this?


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taken from this article over at unnecesarean.com


Beyond 36 weeks, amniotic fluid is comprised of mostly fetal urine. When the baby’s kidneys are functioning properly, the baby will continuously produce and process amniotic fluid. The fluid is swallowed by the baby, and then urinated out, once processed by the kidneys.

As long as the mother is adequately hydrated, and there are no congenital abnormalities in the baby, the baby will continue to create amniotic fluid until birth. Whether this be at 37 weeks, or 44. If decreased amniotic fluid is suspected through palpation, an ultrasound can be done to measure the volume found. However, this is not an exact science, as the volume found can – and usually will – vary from ultrasound technician to ultrasound technician, and can also sometimes be dependent on baby’s position. If the levels are found to be on the low side, evidence based protocols suggest having mom orally re-hydrate and return within 24 hours for another AFI ( Amniotic Fluid Index ), preferably by a different technician. This has shown repeatedly to have improved outcomes, versus immediate induction for low AFI levels.

A study published in the Journal of Reproductive Medicine found a significant increase in amniotic fluid after maternal oral rehydration, as well as intravenous hydration, with neither one better than the other. In all, 62.5% and 44.0% demonstrated improved AFI levels.


Amniotic Fluid Index ( AFI ) – An AFI is basically a mini Biophysical Profile. It measures the maximum amniotic fluid pool depth in the uterus. However, as was shown in the beginning of this article, the AFI in a pregnancy can be contingent on several factors. Being dehydrated can lessen the AFI found. The baby’s position can affect how much amniotic fluid is seen. The skill of an ultrasonographer can make a difference in the AFI level found.
It was also shown that AFI levels can be improved with maternal oral rehydration. Often in modern obstetrics, this protocol is ignored, and induction is recommended very much against proven evidence.


Amniotic fluid is dependent on maternal hydration, in the absence of congenital abnormalities
Thanks for the reply. She may be a little dehydrated so I'll suggest making sure she goes above and beyond in the next week to hopefully give her doctor some more confidence.
make sure you read that article.. it talks about the high false positive rate of NST.
I read it. Her OB is not the "jump the gun" sort and has taken great care to model his practice after the midwifery model of care. His judgment is trustworthy IMO and if he suggested intervention at some point it would be justified. She is the type to research everything and get very well versed on a subject for her own piece of mind, so I wanted to do some research for her.

Again, great article, thank you.
awesome! that's so wonderful to hear. it sounds like you have all your bases covered. good luck and happy birthing for your client!



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