I have a couple questions I would like to ask everyone based on their experiences and expertise.

My 1st one is, how reliable is an ultrasound when it comes to amniotic fluid levels?

Heres why I ask... when I was around 38 weeks pregnant my midwife sent me to get an AFI ultrasound because I was measuring small, she thought my fluid might be low. I measured 8 cm. Then at my 40 week apt I was still measuring small so she sent me for another one. This time they said my fluid was 4cm, and that I needed to go to the hospital and be induced asap. I told them I was having my baby at a birth center and I had a midwife... She said "go to the birth center then." So I went. I sat down with one of the midwifes at the center, she told me that I could no longer have my baby there and that I needed to go to a hospital to be induced, they would help me find one. I was incredibly upset, the thought of having my baby at a hospital scared me to death! I did not want to do this at all. I tried to see what my options were, she told me I didn't have any. I wanted to make sure this was completely necessary, so I asked for a second opinion. She scheduled me for another ultra sound at 10am the next morning. After I left the birth center I went to my local health food store and bought some epsom salt and some Natrum muriaticum (the homeopathic remedy commonly known as table salt or sodium chloride). Then I went to my grocery store and bought some Raman Noodles and Gatorade. I spent the rest of my night bathing in epsom salt, double dosing on the Natrum mur, and only eating ramen and drinking gatorade!
The next morning I went to my ultrasound, my fluid level was 13cm! my midwife was pleased and after that I had to continue getting repeat AFI's every 3-4 days till I went into labor at 41 weeks and 3 days. My fluid level was between 10-15cm with all of them and I continued with my crazy diet the whole time.

My second question is, how did I go from 4cm to 13cm in less than 24 hours? Could it really have been my salt intake?

3rd question, why didn't my midwifes have any remedies for me to help increase my fluid levels? their only advice was to drink more water, which wasn't the issue, I drank plenty of water.

I ended up having a wonderful birth at the center, only 7 hours of labor, and the thought that my experience was almost taken away from me puts a VERY bitter taste in my mouth. If I would have listened to this midwife(thank god she was not the one on call the night my baby was born) I would have been at a hospital being induced and who knows what other interventions would have followed!

I loved having my baby at the birth center and I want to have my future babies at home with a midwife, it's just hard now for me to FULLY believe and trust in a midwife again, knowing that one almost led me down a path I didn't want or need to go. I don't really want to have an unassisted birth, but it feels like its all I have left????

Tags: amniotic, birth, center, fluid, low, midwife, ultrasounds

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I'm sorry that you had that experience. Did you share your outcome with the midwives at the birth center? I think it could be a good learning experinece for them. You have to remember that even midwives are human and not all of them are going to have all the right answers all the time. If you trust in yourself and do what YOU feel is right - as you did with your last birth - you will always come out on top.

For your next birth I think it is important to cover all of your bases with the midwife. Ask them what they would do it certain situations - like measuring small. I know that many midwives do not rely on ultrasounds to determine fetal size or fluid levels precisely because they are so unreliable. I would make sure that your next midwife is more "hands-on" and doesn't rely too much on technology.
Yes I did talk about my experience with the midwife that delivered Lucy, she was not there the day of the bad ultrasound, and she told me that when she heard about it she was very happy I chose not to go to the hospital and get a second opinion.
thanks so much for the advice, I will try to find a more "hands-on" midwife next time!
Question #1 Ultrasound can be a reliable indicator, but really is only as good as the tech doing it. The most reliable indicator is to have the same tech do it every time. Amniotic fluid level normally increases until 28 to 32 weeks then the level usually stays constant until 37 to 40 weeks when the level begins to decline.

Question #2 Amniotic fluid level can be modified by dietary NaCl through maternal water retention which increases maternal plasma volume. NaCl influences water and electrolyte balance during pregnancy (water retention). Differences in dietary NaCl are accompanied by large differences in the daily patterns of maternal urine sodium, urine sodium/potassium ratios, water intake, and urine volume (water retention) and that then increases the maternal plasma volume thereby increasing uteroplacental blood flow. But excessive sodium intake can cause problems for the mom.


Question #3 Certified nurse midwives are held accountable for their patient’s pregnancy outcomes. Poor pregnancy outcomes have been associated with an amniotic fluid volume of 5 or less as it can indicate poor placental perfusion. Your midwife counseled you within her licensure. Perhaps the outcome would have been the same if you had followed their advice to drink more water. Her advice was right on as H2O intake is the biggest contributor to fluid volume. While you feel you drank plenty of water the recommended fluid intake in pregnancy is 3L/day. That is a lot of water. Oral hydration increases the maternal plasma volume thereby increasing uteroplacental blood flow. This in turn influences the amount of amniotic fluid as mom and babe as are essentially a closed unit :<)


Love and laughter, Maureen
Yes I know that excessive sodium intake can cause problems. I ate very healthy when I was pregnant, I was on a completely organic diet and my sodium intake had to have been very low. Now I drank PLENTY of water. Since my midwife first told me to, I started increasing my water, it was ridiculous the amount of water I had to drink, I just peed it all out. I swear to you I could have literally drank my pee it was crystal clear. water did nothing. But i think salt did ???
Thank you for your help I really appreciate it.

maureen stevens said:
Question #1 Ultrasound can be a reliable indicator, but really is only as good as the tech doing it. The most reliable indicator is to have the same tech do it every time. Amniotic fluid level normally increases until 28 to 32 weeks then the level usually stays constant until 37 to 40 weeks when the level begins to decline.

Question #2 Amniotic fluid level can be modified by dietary NaCl through maternal water retention which increases maternal plasma volume. NaCl influences water and electrolyte balance during pregnancy (water retention). Differences in dietary NaCl are accompanied by large differences in the daily patterns of maternal urine sodium, urine sodium/potassium ratios, water intake, and urine volume (water retention) and that then increases the maternal plasma volume thereby increasing uteroplacental blood flow. But excessive sodium intake can cause problems for the mom.


Question #3 Certified nurse midwives are held accountable for their patient’s pregnancy outcomes. Poor pregnancy outcomes have been associated with an amniotic fluid volume of 5 or less as it can indicate poor placental perfusion. Your midwife counseled you within her licensure. Perhaps the outcome would have been the same if you had followed their advice to drink more water. Her advice was right on as H2O intake is the biggest contributor to fluid volume. While you feel you drank plenty of water the recommended fluid intake in pregnancy is 3L/day. That is a lot of water. Oral hydration increases the maternal plasma volume thereby increasing uteroplacental blood flow. This in turn influences the amount of amniotic fluid as mom and babe as are essentially a closed unit :<)


Love and laughter, Maureen
Toni,

Restricted sodium intake can cause problems also. Restricted sodium intake can interfere with adequate maternal blood volume increase. Recommended amounts are 1.5 to 2.3 g/day.
Sounds to me like you corrected the problem yourself and went on to have the birth experience you desired. What an empowered woman you are. By the way; your baby is beautiful.
thank you so much for answering all of my questions maureen! i think i have a little more of an understanding now. thanks a bunch :)

maureen stevens said:
Toni,

Restricted sodium intake can cause problems also. Restricted sodium intake can interfere with adequate maternal blood volume increase. Recommended amounts are 1.5 to 2.3 g/day.
Sounds to me like you corrected the problem yourself and went on to have the birth experience you desired. What an empowered woman you are. By the way; your baby is beautiful.
Listen to your Mommy gut and get your second opinions...I am so glad you listened to yourself. Not all midwives are the same...
thank you :)

Hannah Ellis said:
Listen to your Mommy gut and get your second opinions...I am so glad you listened to yourself. Not all midwives are the same...
Amniotic fluid is constantly being replaced. I can't remember the exact figure, but I think it's about every hour that the whole amount of fluid has been replaced. Drinking adequate water is essential because of this, as it provides the replacement fluid. I wouldn't have thought of salt intake affecting it as well, but it makes sense. It sounds like you did an exceptional job of listening to your body and doing what was needed to remedy the situation.
Oh wow, I'm so glad someone else went through this! My midwife (who I love and trust) did the same thing to me. She said the amniotic fluid was too low, and I would have to go to the hospital and be induced, etc, etc...This was my second baby, and like you, I was very, very upset about going to the hospital. I had a wonderful homebirth with my first, and I wanted the same experience, thank you very much! So I went to the hospital, doctor did an ultrasound, said it was at a 2, and that he would give me 2 days to get it up, or else I would be induced and probably c-section. (To his credit, the OBGYN was very blunt, and honest- he knew the outcome of inducing was usually surgery.) I then went back to my midwife and told her and all the other midwives there that I was NOT going to have this baby at the hospital, and what could I do? They told me to eat tons of goji berries, drink lots of water, and take baths, and stay lying down for the next two days! Then I went to our naturopath, and asked for her advice, and she said that pear juice, of all things, is the closest in nature to mimicking amniotic fluid. She said to do all the stuff the midwives said, and add tons of pear juice instead of the water. I did all of the above. My husband thought I was crazy :), but I was determined to be in charge of our fate- the baby's life and my life. The next ultrasound showed 10.2, and the doctor didn't believe it. He said he'd already scheduled me in at the hospital! He had never seen a mom be able to control the amniotic fluid. I told him what I did, and how I followed the exact directions of these smart women, and he still said he didn't believe in natural quackery. Wow, thanks. But it is also interesting to read how you got the amniotic fluid up! The naturopath said that water usually isn't enough to help, as we pregnant women are already drinking tons of it. Ramen, gatorade, and other salty things....I would not have known to do that. How did you figure it out? I'm so glad you still got your gentle birth, but yes, I understand the panic at the situation! No mother wants to be told she can't go with her midwife of choice, and must go to the hospital. Scary.
Thank you for sharing! I am also glad to hear SOMEONE, ANYONE had a similar experience as me! I am happy those things worked for you, and that your midwives had some ideas. And pear juice?! Really?! My midwives only suggestion was the Natrum muriaticum. My father was actually the one that said something to me about salt, that sodium could help me retain fluids because he knew I was drinking a TON of water and just peeing it all out! He said something to my midwives about Epsom salt baths, and they thought it sounded like a good idea. We just took it one step further with the Gatorade and ramen. It still makes me upset when I look back on all I had to do to get my natural birth, but in the end it was totally worth it. I hope you feel the same about yours, did you get your 2nd homebirth?? xo
Yes, it was another great experience, and I loved having both births in a calm environment where I wasn't pressured. Now my sister has just had her very first homebirth! She was so excited to be out of the hospitals and doing things her way- this was her third baby, and first natural birth! Isn't life great? So glad your father thought of something to help you- I know, it IS worth it. Congrats on your natural birth, and sticking to your guns. :)

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