“Can I ask you a clinical question?” She was a nurse practitioner and 30-something weeks pregnant.
“Sure.” We were done reviewing her labs, discussing childbirth education and listening to the baby.
“How much amniotic fluid is enough?”
I felt a jolt that made my heart beat faster and made me sit up straighter. Did she know? From 27 weeks onward, all I could think about was amniotic fluid. Make more, baby! I wanted my baby to have more than the 1.2cm they saw at that routine ultrasound.
No, she couldn’t know. She had just had an ultrasound the week before, maybe she was curious about her own fluid then.
“Well, it depends on the gestational age,” I said calmly. “At term we like it between 5 and 25. Amniotic fluid is very important. I know a few things about it.” I learned the hard way. I can tell you this: 1.2 is bad. Very bad. Babies need fluid to grow, to develop their lungs. When the fluid is too low, babies can die. Mine did. “Yours was 18, perfectly midrange.” What I would have done for 18!!
I was brought back to January, when I was still pregnant with Mabel. I had patient who had twins. She was due the day before me. The ultrasound in our office showed that her babies had low fluid at thirty-two weeks pregnant. “What happens if there is low fluid?” she had asked me. I told her how fluid is needed to help their lungs develop. The good news for her is that if this low fluid was real (we were going to get a specialist ultrasound to confirm), she was late in pregnancy and so the babies had had a fair amount of time to develop their lungs. The follow up ultrasound showed good fluid. It was a one-day fluke for her. She had her babies and they lived.
My patient in front of me today went on to explain that her cousin is pregnant, due within a few week of herself. They often compare notes, checking with each other to see who has what going on. Amniotic fluid had been part of that conversation.
I wanted to tell her everything I knew about fluid and why I knew so much. But that would have entailed the words “my baby died.” If someone asked, I would tell; however if no one asked, I would not volunteer the info. That kind of information should only enter the patient room if invited. Otherwise I feel like I’m saying Look at me! Look at me! My baby died! Nothing but awkwardness would follow. And the visit was not about me- it was about the patient. So I left Mabel out of it unless she was asked about.
She seemed satisfied with my answer. The dangers of oligohydramnios danced through my head, but never left my mouth. She left her appointment without ever knowing how much that simple clinical questions stirred me.