Conversations about Amniotic Fluid

“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.

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6 thoughts on “Conversations about Amniotic Fluid

  1. “Make more, baby!” I can so totally relate. Though I would’ve felt better even with only 1.2cm show in the ultrasound. Our ultrasound AFI had been 0 since 20 weeks until I delivered Baby Rheice at 38 weeks. The words amniotic fluid & anhydramnios totally changed our lives forever.

    • Interesting fact: when I was filling out my disability paperwork they needed an ICD-9 code (a diagnosis code) for why I was out. At the time I too had anhydramnios (I ranged from 0-2 at the most). When I searched for an anhydramnios code nothing came up, so I used the one for oligohydramnios. It’s like the condition didnt even exist! Is it so rare to have no fluid?? It can’t be because I have seen it on others and myself! It’s a thought I’ve been mulling over…

      also Rheice is such a beautiful name!

      • Everytime I talk to people about our condition on the amniotic fluid, they say that it’s just not possible! They have never heard about it. How can the fetus inside be without fluid?? Well I guess I would’ve said the same thing, before we were diagnosed last January, before I have spent hours reading about it when a lot of links/blogs/sites/forums surfaced upon typing “anhydramnios” in google search.
        I actually felt comforted to know that it’s not that rare after all, that I am not alone.
        So let me just say THANK YOU Meghan for writing your blog. A lot of times while I’m reading, I’m like “yes, my thoughts exactly!” or “I know right!” .I totally relate to you in a lot lot of ways. And by the way, purple’s my favorite color too!

        Thank you for the kind words about Rheice. Well you know I feel the same way about your baby’s name. ^_^

      • Thank you Mabel! I get a little drop in my stomach, a surge in my chest writing that. And seeing something in my inbox that says “from Mabel.” It’s just so amazing. Thank you for reading and making yourself known. It’s like I’m hearing from my daughter.

      • Yes! I know what you mean about people saying it’s “not possible” for there to not be fluid. I give other mothers a break who have never had a scary day in their pregnancies (how lucky), but I was furious at a nurse who told me I didn’t know what I was talking about when I told her we didn’t know the baby’s gender because it was hard to see ANYTHING without fluid (she had been saying, “What kind of a parent doesn’t want to know their unborn child’s gender??” and “We didn’t want to know,” just wasn’t enough for her). You’re right–it isn’t AS rare as folks think it is. It’s not like the three of us are the only ones in the world who have ever seen this. 😛

      • That’s one of the parts that makes me ache especially- those who don’t get the chance (if they want) to know their child’s gender. People are unbelievably opinionated. We didnt know with Mabel (we chose not to know) and people would sometimes give us a little pushback. But knowing the child’s gender is a privilege and also in most cases medically unimportant. patients all the time ask me when they get their gender ultrasound and I tell them they get an anatomy ultrasound at 20 weeks- it’s looking at all the baby’s body parts and happen to look at gender if desired. One couple was giving me a hard time at 14 weeks that they had to wait that long, because you know, they have family who want to buy things and they really need to make a registry. I wanted to scream at them! really? really?

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