What Does Low Amniotic Fluid Really Mean?

Wednesday, July 29, 2020

What Does Low Amniotic Fluid Really Mean?

Recently a client brought up low amniotic fluid concerns after a prenatal appointment. After a deep dive into this with them, we thought we'd circle back to our community here and chat low amniotic fluid (Otherwise known as: Oligohydramnios) and inductions. The standard practice in the U.S is to jump to induction if a full term mother experiencing an otherwise normal pregnancy is reported to have low amniotic fluid. You know we are all about the facts here, so let's dig in.

Is low amniotic fluid a valid reason for induction?

'A recent review of the literature (Rossi & Prefumo 2013) found that in term or post-term pregnancies oligohydramnios (with an otherwise healthy pregnancy/baby) was not associated with poor outcomes. However, it was associated with increased risk of obstetric interventions… probably because the diagnosis leads to intervention.' Check out the evidence on Low Amniotic Fluid and why inducing for this reason may not be the best answer when it’s used as a “blanket statement” solution. For example, "There is a lack of evidence supporting induction for oligohydramnios in ‘low risk’ pregnancies ie. when there is nothing else ‘abnormal’ going on with mother or baby (QuiƱones et al 2012). Driggers et al. (2004) concluded that: “evidence is accumulating that in the presence of an appropriate-for-gestational age fetus, with reassuring fetal well-being and the absence of maternal disease, oligohydramnios is not associated with an increased incidence of adverse perinatal outcome.’’

So quick recap, even if you are one of the rare true cases of low amniotic fluid, (see below for how accurate fluid testing can be!)  there is no current evidence that low amniotic fluid at full term in an otherwise normal pregnancy shows poor outcomes for the mother or infant.  However, the use of inductions for low amniotic fluids alone does show an increased risk for a Cesarean section for the mother.  You need to make sure you are keeping the lines of communication open with your provider if you are diagnosed with low amniotic fluid in your prenatal care. 

( Also, here is a bit of information showing that inducing for due dates actually usually causes more harm than good if there is not a solid, medically founded reason for it. )

What can cause low amniotic fluids?

There are factors such as dehydration, broken waters, placental complications, past due pregnancies, medications, infant health conditions, the fetus swallows more of the fluid as the pregnancy progresses, etc. which can impact fluid levels. As well, you should remember that your fluid levels fluctuate throughout the day normally, so a report of low fluid levels can sometimes be addressed by increasing water intake.

How do they test your fluids?

You want to ensure they are using the "deepest vertical pocket" method to measure fluid, and not the outdated "amniotic fluid index," which is a 1-25 scale and what is typically used. ACOG no longer endorses the AFI, instead it endorses the DVP method because it reduces unnecessary intervention without additional risk to the baby. It is important to remember as well that testing used to measure your amniotic fluid catches only 10% of all cases of true low amniotic fluid accurately (Gilbert 2012). Low fluids can be a sign that something is wrong with the mother, the placenta or with the baby genetically, but it can also be dehydration or normal fluid fluctuation throughout the day. To increase the accuracy of your results, try to drink two liters of water before your appointment to keep your fluid levels up and lay on your left side during or before the testing to get the deepest measure.

The Final Word

You are responsible for you birth. You are responsible for planning and educating yourself. You are responsible for speaking up and using your voice. You are responsible for keeping the line of communication open with your provider when it counts.  Make sure you are making informed decisions about your care. 

You can do this. 

If you are concerned about having an unwanted c-section or being feared into decisions that are not based in evidence and science, let us help! Join The Birth Lounge to have an informed and confident birth experience, push for less than one hour, and avoid a c-section!


Post written by Kristin, TBH Team Member & Doula

Delayed Cord Clamping & Jaundice

Wednesday, July 15, 2020

Delayed Cord Clamping

Delayed Cord Clamping is a hot topic in the birth world! It is something that almost every client wants to have pretty lengthy conversations about. Per usual, when I research this for clients, I went a little overboard! I’m going to share what you need to know about one of the biggest questions about delayed cord clamping: does it cause jaundice?

Delayed Cord Clamping has been shown to increase iron stores in newborns, increase red blood cells, and it gives your placenta enough time to drain which returns 30% of your baby’s blood back to them. ACOG and The World Health Organization recognize delayed cord clamping as positive! 

I want you to have all the information so you can make whatever choice feels most aligned to you should you find yourself facing the questions of jaundice. The myth that delayed cord clamping causes jaundice is an antiquated belief and has since been strongly debunked. I wanted to give you the spectrum of research and resources for you to sift through on your own. Feel free to share these with your provider, too. I found a lot of information so here it is:

  • - Delayed cord clamping could cause "slight risk" according to this article. It also shares that it is incredibly beneficial for preterm babies and the increased Iron levels that I mentioned are supportive of developmental outcomes! 
  • "No association" between DCC and jaundice levels according to this article It’s important to note that this study had less than 500 participants. With that, it did produce strong results
  • - On the other side of the ‘delayed cord clamping causes jaundice’ argument is the delayed cord clamping "prevents neonatal jaundice" as seen in this article. The thought is that as the 30% of remaining blood in the placenta and cord return to the baby, so does the correct amount of vitamins, minerals, and other elements that prevent jaundice. 
  • Dr. Jack Newman I have been following him for 6 years (longer than I've been in birth work because I was the Lead Teacher of an infant program and most children were breastfed and/or bottle-fed breast milk. His research makes so much sense to me. He is Canadian so sometimes American Dr's may scoff at the research. It's yours to take in and just have in your toolbox once your baby gets here. He shares how the endocrine system of a newborn works. My Masters is in Human Development and Family Studies so it makes a lot of sense in that regard. I believe his work is much more nursing-parent led than many American approaches. 
  • - Infant "Intact Resuscitation" There's pretty strong research that I forgot to mention while we were on the topic of delay cord clamping and that is that there's a strong association between DCC and infants spontaneously resuscitating themselves if there are any breathing issues. This is especially important when we think about using narcotic medical pain relief. Your body is designed to resuscitate your baby's body. You can see the obvious push back in this study as doctors say they weren't able to reach for the right tools (would that be the case for anything else? That would probably be looked into, if so.) or they had poor access to the baby which I'm not sure what that means because they should be right behind/in front of you and the article didn't define that part. This push might be due to panic, or due to the doctors not truly trusting the natural process of intact resuscitation, or due to it not being widely taught in medical school! 

Know what the research says. Have discussions with your provider before birth. Put your preferences on a birth plan so all medical staff are aware. Hire a doula or assign your partner to double check whichever provider attends your birth is abiding by your wishes as long as it is safe. 

If you are looking for more resources and support in pregnancy - join us in The Birth Lounge to have an informed pregnancy and confident birth experience!

How to Pick the Best Baby Bath

Wednesday, July 8, 2020

How to Pick the Best Baby Bath 

There's a few things to know about bath time with children! First and foremost, babies don't like baths to begin with. Some do, but for the most part babies less than 8-12 weeks don't love bath time. With that being said, bath time plays a crucial role in your routines. First, it is an anchor. An "anchor" is a point in time of day or an action that happens at the same time each day. For example, when a child eats lunch, they come to learn and expect that nap time follows. If there is one parent in the house who returns home at a similar time each day, that will become an "anchor" for the children in the home and they will learn that this anchor means the day is coming to a close, dinner is next, and bedtime is soon. 

Bath time will serve this same purpose for your child. Not necessarily a newborn, but whether you take a full-blown bath every night or not, having your child's body safely submerged in warm water will do wonders for their sensory system and provide them with this anchor in their day. A warm bath is also the answer to a baby (older than 8 weeks) that won't stop crying. Usually, a warm bath will be a reset. With this in mind, you want to be mindful of two things:
  • - Growth Spurts: You want to make this a place that children can come to relax--especially because you will use the tub as a place of comfort for so many growth spurts (teething, gas, the first vomiting or diarrhea, when your baby can't/won't sleep because they are learning to crawl, the first ear infection, etc). This means making it a place that your baby doesn't feel overstimulated. Adults tend to give tiny humans a bazillion toys in the bath (which is okay if the bath is at a time of day that engaging their brain is the goal), but sometimes less is more. 
  • - Exploratory Play: The bath will be a place that as your baby grows, so does your time spent doing baths. With the right balance of safety and freedom to play, your cold can share with you their imagination, expressive and receptive language skills, and their ability to pick up on routines. The bath can be a place that you share intentional toys like colors and numbers or letters. Maybe you talk about shapes and sizes with various sizes of cups that, also, share cause and effect (pouring). You’ll be able to see associations that your child has picked up like swimming like a fish or spitting like a fountain! We’ve set the foundation for the bathtub to be a place of comfort and safety for them, now let them shine! Keeping safety in mind, this non-slip mat and this faucet cover are definitely two must-haves for any baby that is rolling over or mobile! 

Mold/Mildew

Most families we support never have any problem with mold or mildew growing on a baby tub. However, you aren't the first parent to question this! There's been a lot of success in using a vinegar (1/3), Water (2/3) and lemon juice (1 tablespoon) mix in a spray bottle. When you get done with the bath, you simply spray the tub with the mix and let it dry. If you're worried about the vinegar and lemon juice on your baby's skin, you can simply give it a once over with the shower head before filling up the baby tub! 

The Best Baby Tubs

I’ve narrowed it down to my top two picks (and a crowd favorite) plus why those are my top choices! You have a few options when it comes to bathtubs for your tiny human! If there’s one thing I have learned from working with hundreds of families over the last 10 years, it is that there is no one-size fits all in anything… and I mean nothing. When it comes to picking the right tub for your baby, there are so many options. We often get asked about 3 things when it comes to tubs and babies--preventing mold, making sure it can grow with your child, and storing that is easy/compact. While there are no “easy to store” baby baths, there are these handy hooks that you can hang in your shower so you can hang the baby bath. This allows the baby bath to drip dry, too, if wet fabric is really icky to you like it is to me! 

  • Summer Infant is a great brand! I like this one because it sort of grows with your child! It supports their development of sitting up, too! I really love that this one can go on the countertop (for a newborn) or directly in the bath. It can be easily hung with the hooks mentioned above.
  • - Next up is Angelcare. This is a super common one. It doesn't grow with your child, but it does allow them to sit up (once they are to that stage) which is nice! I love the minimalistic look of this one. It hangs beautifully with the hooks mentioned above, too. 
  • - We also have gotten great feedback about this foam flower bath that sits conveniently in your sink! We’ve also gotten the question, “How long will my baby be able to fit in it?” Parents report anywhere from 4-8 months, but I think 4-6 month is probably more realistic. Remember how I mentioned that your baby was going to want to be on the move--well, the sink won't be able to accommodate that very well. 

Head, Shoulders.. Knees & Elbows??

Something that folks never consider is where you will be giving this little baby a bath! For a newborn, on the kitchen counter or even in the kitchen sink is totally fine, but that won't last long because before you know it, your babe will be too big to fit! This means you will be moving to a bathroom in your home. With that, you are going to be spending a lot of time on the floor. As your baby grows, you will find yourself spending more and more time on bath time (remember the exploratory play). 

The more time you spend during bath time, the more your knees and elbows take the blow... literally. This bathtub knee pad can be super helpful! You can always use towels, too! This is Knees and Elbows in one

Finally, remember when I mentioned that your child will learn to love bath time? Well, this means you will need to provide them with a safe space to do all that exploration! Usually around 6-8 months we see children put up a fight to be able to move about in the tub. Your gut instinct is probably to stop this because we associate water with young infants as a danger.. but what if instead, you slowly gave your child more room to safely explore? I recommend getting an inflatable toddler tub that is cushy and you can control how much water (and how many toys) are in there with your baby. In order to be "ready" for a toddler tub, your child must be able to sit by themselves. A child should never be left unsupervised without water, but eventually, you'll be able to sit on the floor or the toilet and they won't need your hands-on assistance! Following that, they will start to explore the toddler tub.. but with time, they will start to ask to get out to have the freedom of the whole tub. If you want a quick, handy fix for this--a laundry basket works just as well, but requires you to fill the entire tub rather than just the toddler tub. For examples, google "babies in laundry basket bathtubs."

If you are worried about ensuring the water is a safe temperature, this bath thermometer is a quick and easy way to see just how hot the bath is before putting your baby in!

If you are looking for more resources and support surrounding diet and nutrition in pregnancy - join us in The Birth Lounge to have an informed pregnancy and confident birth experience!

Search This Blog

Powered by Blogger.
Theme Designed By Hello Manhattan
|

Your copyright

Copyright © 2019 - All Rights Reserved.