Consultant wants to take baby out now (32 weeks), I disagree, 2md opinion question.

[EBenes]

A few weeks ago I was told I had low but within normal limits amniotic fluid and low abdominal circumference (just below 3rd centile) and they wanted to monitor both but were chiefly worried about the latter.

Today, my baby is 13th centile AC, and my amniotic fluid has fallen since last week, so is now very low. My consultant thinks it may be time to take the baby out. But he didn't even talk to me about the AC, I had to ask. Doppler, heart and movements are all normal.

My first baby was quite small (5.5lbs at 38 weeks) and I was monitored constantly for amniotic fluids (always low) and size, but they let her go to 38 weeks, which was considered full term, and only scheduled her then because it suited the consultant.

I feel like this is a retread of that pregnancy. My baby has grown tons in the last 2 weeks, they're no longer looking at her growth the same way, the amniotic fluid has been literally within normal limits, though worth monitoring, before today, and everything else seems normal. I feel like they're going to risk her life over one scan. But because the consultant is going on holiday next week, he's doing the follow up scan in just 2 days, which I don't think is enough to see a change with. I'm just terrified and broken-hearted. I don't doubt that he's doing what he thinks is right and that he has great reasons for this, but I think another doctor would take the course I had with my first baby, who is perfect.

I only have two days now, I was told to bring an overnight bag. I don't know how to get another opinion, and am scared that if I do, my consultant will be insulted and angry. I just want to be sure, it's my baby, I am pregnant therefore I am slightly crazy.

Has anyone sought a second opinion? Has anyone had a premature birth because of low amniotic fluid? I wish I knew what to do.

poor you being in this situation.
i have had no experience of premature birth or low amniotic fluid.
it must be so scary thinking of having your baby come into this world alot early than you were expecting!!.
the consultant is only doing what is best for your baby.
good luck with scan on friday hope that it all works out for you.
make sure that you ask the consultant everything that is concerning and worrying you as like you said this is your baby

Aitch had a premmie about a month ago because of low aminiotic fluid (and pre-eclampsia).

Thing is I would say that if there has been a trend of reducing aminotic fluid over the last few weeks, even if it has been within normal - but reducing (your post isn't explicit) I doubt it is going to suddenly start increasing.

Any time a medical person wants to do something, ask them 'What would happen if we do nothing?'
(there is a list of questions but i can only remember this one!, something like what are the risks? what are the alternatives?etc.)

If you agree to go in for regular monitoring/scanning would that help?

Don't let your manners get in the way of asking for a second opinion! Though I don't know how to get one sorry!

And sympathies for being put in this situation, make sure you explain that DC1 was a small but healthy baby.

Good luck!

Ring your GP now and ask for an urgent appt (burst into tears if you have to, doesn't sound like it would take much). Tell them the same, and ask them to refer you for an urgent second opinion. It is your right to do this. For courtesy, you could ring the original consultant's secretary (via hospital switchboard if you don't have the number) know that you are doing this. If the secretary sounds at all sympathetic, make it easy on your GP by asking her if any other consultant might be able to squeeze you in in the next 36 hours for a consultation.

Very best of luck.

Sorry, I think there are some bits missing from that. Basically, your GP should ideally refer you to a consultant for a 2nd opinion, but things would be a lot faster if you can give your GP a name of a consultant who is standing by for the referral letter. (Get the fax number for the 2nd opinion consultant from the original consultant's secretary).

To find all the Obs consultants at your hospital, google your original consultant's name with Obstetrics and the hospital name. You should eventually find a list.

Can your DH/DP help with demanding a second opinion? I'm suggesting that because I know it's really difficult to stand up to the medical profession when you are feeling so vulnerable.

Only experience I have of this is that I was over 40 during my last pregnancy and after 38 weeks was monitored 3 times a week to check amniotic fluid levels. Can you say that you are happy to be monitored as often as the hospital thinks necessary and that if levels fall further then obviously you will want the baby out as quickly as possible?

you have the right to ask for a second opinion - don't be worried about upsetting the consultant, this is his job and it's your baby's health, so that comes first.

if you feel like you're being pushed into an early birth to suit their schedules, then ask for a second opinion, and as JustKeepSwimming says, ask them what the alternatives are and what the risks are.

they can only advise you, they can't force you into doing anything you don't want to.

ring the hospital, say you want a second opinion, explain that you have nothing against your consultant but that this is a very difficult decision and you would feel more comfortable if you had more than one opinion to go on. that's an entirely reasonable request.

good luck!

I would want to ask the consultant: is this the action he would take if he WASN'T going on holiday next week? i.e. how far is this about medical need, and how far about him tidying up before he goes off?

I had low fluid with DD1, all gowth scans showed normal but only born 37 weeks 5lb! She was a CS. I would strongly suggest you ask if your waters are just low or to low. There is a measurement that means it baby has to come.
There should be another consultant @ hospital, ask to talk to him/her. also agree you should ask what would happen if you did nothing. hugs

I had a 32 weeker because my waters had gone a couple of weeks before, I know it isnt the same as your situation though but dd did spend 2 weeks with very little water.

To be honest with you i would never agree to get a baby out unless it was 100% necersary, certainly not to fit in with a consultants holiday plans.

Have you had the steroids ?

For what its worth, although it was a pretty unpleasent experience for me and DF Our Daughter is 3 now and you'd never know. She was 4lb8oz when she was born and although she was bruised and squashed from having no water she was fine. She had to spend a month in scbu though.

I hope you manage to work out what is right for you

Sarah

Oh, thanks so much for all the replies. Now I've been home a bit I do think my reaction was probably fairly nuts, it's not like an NHS consultant wants to use a scbu that doesn't need to be used, and the fact that he wants to see me rather than have me see a colleague indicates that he wants continuity of care, which is a precautionary thing rather than a lazy thing. So I feel a bit bad. But like a lot of consultants he has a slight people-skills issue, and I think it's up to me to start asking a lot of the questions you've suggested. I was a bit gobsmacked and dh asked things, but he didn't seem to answer them - he was asking about weighing up the risks and what was the deciding factor, and consultant just said, 'yes, you weigh up the risks, that's right'.

Have spoken to GP, she thinks there's no way I can get an appointment in a few days, but is making a call for me.

It's just that my baby did such a massive growth spurt in the last 2 weeks, and they'd told me they were worried about growth, and I just feel like, she did it! Let her stay! She's happy there!

My waters started leaking early on in my last pregnancy from then on I bordered between oligohydramnios and being ok. I was advised that you can help your waters increase by upping your fluid intake though its not a cure all. They should also advice bedrest for the babys urine volume as well as the fact the baby will have no cushion.
Good luck getting a second opinion and I think you're wise to seek one.

With Daniel, when we wanted a second opinion, we just rang up the Fetal Medicine Centre in london and had a very quick appt schduled to see Prof Nikolaides & to get scan. It was expensive but worth it.

HTH

32 weeks is a "good" age for a premature baby, a healthy baby will just need to fatten and be feeding before they went home (I think Aitch's baby wasn't much older and stayed in one night) if they are planning to get the baby out soon they will give you between a day or two and a week so that they can get steroids to the baby. Even without steroids Tink was breathing for herself at 31 weeks and was only in for 24 days.

Ask the questions about the risks of either, get him to make two lists if you need to. What will happen if you do nothing. They can't force you to have the baby early and if they want your consent they will have to convince you.

Different situation but with DS2 I was told from 26weeks that I had a low placental blood flow and as such was at high risk of pre-eclampsia and IUGR. There were plans being pushed on me for a CS at 38weeks. I held out and had the CS at 41weeks. DS2 was perfectly fine and weighed 10lb 3oz so either no weigh problem or he was meant to be born a toddler
I'm not suggesting that you wait til 41 weeks but just telling a story that shows sometimes they err too much on the side of caution. Ask for daily scans and monitoring of the baby until you get a second opinion so you cn see how the baby is coping and make sure you get that second opinion.
On the other hand, I had DD at 32 weeks, she was in hospital for a month as a result of a pneumothorax, but she is fine now, so try not to worry too much if the baby has to come now.
You say a cons doesn't want a baby in SCBU, but they do, IME go for the most careful option, they want a dead or poorly baby much less and can sometimes jump in too soon.
Good luck

The acronym I remember from NCT classes was "BRAIN". You need to know:

What are the Benefits?
What are the Risks?
What are the Alternatives?
What does your Intuition say?
What happens if you do Nothing?

Keep asking the questions until you're happy you understand where they're coming from.

Otherwise nothing useful to add other than some positive thoughts.

Actually - having been thinking about this the consultant would not choose to cs at 32 weeks for the sake of his holiday.

No doctor would make this decision for any other reason than medical need. Whilst 32wks is a good age for baby - there are obviously risks.

Not only that - but I have heard that every day a baby is in SCBU it costs the NHS a 5 figure sum.

There would only be 1 reason to have a cs at 32 weeks. The medical benefits outway the medical risks.

I know nothing but my instinct is a baby should not be delivered this premature because the consultant is going on holiday,

all i can tell you is what happened to me, which is that i had high bp and occasional protein in urine so was being monitored for pre-eclampsia. thank god i was being scanned regularly, as at 33+3 they told me the baby hadn't grown in a fortnight. they got my bp under control, but by 33+6 my amnio had all but disappeared, having been well withing normal on the scan three days previously.

what they said to me was that amnio disappearing fast indicated the end game, and they should get the baby out that afternoon. it was frightening, but i'm glad they did as my doctor told me that when they saw my placenta they reckoned it didn't have a couple of days left to go. so for me, amnio was a final straw, which is different i appreciate.

thing is, dd2 (4lb1oz) was fortunate in having been under stress for the previous fortnight (much as i panicked that it would mean bad things) as apparently when these last things start to topple the body (which isn't counting the weeks, just feeling things like amnio, placenta etc) prepares the baby for coming out so they are stronger than if you just went into labour and pop!

have you had your steroids yet?

it's so awful, all this, losing those final weeks, losing being pregnant, frightening everyone including yourself, but in my case it was all fine, much worse in the anticipation than the final result. as it was, in our case dd2 came out screaming (best noise in the world) and was only in SCBU for one night. i hope it's the same for you.

and re the second opinion. yes, of course, you should always ask for one. i do, it doesn't cause any offence at all (or if it does i'm past caring by that point ).

good luck.

Can you get a second opinion at Fetal Medicine Centre (in London)? You would have to pay for it of course.

Thanks, again, and thanks Aitch. I have low blood pressure and one of the reasons it feels wrong is that the baby has grown so much in two weeks, and started moving constantly, and because I had all the same concerns with my first, normal, pregnancy, I just instinctively want them to give it another chance. But you're right about the importance of amnio, too. Lovely to hear your dd did so well!

i think one of the reasons i was so cross was that i'd had a lot of the sam issues with dd1 and made it to 38 weeks, so i was pig headed that the same would happen with dd2, iykwim?

Yep. Good point.