Overdue babies and the AFI.

Statistically speaking, first babies are generally late. Usually by about a week. Also, statistically speaking, the placenta stops functioning at full capacity around 42 weeks, so midwives and OBs all agree that babies should be born not much later than 42 weeks to decrease the risk of serious complications and stillbirths. Totally reasonable and supported by fact.

A common diagnostic in pregnancy is the amniotic fluid index (AFI). I've mentioned this before, but the AFI is crap. I have very strong feelings about the AFI, as I'm sure you can tell. At best, it's wildly inaccurate. The ultrasound tech is trying to estimate how much amniotic fluid is present in the womb. Basically, they are trying to measure fluid volume in an irregular space that is mostly taken up by a body of unknown mass when they can't see the entire space. It's ridiculous. I mostly feel like it's yet another tool designed to scare women into unnecessary medical interventions. And two different techs will give you two different numbers. You can even ask the same tech to re-measure and get a different number! So why on earth are we using this?

More importantly, why on earth are the midwives requesting that I (and anyone else who is overdue) get an AFI check at 41 weeks?? I intended to have one ultrasound during my pregnancy. One. The 20 week anatomy scan to find out gender and make sure there was nothing funky going on to disqualify me from an out-of-hospital birth. I have had three. Unless there is an extremely compelling reason to have a fourth, I am refusing the 41 week AFI. The only reason I could see doing it is if the midwives told me they would transfer me to the hospital for the birth without it. And even then I'd probably refuse because I won't be bullied into something I know is, at best, unhelpful.

After a discussion with one of the midwives today, it seems that the reason they request the 41 week AFI is mainly to placate the doctors they have as back up for their practice. They request this essentially meaningless diagnostic so that they can maintain relationships with doctors for emergency cases. I guess I understand that logic. I mean, midwives are balancing on a very precarious edge with the way hospitals and doctors and insurance companies have overtaken the healthcare system and model of care for childbirth. But given that no one could given me a compelling reason to get it done, I'm refusing. This is informed consent. They want me to have an AFI done for unnecessary and irrelevant reasons, I know what the AFI is capable of and what it isn't capable of, and I'm not overdue yet. So until such time as new information becomes available, I'm going to pass.

I wish more women felt empowered to take control of their healthcare...