Water break- possible complications?

[heatherweh]

OK, so I've read many, many books now and even the more relaxed ones basically say once your water breaks head to the hospital or birth center. That's exactly what I did the first time around and it led to a "cascade of interventions".

My plan this time is to labor at home as long as possible, even if my water breaks, but that is my trusting my body to go into labor on its own after my water breaks. I wasn't even 37 weeks yet the first time around and ctx never did start on their own, they barely started after the cervadil.

I read that one of the big concerns is that sometimes when water breaks, particularly a gusher, that the cord can pop out and cut off the babies supply, or prolapsed cord. That got me a little bit worried. Is that something that I should be checked for right away in such a scenario? What do your midwives say (or how do you see that)? My cervix is generally far back, so I don't think its something I could check myself, unless I felt like something was lodged in the cervix.

I know they're concerned with risk of infection if the baby isn't delivered within 24 hours, but could that be negated by using antibiotics?

How long could one stay home and wait for labor to begin after one's water breaks before it became dangerous?

Again planning and hoping for the best but wanting to be prepared for anything else as well. I am not against asking my OBs this question as well, but afraid I will get the canned response of "If your water breaks report directly to the hospital". TIA!

[dogmom327]

My understanding is that prolapsed cord is extremely rare and even if you did head to the hospital immediately, it a bit more of an emergency situation than even that.

From what I've heard and read, the bag can actually reseal so if mom and baby aren't showing any signs of distress, there's no need to rush off. I've heard of people going a week or two without contractions and then labor started normally.

If this happens again, remember absolutely nothing anywhere near your vagina. Be extra vigilant after using the restroom, no sex and definitely no internal exams by you or anyone else. Monitor your temperature and your baby's movements. Drink tons of water.

[rhiandmoi]

There is a difference between a leak and a break. Leaks can seal up again. But a break is a break. Baby needs that fluid to prevent being compressed, not just the cord and placenta, but the baby too. So I would keep an eye on how much fluid comes out and then how long has it been. If you have a way to monitor fetal heart rate I would do that. Also anecdotally, I have heard that a dry labor hurts a lot more since the only thing to squeeze against is the baby and no cushiony amniotic fluid.

[wombatclay]

My water broke roughly a day before contractions began with dd1, and about 3 hours before contractions picked up with dd2. With dd1 I was attended by family practice drs and with dd2 I was attended by OBs.

Keep in mind that your body continues to produce amniotic fluid even after the bag breaks. If your water breaks, you're going to keep leaking uless your babe's head acts as a plug so having pads or towels on hand is a plus. So "dry labor" is a bit of a misleading term (though it's one you hear a lot )... it's more of a "moist drippy labor" and it's one reason I adored laboring in the tub... I didn't feel like a leaky faucet! (once the water breaks though it's harder for babe to rotate so a poorly positioned babe has less chance of shifting into a better position)

My instructions in both cases were to call my care provider to let them know what had happened, let them know if the fluid was clear/smelled ok, keep track of babe's movement and let them know if there was any change from normal, avoid any and all vaginal penetration, and keep track of my temp. If there were no contractions at all for 24 hours, a change in babe's movement, a sense of something "in my vagina", or a change in my temp, I was to go to the hospital for monitoring.

A prolapsed cord is a risk after the water breaks. It's rare, but serious, and your best bet in that situation would be to get in an inclined position (so gravity is pulling your babe towards your head) and call your care provider/an ambulance. But again, it's rare. Infection is a bigger risk and one reason why there is a "no penetration" rule and a "watch your temp" rule too. My OB's policy with ruptured membranes was to head for the hospital after 24 hours if no contactions so that they could do blood work and fetal checks to make sure there was no infection. The longest they attended a mama with ruptured membranes was a whole week... she stayed at the hospital but they waited for labor to start on it's own since there was no infection/change in babe's health.

Anyway, it would be worth discussing this with your care provider. It may not be an issue (tv shows to the contrary, the majority of women start contractions before their water breaks... mamas like me are the minority), but let them know you want options instead of a blanket "go to hospital" guideline.

Happy birthing!

[heatherweh]

Thanks for the replies. The first time around it was a pop and gush and the water kept gushing. I was leaky all day. I'll definitely bring it up to my OB next time I come in then to see what he thinks and explain that I want to avoid induction this time even if my water does break like that again. But like you said, each baby is different, so it might be totally different this time and break only once I'm well into labor.

[boscopup]

Sometimes it can take a while to start labor after your water breaks. Midwives will often let you go a lot longer, as long as you keep good hygiene (including no cervical exams!) and watch your temp and such.

My water broke at 29 weeks with #1, and contractions didn't start until 11 hours later. The hospital stopped them and kept me pregnant 4 more days, although they did give me abx because when water breaks that early, it could be caused by infection. They couldn't find any infection though, so we have no clue why it broke. When they took me off the anti-ctx drugs, they said "If you go, you go. If not, you could be here for weeks." So they were not in a hurry to induce me, but of course that was based on how early I was. If I'd been 36 weeks, I'm sure they would have wanted to induce.

Second pregnancy, I started labor before my water broke, although I may have had a small leak for several weeks before that. I'd kind of suspected it based on some discharge, and I'd alerted both my midwife and OB. Neither was concerned at the description of my discharge, even knowing my prior history, and no one tested it. So we'll never know. My water broke halfway through labor, but it was a smaller amount than with #1, to the point that I wasn't entirely sure that it had broken. It was only after the birth when the apprentice who caught my baby said there was no fluid with the baby - my water had broken earlier. And then I remembered that slight gush while on the toilet.

Anyway, it may not happen again for you. Even after my preemie birth, my OB said it was unlikely to happen again. There *was* an increase in the chance, but it wasn't enough for him to treat me differently than any other pregnancy. I was never labeled high risk or anything.

[Devaskyla]

I read that one of the big concerns is that sometimes when water breaks, particularly a gusher, that the cord can pop out and cut off the babies supply, or prolapsed cord. That got me a little bit worried. Is that something that I should be checked for right away in such a scenario? What do your midwives say (or how do you see that)? My cervix is generally far back, so I don't think its something I could check myself, unless I felt like something was lodged in the cervix.

I know they're concerned with risk of infection if the baby isn't delivered within 24 hours, but could that be negated by using antibiotics?

How long could one stay home and wait for labor to begin after one's water breaks before it became dangerous?

I did a lot of reading on this subject before ds1. Not even , as it turns out. I got cut for hospital time limits after my water broke & labour didn't start in their time frame.

I did a lot more reading before ds2 was born. My water broke 88 hours before contractions started with him.

First of all, cord prolapse is only a worry if the baby is not engaged when your water breaks. If the head is engaged, the cord can't come down. If it does prolapse, it's extremely likely it would come out a lot further than just your cervix, possibly even so it could be seen outside your vagina. If your water breaks & baby isn't engaged, you should definitely do a quick check for the cord. If possible, just get your partner to look & try to keep anything out of you.

You don't need antibiotics to avoid infection, you just need to keep everything out of your vagina. It dramatically reduces the chances, to almost 0. The only exception is if your water broke *because* you have an infection. That's more likely if it's very premature, but it does occasionally happen in term babies as well. You can also reduce your chances of infection by taking vitamin C and/or echinacea every couple hours until labour starts. Gloria Lemay reccomends no underwear or pads, just a clean towel under you to catch the water. When it gets wet, get another one. Monitor your temperature regularly, too. If it starts going up, you may have developed an infection.

So long as you are staying hydrated and showing no signs of infection, it's safe to stay home as long as it takes for labour to start. The amniotic fluid will replenish itself as you're long as you're drinking lots. As I said, it was over 3 days until mine started with ds2. I know of other women who've waited even longer. I read at least one story of a woman who finally went into labour 21 days after her water broke. *Most* of the time labour will start a lot sooner than that. I can't remember the exact number, but I think about 75% start within 24 hours & 90% within 3 days.

[rhiandmoi]

Just a small reminder that amniotic fluid is produced by the baby, not the mother.