Induction Question

[ck1]

Say your water breaks but you don't start contractions: how long can you wait until you need to be induced? 24 hours because of infection?

Say you start contractions but your water doesn't break: should you let them break your water or wait it out? (It's got to break on it's own as the baby comes out - right / wrong?) Does it make it more difficult for the baby if the water hasn't broken? Or diffiuclt for you?

Personally I'd prefer to wait as long as I can because I don't want to be induced. I also do not want my water broken by outside interventions. But I'm unsure about what the real medical necessity is if everything is okay (no medical complications). I realize every birth is different, so just trying to figure out options just in case.

Thanks!

[belltree]

Most US hospitals have 24hr policy. The hospitals in my home country have a 36hr policy. I have heard of a woman who went 5 days and she gave birth to a healthy boy, another one waited 3 days and the baby ended up in the NICU, because an infection.

If you wait, don't put anything in your vagina (not your finger's not anyone elses), you shouldn't take a bath either. Also, measure your temperature regulary. Keep yourself very well hydrated.

[MamaMonica]

Moved to Birth and Beyond.

[cristeen]

Well, the 24 hour rule is pretty common in most medical communities in the US. BUT if you keep EVERYTHING out of your vagina (this includes your caregiver's fingers), stay out of the hospital, and monitor for fever, then 24 hours is just another "rule".

If contractions start and water doesn't break, usually you don't want to break it artificially unless you KNOW the baby is engaged in the pelvis. The waters provide the baby with the ability to more easily rotate into a proper position. And breaking the waters before the baby is engaged risks cord prolapse as well as serious malpositioning. The baby can actually be delivered in the caul (with the bag intact), but some moms find that once they're complete and ready to push the bag may actually be making things more difficult and they choose to break it themselves when it starts bulging (with their fingernails).

[kcparker]

A caregiver may want to rupture your membranes to 'get things moving'. If the baby is really high, breaking the waters can be not such a great idea because the cord can come down ahead of the baby, creating a true emergency. If the baby is low, but not putting a lot of pressure on the cervix, sometimes caregivers will want to break the water to get the baby to come down more and hopefully apply more pressure to the cervix. However, the baby can also come down asynclitic and not apply the hoped-for pressure evenly, and then it has a harder time rotating because its head more deeply engaged in the pelvis.

If the membranes are intact, the bag of waters provides a nice cushion for both you and the baby during contractions, tending to make them less painful and helping the baby ride them out with less stress. They protect the baby from infection, and they will break on their own in most cases anyway. If the baby is born in the caul, folk wisdom holds that it's considered a sign that the baby will have psychic powers.

[catballou24]

with my firstborn (ds 22 years ago), they broke my water at 2cm's...: i honestly didn't know any better and really wish they hadn't done that, but the birth was fine and pretty much uneventful (he was posterior so back labor was bad). he was born less than 24 hours afterwards. with dd1 we had a homebirth and so didn't break my water. it actually didn't break until she was almost completely born (we had a waterbirth and she came completely out in one push), and she had the entire sac around her still (born in the caul). second dd was bigger and same thing happened, except she was posterior like my first. pain was just as bad with her as with my son.. ...neither of the girls' births were affected any differently for me from my first where my water was broken. i don't know if that helps you at all, but that is my experience...

[jecombs]

[QUOTE]

Originally Posted by ck1

Say your water breaks but you don't start contractions: how long can you wait until you need to be induced? 24 hours because of infection?

As most folks have said, 24 hrs is an arbitrary number that most hospitals use. Many MWs will let you go a little longer than this, like 36 hrs. The risk of infection increases every time something goes into the vagina, so avoiding all VEs is very important.

Say you start contractions but your water doesn't break: should you let them break your water or wait it out? (It's got to break on it's own as the baby comes out - right / wrong?) Does it make it more difficult for the baby if the water hasn't broken? Or diffiuclt for you?

I labored to 9cm before I asked my MW to break my bag. I now regret asking her to do it, because my DD was facing the wrong way (sunny-side up) and keeping the bag intact may have allowed her to turn to the proper way. As it was I pushed for 3 hrs and had a really hard time moving her past my pelvis because of her position and nuchal hand. The only reason I asked the MW to break the bag was because I had been in transition for over 2 hrs and I wanted my labor to move along, so I could push the baby out and have a rest.

Personally I'd prefer to wait as long as I can because I don't want to be induced. I also do not want my water broken by outside interventions. But I'm unsure about what the real medical necessity is if everything is okay (no medical complications). I realize every birth is different, so just trying to figure out options just in case.

The only reason to break the bag is to help move labor along a little quicker. But if you and baby are doing fine and tolerating labor well, there is really no reason to break the bag (other than your doc being in a hurry to get home). As others have said, breaking the bag can actually make it more difficult for the baby to tolerate the contractions.

[boysmom2]

The 24 hour rule is pretty common, but I've known people to just ignore it. A friend of mine just lied and said it broke on her way into the hospital, rather than several hours before to buy herself more time. One friend of mine had her water break before the onset of labor with all 3 of her kids. The 2nd and 3rd broke almost a week before they were born. She was just careful not to contaminate herself, ate and drank well, and monitored herself for fever. Everything was fine. When my mom was pregnant with my sister, she started leaking at 36 weeks. They tried to induce her, but nothing happened, so they sent her home! Can you imagine that happening now? She didn't deliver until almost 40 weeks. Also fine.

I know I've read that the risk of infection after 24 hours is much greater if your water breaks before you're full term. This has been extrapolated to all babies, even though it's not the same for full term babies. I think I read it in Henci Goer's Obstectric Myths Vs. Research Realities, but I'm not sure. Someone else probably can give you better specifics.

As for your water not breaking, I agree with all the pp. It's better to leave it alone. It will probably break in it's own at some point, and if it doesn't, it can be broken after the baby comes out. I'm all for not messing with stuff!

[mamabutterfly]

For spontaneous ROM, my birth center "gave" 72 hours before artificial induction/transfer to hospital. But during that time they ask moms to monitor their own temperature at home (watching for sign of fever), and by the second 24 hours will often suggest gentle natural measures to stimulate contractions. (After 48 hours they suggest castor oil, I think many people do that by 24 hours).

[mamabutterfly]

Oh, also in the above scenario they do monitor the baby (NST) once per day.

In general around here I found as a doula that most hospitals induced right away or 12 hours, the birth centers give 24-72 hours, and the homebirth midwives monitor and let nature take it's course if there is no risk factors/signs of infection.
I've read that after SROM 70% of moms are in labor by 24 hours if left alone, 90% by 48 hours if left alone.

I was in that 2nd camp with dd1. Had ctx after ~ 30 hours, she was born on the third day after my water broke. We were both perfectly fine. Had I been in a hospital setting, definately would have been induced.

[guestmama9916]

I've been induced twice for pre-e. My first induction my water broke spontaneously but I still had a long ways to go because baby was really high and my body wasn't ready. I ended up with a forceps delivery due to maternal exhaustion after 16 hrs of labor (nothing to eat or drink) and 3 hrs of pushing. Not a good experience but one I learned from.

My second induction went alot better even though I was only 35 weeks and again my body was not ready. I held the OB off about breaking my water that morning but when I wasn't making any progress by that afternoon, I let him do it. My baby was born very soon after that - within 2 hrs. So I feel like in my case it was a good thing to have it done.

[wombatclay]

My water broke roughly a day before contractions began with my first babe. Turns out she was malpositioned (which can lead to pSROM and no contractions). Although that birth ended in a c/s, my family practice providers and the hospital had no problems with my situation, didn't request EFM, and were ok with me in the tub. They did have the "hands off" rule and had me monitor my temp hourly.

With my vbac it wasn't an issue, but I asked my OB about it and it turned out they'd actually done research on PROMs as part of their degree work. They had no problem with mom monitoring her temps at home for the first 24 hours as long as the babe was moving well, after 24 hours they wanted mama in the hospital so they could monitor white blood cell levels, temp, and blood pressure while also monitoring the babe's heart tones every few hours. But they wouldn't induce just because the membranes were ruptured! A fellow vbac mama at their practice had sPROM and spent 4-5 days at the hospital (she called it her mini-vacation ) before her babe arrived.

In terms of breaking the membranes during labor... as pp mentioned there is the risk that this will compromise the babe, and it generally puts you on a "clock". However, it can speed up the birth since the babe is pushing more firmly/directly on the cervix and this can speed dilation. It's probably one of the most invasive induction/augmentation options on the "natural" induction/augmentation list but it can be a good thing in some births. Like everything, there are pros and cons. I've always wanted a babe born "in the caul" but so far no luck!