Question about laboring in water after ROM

[vegasgrl]

My cousin had an extremely managed hospital birth in April that solidified my desire to have a HB. There are more than a few things about her birth story that make me want to cry for her, but alas it's her birth story to tell not mine.

Anyhoo, she REALLY wanted to labor in water and is super jealous of the pool I'm getting - she had planned to labor in the birth tub at the hospital. Except they wouldn't let her get in the water because her water had broke, and "you're not allowed to labor in the water after your water breaks - you'll get an infection!!!!!!!"

I have a hard time responding to this around my family, as I plan to be in water the whole time, aminotic fluid or no. (Obviously if my mw saw a problem with it I'd get out.)

Is this a common hospital policy? If so, why?

If it's common, should I be worried about being in the pool after my water breaks? Why not?

(To clarify, I'm NOT worried about it, but I don't have facts either way as to WHY I'm not worried about it and I would like to arm myself with some info here to stifle the masses.)

[NamastePlatypus]

That is outdated advice, totaaly safe given laboor is progressing fine and baby is good!

[AzariaJordan]

The vagina is not a vacuum. It does not suck stuff up

Formally there have been heaps of studies done that have shown no increase risk with labouring in water after ROM. In ten yrs of homebirths (majority waterbirths) I have never once seen a problem.

[Belle]

Common hospital policy. No sound reason. She's much more likely to get an infection from the zillion VE's they want to do in hospitals.

With Dd1 I labored in water for a couple hours in the hospital with the caveat that if my water broke I needed to get out immediately.

For Dd2's homebirth. My water broke 36 hours before I even went into labor. No infection, I also didn't have any hands up there invading me and introducing infection. I got into the tub about a half hour before she was born.

[vegasgrl]

Originally Posted by Belle

She's much more likely to get an infection from the zillion VE's they want to do in hospitals.

The irony is that she DID get an infection, they think from the IV somehow. She swelled up like a freaking BALLOON and was in the hospital for five days trying to recover from the infection. : Poor thing pushed for 5 1/2 hours and tore something awful. The whole thing was a nightmare and just from what I've learned I can see how it all went down. Except for the water thing.

I guess I'm wondering where this policy came from then. I'll have to dig some more. I always just tell people "I'm really not sure why that's hospital policy; I've read hundreds of birth stories of women who labored in water after rupture without incident." That doesn't make my mom, or for that matter my cousin, feel any better, you know?

[Astraia]

It's like a lot of hospital policies- based on outdated, and since-proven-wrong theories.

Their idea was that once your water breaks, then all the water in the tub rushes up your vagina, in your cervix, and gives you an infection.

I read a study on women having tampons inserted during labour (and I believe post partum?) and sitting in a tub of colour water and none of the tampons were coloured afterwards, disproving the "water rushing in" theory. (I feel like I read something negative about this study, but I don't remember...)

Also there is some evidence that shows that when the water is warm enough AND the fact that there's so much of it helps to reduce your rate of infection because if something nasty got into the water it would be diffused (is that the right word?) by the water so there would be less in direct contact with you and baby.

Sorry, this doesn't make much sense. My brain is on vacation. Hopefully you can get the gist of what I'm trying to say!

[fwlady]

Our hosp also offers tub labor, but not birth. With the last birth, had I been there, I wouldn't have ever known when my water broke. Since I UCed and was in the tub and shower the rest of the 1.25 hrs when I finally realized it really WAS labor, I never knew when my water broke. Anyway....

I had a high leak for 5 days (I didn't know this until that morning) and had the best waterbirth. No infection ever.

I had broken waters for a full 4 days before number six was born. I took a bath before transferring to talk to baby, drink OJ, do a kick count, and pray about whether or not to transfer for meconium. I didn't take baths before that. I labored in shower at the hosp, and had the baby just fine. No infection ever.

So, believe me, no worry. You can get an infection in the hospital for any reason, and if they can blame the woman's body, better for them and their insurance. Kymberli

[sonicfrost]

Originally Posted by Astraia

I read a study on women having tampons inserted during labour (and I believe post partum?) and sitting in a tub of colour water and none of the tampons were coloured afterwards, disproving the "water rushing in" theory. (I feel like I read something negative about this study, but I don't remember...)

I have not heard of this study being done, however, what comes to mind as a negative about that study is that tampons are MADE to not let things in or out (mainly out) but since they're designed to keep fluid on one side of the tampon, it would make sense that this study isn't reliable, since the tampon would be blocking the vagina and acting as a barrier from the water.

That said, I'm not defending the hospitals and saying water causes infection, I just thought I'd mention the tampon thing.

[wombatclay]

With dd1 and dd2 the hospital I used didn't mind my being in the tub after ROM (in fact, I had sPROM with both girls so it's not like they didn't know).

However, there is at least one local hospital that does not allow mamas to stay in the tub after ROM... their stated reason is that the jets on the jacuzzi style tub cannot be sterilized between uses and they don't want to risk cross-contamination between laboring women. I don't know how or why they reached this conclusion, or how or why they decided that ROM is the crucial factor, but it's the reason they give. I'm guessing that it has to do with their malpractice insurance though.

And to play devil's advocate, while it is certainly rare, infections can move "up"... it's one risk of prolonged ROM (especially in a GBS+ scenario) and the reason women with prolonged ROM are often monitored for fever/fetal activity/white blood cell count even if there have been no vaginal exams. Vaginal exams (and other penetration following ROM) obviously increase the risk of infection by a huge amount, but an infection can still happen on it's own. (just like bladder infections where the flow of sterile fluid is down and out, but every so often an infection moves up and in) Not that this is in any way common, or a good reason to base a policy about tub use on, but it could be where their thinking is coming from. Especially if that thinking is being driven by an insurance provider playing the "defensive medicine" game.

[Belle]

Originally Posted by wombatclay

And to play devil's advocate, while it is certainly rare, infections can move "up"... it's one risk of prolonged ROM (especially in a GBS+ scenario) and the reason women with prolonged ROM are often monitored for fever/fetal activity/white blood cell count even if there have been no vaginal exams. Vaginal exams (and other penetration following ROM) obviously increase the risk of infection by a huge amount, but an infection can still happen on it's own. (just like bladder infections where the flow of sterile fluid is down and out, but every so often an infection moves up and in) Not that this is in any way common, or a good reason to base a policy about tub use on, but it could be where their thinking is coming from. Especially if that thinking is being driven by an insurance provider playing the "defensive medicine" game.

If they really wanted to play "defensive medicine" and prevent infection they'd quit giving IVs to everyone and stop doing vaginal exams. But that's not going to happen.

[XanaduMama]

Anecdotal, but I had a hospital birth (with my first), had prolonged ROM (and was GBS+), and they had no problem with my laboring in the tub. Water does *not* enter the vagina under normal circumstances; ITA with the PP that it's the million VEs they insist on that are way more likely to lead to an infection.