If your waters break - and you don't go into labour...

[ann_of_loxley]

Do you have to be induced?

I mean - I would think 'induction' would be the last thing right?...I mean, surely there are things you could do/try before hand... and perhaps, the whole 'baby will die of infection' is actually not really that true? (I mean - within reason)....

What the length of time before you have to worry -and what exactly is there to worry about and can you do anything about that to avoid worry and/or induction?

[MamaMelis]

I think that this really depends entirely upon your own personal comfort level and where you have chosen to birth (i.e at home or at a hospital or what). My first birth was at a hospital, and as such I was subject to their 24 hour "rule" for ruptured membranes and GBS+ status. Had I been having a homebirth, I would have had a different set of "rules" within my caregivers parameters or comfort level. I'm sure that the time frame for "worry" varies from provider to provider, as well as from mother to mother. It would also be affected by GBS status, as well as managing to signs of infection. I don' t believe that there is necessarily one right answer to your question.

[tine1973]

Hi - I had was is called PPROM - my water broke at 25 weeks. I had to be on hospital bedrest for the duration of my pregnancy, but I stayed pregnant for another 4 weeks. This is very unusual - the doctors were constantly telling me I was going to go into labor at any time, and I did have an initial round of IV antibiotics. So it definitely IS possible to have your water break and not go into labor, but the risk for the baby goes up. I had a great deal of monitoring of my temp (for signs of infection) and at least 6 checks a day of my babies heartrate etc.

[flapjack]

NICE guidelines have changed since our 4yos were born. They're currently recommending induction at 24 hours, antibiotics at 18, whereas it used to be nothing up the vagina and wait it out for up to 96.

(For the Americans reading, it isn't standard procedure here to swab for GBS. Instead, women in high-risk situations for GBS and other infections- prolonged ROM, GBS in urine culture and so on are routinely offered abx to prevent infection. )

We went through this last time round, and for me (as a multip, with homebirths under my belt), I'd kind of made the decision that if I wasn't having serious contractions by the time the 18 hours was up then I'd accept the offered abx/induction because that would be unusual for me. YMMV.

[nia82]

It depends... Homebirth midwives will "allow" longer. Obgyns won't and can be pretty strict about it.
My water broke and I didn't go into labor for a couple hours (it broke at 1-2pm, and we arrived at the hospital around 5-6pm). I was a little scared and hadn't read that much about it before and was dumb enough to go to the hospital. It was fairly naturally minded so the nurses were mostly supportive. I lied and said it just broke on the way. The obgyn wanted ABX after 18 hours and I knew I didn't want that and would have fought it if I hadn't delivered by then, but I did.
Next time for me: getting a good fetoscope and learning how to use it or rent a fetal doppler for the time. If water breaks early again, no internal exams, fetal doppler can reassure baby is fine and there is no cord prolapse. I wouldn't show up at the hospital til I feel like pushing or something is wrong.
Definitely avoid internal exams, they introduce bacteria in the first place!

[AlexisT]

Flapjack, fwiw, some areas are not inducing that fast. When we were over for Christmas last year, DH's cousin's waters broke on Monday but they didn't admit her to hospital till Wednesday--can't remember if it was 36 or 48 hours.

[etsdtm99]

when i went to the hospital with my first .. my water was leaking, and had been all day, so i went in around 7-8pm (didn't know it hadn't actually broken and then leaked - no ctx) and it totally broke on the table.. couldn't really lie at that point, so that started the clock they gave me about 2-3 hours to 'make progress' which i did not.. so i was induced. they did not give/offer antibiotics (i was GBS -) but i had a 24 hour time limit, baby out or C-section.. she was born 19 hours after my water broke 17 hours after they started pit... I did not want the pitocin but the policy was that the baby HAD to be out by 24 hours, not that labor had to start by then.

w/ baby #2 i bought a doppler so i could monitor baby if this happened, since i was told that the biggest danger if your water breaks before the baby is engaged is cord prolapse.. infection would be the 2nd biggest concern, to avoid that you need to avoid internal exams and monitor for fever.. (btw. the 2nd time my water didn't break until well into my (2nd) unnecessary induction.. )

[ann_of_loxley]

I remember beign told 72 hours with DS - but I couldn't remember why or how or what. That was a little over 4 years ago.

Thanks for the responses so far - good info!

[amyjrn23]

Srom

This is a very difficult question to answer because it varies so greatly from provider to provider. Most of the MWs in my area go by the 24 hour rule. Meaning that if you are not in active labor in 24 hours they will recommend a hospital transfer...not that you have to be delivered in 24 hours, just in active labor. The bottom line is it will come down to the mother and providers comfort level.

What I believe that most NCB moms aren't really educated about is the fact that pitocin has a half life of 3-7 minutes (depending on what you read). Meaning if you are ruptured (or need to be induced for a medical reason) you can give pitocin, get the ctx going, get mom to change her cervix, then turn the pitocin off, and in 3-7 minutes she is essentially having natural labor. Meaning that there is no synthetic pitocin in her system.

I learned this from a great MW I work with. Moms on pitocin are required to have continious monitoring, but if you turn the pitocin off you can go to intermittent monitoring. The ctx might slow down some...but the labor will not stop. Once your in labor (meaning cervical change not just having contractions) you can't stop it if you wanted to. Otherwise we wouldn't have any preterm labor babies. The labor will most likely take longer but it makes the patients more pleased with their birth experience.

[Pumpkin_Pie]

My water broke on a Sunday evening and I didn't go into labor. I went in immediately for a check by my midwife and she told me to go home and come back in the morning. I essentially came back every 12 hours for a non-stress test and temp check until I hit 48 hours. She wanted to induce me after 24, but I refused against medical advice. I again refused at 36 hours and finally consented when I hit 48 hours. I didn't have a temp, and if I were to do it again, I would refuse for another 24 and try a few other things to get it started. I was also GBS neg.

[calpurnia]

Originally Posted by AlexisT

Flapjack, fwiw, some areas are not inducing that fast. When we were over for Christmas last year, DH's cousin's waters broke on Monday but they didn't admit her to hospital till Wednesday--can't remember if it was 36 or 48 hours.

yeah, a friend has just had her waters break & she's been told she has 96 hours. send her labour vibes! she's hoping for a homebirth.

[ann_of_loxley]

I think you are backed up a bit more legally here - so the choice is probably more down to the mother. Its good to hear that this kind of thing can be easily monitored though (like going overdue). So that you can make an informed decision and hopefully avoid induction and intervention if at all possible. 96 hours is a long time - 4 weeks is even a longer wait! hehe

[AlexisT]

The UK is very different from the US, IME.

On a provider level, there is less individual variation. There are NICE guidelines and trust policies. Midwives in any given place tend to have very similar policies. The exception is if you are hiring an independent (private) midwife, as they are not bound by NHS policy.

On a personal level, you do have the right to refuse treatment. It's not always as simple as just declining, though. Depending on the situation, they may have you speak to the consultant (OB) and/or the supervisor of midwifery. Yes, they are covering their rear ends, but in some ways this makes the system work better for everyone--the midwife can be more comfortable with letting the patient decline because as long as proper procedures have been followed, she can't be held responsible.

[MammaG]

I was also the victim of 'hospital 24-hour policy' and an unnecessary induction (now I do homebirths!). What I did not know at the time is that there's a break and then there's a break.....not all ruptures are equal. I had what was better termed a leak with DS1, but apparently any amniotic fluid loss can trigger that hospital policy.

With DS2, I also had a leak at around 38 weeks. Midwife explained that a small, high tear usually repairs itself and poses very little infection risk. Also, even with a full rupture, your body keeps making amniotic fliud, so each woman's situation could be very different from another's. And, by the way, DS2 was born a week after that leak, in the caul, so the leak very definately sealed!

Anyway, I think that you ought to have a team in place who you can trust to give you good information that you can then use to make your own decision abotu your particular situation.

[Birdie B.]

I had SROM w/out contractions - and my midwife had me transfer to the hospital. She was under a legal obligation - I guess here in Florida you can't go more than 24 hours with unbroken water.

I did try acupuncture and castor oil about 10 hours after my water broke with no contractions. I finally started having ctrx about 12 hours after ROM. But by 22 hours I was only dilated 1 cm, so I transferred. Meadow was born 4 hours later - no Pit or anything. Looking back, I would do it all differently. I wouldn't notify the midwife of the ROM - it didn't matter. My daughter was born 26 hours after my water broke - 2 hours after the "magical 24-hour window" - absolutely fine. Why did I transfer???? It was my first birth, so next time I hope things are speedier.

For you, it is probably different since you're in England. Just don't let yourself be pushed into tranfer if you don't think you need it. I narrowly avoided a c-section at the hospital, all because of the dang 24-hour rule.

[Triciabn]

I have known midwives "back in the day" that had waters broke for days and just stayed home in their own bacteria..and not mingle with outside bacteria... and they evenutally went into regular labor.
I remeber just monitoring my temps and watching that my fluids were clear and a few other things I payed attention too... I felt safe to stay home...I knew the second I made someone else responsible for my "care" that they would have legal obligations.
Tricia

[gcgirl]

"Have to" is relative. It's really up to you. I chose to be induced with DS because I was GBS+ and couldn't get contrax started 12 hours after my water broke. I deliberately waited at home until *I* was ready to go to the hospital even though I had been instructed to "go immediately" to the hospital should my waters break first. That was my choice.