Risk of infection after water breaks?

[KGB]

It seems like most pregnancy books will tell women to rush to the hospital immediately after their water breaks because of an increased risk of infection (even if they're not in labor). I've also heard the other side of the argument that says there's no hurry, and if you end up rushing to the hospital it's more likely they will put you on the intervention path.

Being more of a "naturalist" at heart, I would be one to lean more towards letting nature take its course and not rush to the hospital to soon. My wife, on the other hand, is a nurse and her medical background is yelling INFECTION! INFECTION! INFECTION!

Are there any studies out there on this particular topic?

[womenswisdom]

There is a study referenced in Heart and Hands by Elizabeth Davis that compared women who were under a deadline to deliver within 24 hours after SROM and those who were given up to 4 days. There was no difference in infection rates. Another study showed that twenty-four hours after the first vaginal exam, the infection rate started to go up. If she is worried, she can always make a plan that she'll take her temperature every so often, not get vaginal exams, no sex, etc. if her water breaks at the onset of labor. However, it's only something like 10% of labors that start with SROM, the rest usually break during transition or pushing.

ETA: Here are the studies I referenced (don't know how to do the link-looks-like-a-word thing:

http://www.ncbi.nlm.nih.gov/pubmed/8...m&ordinalpos=5

and

http://www.ncbi.nlm.nih.gov/pubmed/6...citationsensor

[cocoanib]

The pp posted some good studies.
For me, I prefer to look at it from a what makes more sense point of view.
If your water breaks and you rush to the hospital. There will be other peoples germs there, sick people, cervical checks, etc

If you don't go and stay around your own germs, no sick people and nobodies hands up in your buisness. Seems to me that's less of a risk of infection.

Plus you have the hospitals rules and regs on time limits and things. So, you may wind up with way more interventions and issues then if you wait.

[ellairiesmom]

Earlier this month, I got my VBAC 45 hours after my water broke. Hospital birth, (with interventions after 27 hours of none) & the staff was much less concerned over the risk of infection than just keeping an eye on the baby since I had gestational diabetes...

Granted my Mom has been an L&D nurse at this hospital for 20 yrs & my OB is close to us & wanted my VBAC for me as much as I did...but still-they are hospital minded & weren't really overly concerned about the water breaking "time clock".

To be honest, I didn't feel at all "exposed" to germs while at the hospital. It is single room maternity & the bathroom was cleaner than mine at home at the time (busy weekend & DH didn't get a chance to clean it for me ). I had no interaction with anyone on any other floors, walked right up to L&D & never left that area.

[AustinMom]

The risk of infections goes up 24 hours after the first vaginal exam after the water is broken. The studies they have done with water being broken longer than that, and no vaginal exams the infection rate does not go up.

Now, if you have one exam, and no others for 24 hrs, your chances of infection are a lot smaller if you have one exam, and an additional exam every hour or so. So, if your water brakes at home, and you don't do any vaginal exams on yourself, then your chances of infection are no greater.

[nia82]

My water broke and I was concerned and went in.... Not a good idea! Well, I was worried about cord prolapse and all those shenanigans, but I deeply regret that I went in a couple hours after my water broke. Labor didn't start until way later (not augmented though), but just being in a hospital, having vaginal exams, baby monitors etc is just too annoying and takes valuable energy away. I wouldn't do it again...

[kltroy]

There's an excellent Cochrane Review (meta0analysis) on this from 2008 here:
http://www.ncbi.nlm.nih.gov/pubmed/16437525

In a nutshell, No difference was seen for neonatal infection (RR 0.83, 95% CI 0.61 to 1.12; 9 trials, 6406 infants). However, fewer infants under planned management went to neonatal intensive or special care compared with expectant management (RR 0.72, 95% CI 0.57 to 0.92, number needed to treat 20; 5 trials, 5679 infants).

The authors concluded that planned management was not necessarily all that different from expectant management for most women (meaning, doctors very often sat on their hands for a good long time anyway), so women should be given good information and the choice to do what they wanted.

I have never had this but my sister's membranes ruptured before she went into labor with her first child. She called her MWs when that happened. They had her come in but did no checking at all - I think they did collect or look at the fluid to verify it was amniotic visually, but then sent her home and told her to come back when she was ready to have a baby or in 24 hours, whichever came first. She returned about 10 hours later on her own, well into labor.

[lunita1]

Finding out your doctor/midwife's protocol and stance on this issue is a good litmus test as to whether you're with the right practice, IMO.

Will they "let" you wait? How long? with what instructions/guidelines? under what circumstances?

I'm not sure of all of the details, but I believe my hospital-based midwives give instructions about not inserting anything in the vagina and using good hygiene, advise you to watch out for signs of infection, and pretty much have you stay home until something happens. They may start prophylactic antibiotics at some point, I think?

Many obstetricians want baby born within 24 hours of your water breaking, so they start inductions within 6-12 hours.

[snoopy5386]

I also think your GBS status plays a huge role in this and how your doc/midwife will want to treat you.

[Mamabeakley]

Standard protocol in the US now is to treat GBS+ women w/IV abx regardless of other risk factors, so for most women, it won't make any difference to be GBS+ (once they are in labor, they will be given IV abx with intact waters or broken.)

However, some women/drs/mws do choose to follow a protocol of only treating GBS w/abx if another risk factor (including prolonged rupture of membrane) is present. In which case it would make a difference.

[nia82]

Yes, it's a good idea to ask your HP what their protocol is. I had no idea, it never crossed my mind that my water might break first and then nothing.
My midwife was supervised by an obgyn, and it must have to do with laws in CA or something, but she had to double check with him all the time. He wanted abx after 18 hours of breakage just because and baby born within 24 hours. We didn't have to fight stuff since labor picked up by itself, but that would have been quite a fight cause we would have refused that stuff.

[sonicfrost]

My water broke when I was at home, and I did go immediately to the hospital. Mainly because I had a failed induction the morning before and when my water broke, I thought things might progress fast, but I was wrong, having given birth 23 hours after my water broke. Anyways, I'm glad i went in when I did, because a couple hours later I developed a fever and had to be put on antibiotics, and the baby's heart beat was 180's to 190's with my fever.

My GBS test was negative.

So, yeah, sometimes it IS a good idea to be cautious, even with a negative test result.

[Ashes]

I'm another person who gave birth 24 hours after my water broke. I had already been in the hospital twice.. (total labour 42 hours). I didn't go in right away after my water broke because I thought they would still send me home since my contractions were still 5 mins apart and 60 seconds long. I waited about 8 hours. They did admit me because of the water breaking but they also put me on pitocin... and I eventually ended up with a c-section for a legitimate reason - the baby's head was brow position.

They did check the baby's lungs for infection a few times after he was born because of my water breaking 24 hours prior to delivery but everything was fine.

[MsVyky]

My water broke first as well.

I DID go to the hospital as requested by my HCP, but vaginal exams were kept to the minimum. I laboured for 20 hours before My first vaginal exam. At 28-ish hours after my water broke, I spiked a fever of 105/Amniotic infection, and ended up with a c-section 31 hours after my membranes ruptured and a sick baby in the NICU for a couple days

[TCMoulton]

Originally Posted by KGB

Being more of a "naturalist" at heart, I would be one to lean more towards letting nature take its course and not rush to the hospital to soon. My wife, on the other hand, is a nurse and her medical background is yelling INFECTION! INFECTION! INFECTION!

While I understand your desire to have your wife see your point of view on this topic I would have to say that since she is the one giving birth that she be the one to decide when i is best to head to the hospital. If her medical background makes her inclined to head to the hospital as soon as her water breaks then so be it. Her birth, her decision.

[Darlingricki74]

I had my waters broken at the hospital, and I did develop an infection in way less than 24 hours(baby was born about 10 hours after they broke my water). I developed a fever and had antibiotics in an IV while in labor, and baby did not get infected.

I think it was from my internal exams, or maybe from the internal scalp monitor they put on baby.

[sanguine_speed]

My water broke a week before my baby was born.

This was because my water broke at 33 weeks. At 33 weeks, they said, the risk of infection is not worse than the risks of prematurity. They would have recommended an induction by 35 weeks, but my baby came spontaneously one week after my water broke, at 34 weeks. I had 48 hours of IV antibiotics and then oral antibiotics until I went into labour.

I did go to the hospital when my water broke, but I was vacationing remotely, 8 hours from home, the hospital was a couple hours away by boat and then car, and I was only 33 weeks.

[RedOakMomma]

My water broke 24 hours before my twin birth and about 16 hours before my singleton birth. Both times I stayed home, for about 12 hours in the first and 15 hours with the second, until my labor picked up on its own. Both times I monitored movement and my temperature, and didn't do any cervical checks. And yes, both times I lied to the hospital and said my water had just broken. I didn't want to be on a clock.

I'm GBS positive, and I'm fine with getting antibiotics during labor. I'm happy to see/read that it's not a big deal to have PROM when you have GBS...some of the threads recently were making me worry about it (despite having done it twice already!).

I feel like if I had gone to the hospital right away, especially with my first/twin birth, it would have been intervention city. My contractions didn't even START until about 10 hours after my water broke, and they didn't get coordinated until 11-12 hours. At home I was able to eat, rest, walk outside, stay relaxed...it was a much better environment than the tick, tick, tick of the hospital clock.

[KGB]

Originally Posted by TCMoulton

While I understand your desire to have your wife see your point of view on this topic I would have to say that since she is the one giving birth that she be the one to decide when i is best to head to the hospital. If her medical background makes her inclined to head to the hospital as soon as her water breaks then so be it. Her birth, her decision.

I understand your point, but that's an oversimplification. It would be like saying that only the husband should make the decision whether or not to circumcise a baby because he's the one with the penis. Although my wife has a medical background, it's not in obstetrics. And I've come to learn that most people with medical backgrounds tend to look for issues where there are none and to commonly think "worst-case scenarios" from the start.

My plan isn't to make the decision for her. It's to get as much information and education about this topic (and many others) so we can both make the best decision possible for our child.

[TCMoulton]

Originally Posted by KGB

I understand your point, but that's an oversimplification. It would be like saying that only the husband should make the decision whether or not to circumcise a baby because he's the one with the penis. Although my wife has a medical background, it's not in obstetrics. And I've come to learn that most people with medical backgrounds tend to look for issues where there are none and to commonly think "worst-case scenarios" from the start.

My plan isn't to make the decision for her. It's to get as much information and education about this topic (and many others) so we can both make the best decision possible for our child.

Nope, not the same at all. Circumcision involves the body of a child which many here believe neither the mother nor the father have the right to make such a decision whereas childbirth involves only the body of your wife. Regardless of how you may feel about how childbirth should ideally be handled the decisions around your wife's labor and delivery should be ones that she is completely comfortable with no matter your feelings.