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If you were hospital birthing, was GBS+, and had SROM with labor not starting....

post #1 of 22
Thread Starter 
how long would you wait before going in? I hope this doesn't spark a debate, as I expect a lot of different opinions.

I have had two hospital births and am prepping for my third. My OB is great and I look forward to working with her again. I was GBS+ last time. My water broke and the next day, depsite everything natural we could think of, not a single one contraction. We made the decision, partly because I was GBS+ and partly because we had a great relationship with our Dr, to go on to the hospital and "start the clock". They followed out wishes and didn't do internal exams. After many many hours of walking and other natural attempts, still no contrx. I was about 10hr from the 24hr point. My OB gave us the option to wait and watch, but did note that at 24 hr approached, people would start waving c-sec flags....or to try and start the lowest dose of pit to get my own body working, then hope to stick to our plan. We waiting a couple hours then went the pit route, felling really good about the choice at that point. They set me up with a continuous monitoring system that still let me move around for comfort vs being bedridden. Well, 9 hours of pit at max dose, and managing with no pain meds, I had my daughter in a pain induced haze that despite no pain medication, I have no rememberance of her coming out or what happened right after birth. The pit just fried my system.

So while we still are not sure we would have done anything different in that situation, we felt listened to, informed, respected, and the Dr and nurses really worked with us to use natural methods, then the lowest intervention level possible, to get to the end.

But that was my second GBS+ birth. This time, I wonder, if my water breaks early and I am in the same situation, knowing that being at home meant zero internal exams....how long would I stay this time?

If you were GBS+, how long after water breaking, if you had truly zero signs of impending labor, would you feel good about waiting?

Thanks.
post #2 of 22
I was GBS+ for both my pregnancies, and both started with my water breaking but with no contractions.

In the first case I was pregnant with twins and a little overdue (40wk 1day), and there had been a lot of pressure to get the babies out by my perineonatologist. The twins had heart/neuro issues and I think everyone was watching my case closely.

I only felt comfortable waiting 12 hours at home, though I filled those 12 hours with as much labor-stimulating anything I could think of...especially walking. I walked MILES, uphill quite a bit of it, and while it was pretty hard on me physically, it did seem to get contractions going. It was only when I held still that they went away, so I walked through most of the day. At 12 hours, I was having semi-irregular strong contractions, so we went to the hospital. I lied and said my water had just broken. The babies were born about 12 hours later.

With my second labor, a singleton, my water broke and again....no contractions. I stayed up all night walking on my treadmill and taking breaks to sit on the labor ball, but nothing really happened until about 12 hours later. My contractions started and I labored at home for another several hours, then went into the hospital when contractions were 3 minutes apart. Again, I lied and said my water had just broken.

I think about 24 hours would be my limit...as far as staying home, I mean. To be honest, both times I was nervous about "breaking the rules," but with our second pregnancy I read Ina May's book and felt a lot better about just waiting for labor to start on its own. Even then, I was worried and did kick counts, etc. to make sure that I could reassure myself things were okay.
post #3 of 22
I should add that I am okay with an IV of antibiotics during labor (for GBS), so for me I was never all that worried about the baby having any effects from the brief, if any, exposure to GBS while my water had been broken.
post #4 of 22
With DD, I was GBS+ and had SROM and no contractions. We called our midwives and they made us come into the hospital right away to start antibiotics. I managed to stall DH and we got there about 3 hours after my water had broken. From the get go the midwife said we'd probably have to do "something" to get labor started. We tried nipple stimulation and walking but it did nothing. At 6 pm the midwife gave me cervadil. It worked wonders. The cervadil fell out an hour later when I was peeing and I started having contractions at that point. It was insanely intense labor - I went from 4 cm at 7 pm to 10 cm at 11 pm with contractions all less than a minute apart. DD was born at 1:20 am after 2 hours of pushing.
I would also for cervadil or the Prostaglandin Gel before I did Pit.
post #5 of 22
Thread Starter 
Thanks for the stories. We didn't have issue with the abx either...just didn't want clocked.

Snoopy-i asked about the Cervadil vs pit. We ended up going w/ pit for a couple reasons. One, I was 3cm+ dialated and nearly 100% effaced when I got there. I'd been dialated 3cm for 3 weeks. My cervix was about as ripe as can be and babies head was right there. The input I got was that cervadil probably wouldn't be the best bet given the state my cervix was at. I didn't have enough info on that part to argue. Also, we were running low on time and if it took several hrs for it to work, then labor was long, I'd have blown past 24 hour in hospital plus my day at home. We ended up going with pit thinking since all seemed optimal, that it would only take a bit. Had I known I'd be max dosed eventually before anything happened, and was going to be on it 9 hrs, I may have thought differently. Hind sight...
post #6 of 22
That was the case with DS. Water broke *sometime* before 8 AM, no sign of contrax. We tried natural induction all day and finally went to the hospital at 6. We kind of decided that if we couldn't get it going by then, we'd go in. I'd probably wait no more than 12 hours, personally. It's a tough call.
post #7 of 22
Quote:
Originally Posted by DeChRi View Post
Thanks for the stories. We didn't have issue with the abx either...just didn't want clocked.

Snoopy-i asked about the Cervadil vs pit. We ended up going w/ pit for a couple reasons. One, I was 3cm+ dialated and nearly 100% effaced when I got there. I'd been dialated 3cm for 3 weeks. My cervix was about as ripe as can be and babies head was right there. The input I got was that cervadil probably wouldn't be the best bet given the state my cervix was at. I didn't have enough info on that part to argue. Also, we were running low on time and if it took several hrs for it to work, then labor was long, I'd have blown past 24 hour in hospital plus my day at home. We ended up going with pit thinking since all seemed optimal, that it would only take a bit. Had I known I'd be max dosed eventually before anything happened, and was going to be on it 9 hrs, I may have thought differently. Hind sight...
I honestly don't know why that was the midwife's choice. I hadn't had a vaginal exam - she had no idea how dilated or effaced I was until she inserted the cervadil. I've now found out cervadil is contra-indicated in someone with PROM, so I really don't know. The "plan" was to have the cervadil in overnight then start Pit in the morning. Luckily for me the cervadil jumpstarted labor almost right away. I would still ask for the cervadil/gel - if it doesn't work right away they can just take it out (the cervadil anways).....
post #8 of 22
Have you thought about taking 500-1000 mg of vit c per day to help strengthen your amniotic sac, to reduce chances of breaking before labor starts? this works for some.

Disclaimer - didn't work for me when I had DS#2, but I had had the mw sweep my membranes @ 41W1d, which I think weakened the bag enough to rupture later that night. All three of my labors started with SROM, but the others were pre-term, so maybe the Vit C worked after all...
post #9 of 22
Thread Starter 
Quote:
Originally Posted by sweeetpea View Post
Have you thought about taking 500-1000 mg of vit c per day to help strengthen your amniotic sac, to reduce chances of breaking before labor starts? this works for some.

Disclaimer - didn't work for me when I had DS#2, but I had had the mw sweep my membranes @ 41W1d, which I think weakened the bag enough to rupture later that night. All three of my labors started with SROM, but the others were pre-term, so maybe the Vit C worked after all...
I drank 1000mg of Emergen-C daily in pregnancy. With my first my water didn't break until the end. I have been slacking this time, so thanks for the reminder! I am really curious what causes SROM before labor is ready to begin.
post #10 of 22
That was my first pregnancy... I actually only waited at home for about four or five hours, and only then because I was kind of in shock about the water breaking and I wasn't ready, didn't have my bag packed, etc (I was only 36 weeks). But because I do believe in antiobiotics in case of GBS, and because I was a little worried at how early, and because I was floored that my water had broken (with my mom, hers never broke until late in labor, so I felt really weird), I didn't stay home long. I guess my water broke at 2-3 am, I went in close to 8 am.

I did end up having pitocin, but had no problems or complications, no epidural, birth went great.
post #11 of 22
I'm on the fence about the abx, but if I was planning on getting them upon arrival at the hospital, here's what I would do.

-No internal exams, and nothing in the vagina.
-Monitor your temp regularly.
-Take extra care when using the bathroom.
-I wouldn't go much past 24 hours, maybe up to 36 if I was feeling good.
-I may even consider no baths/only showers, but that would be on the extra careful side.
-I'd also pay close attention to my body and go in if anything felt off that I didn't mention above.

In that time, I'd try everything I could think of to get labor going. I'd also make sure to get lots of rest, stay very hydrated, and eat some good nutrient rich meals considering it might end up being a long labor/hospital stay.
post #12 of 22
Thread Starter 
I must say that all in all I am not terribly worried about it....just the SROM and no labor part. I am fine with the abx...luckily neither of my kids or myself have ever been effected by the yeast/abx monster that many battle (knock on wood). Our ped is a good friend of ours and will sign baby out early with agreement with hospital that she will swing by at the 48 hr mark (when they usually make you stay at the hospital until) and check baby out. So we have been in and out the next day with no ill effects. My only major hang up is not wanting to end up in a situation of needing pit again. Again, would not have chagned a thing in that case, given the situation, but would love to avoid it.
post #13 of 22
Quote:
Originally Posted by MammaB21 View Post
...if I was planning on getting them upon arrival at the hospital, here's what I would do.

-No internal exams, and nothing in the vagina.
-Monitor your temp regularly.
-Take extra care when using the bathroom.
-I wouldn't go much past 24 hours, maybe up to 36 if I was feeling good.
-I may even consider no baths/only showers, but that would be on the extra careful side.
-I'd also pay close attention to my body and go in if anything felt off that I didn't mention above.

In that time, I'd try everything I could think of to get labor going. I'd also make sure to get lots of rest, stay very hydrated, and eat some good nutrient rich meals considering it might end up being a long labor/hospital stay.
This pretty much sums up my approach. I'd also add that the fluid I was leaking needed to be clear. If there was any mec. in the fluid I'd probably head in right away.

....I'd never heard of the vitamin C connection. Are there articles on this? If so, I'd really consider taking vitamin C with this pregnancy. Does anyone know if you need to take it the whole pregnancy, or just at the end?? I'm not worried so much about prematurity...I get the feeling that my waters ruptured when the babies were ready to be born, but that for some reason labor stalled until my water had been broken for a while.
post #14 of 22
Thread Starter 
Quote:
Originally Posted by RedOakMomma View Post
I'm not worried so much about prematurity...I get the feeling that my waters ruptured when the babies were ready to be born, but that for some reason labor stalled until my water had been broken for a while.
Ditto this! Mine came a day early and was 8lb9oz, which was about the same size as my first. And i also agree on the meconium part....would be a fast trip in.
post #15 of 22
I had links to two studies on the Vit C/strong sac correlation, but could only locate this one right now:

Vitamin C protects against PROM
Source: American Journal of Clinical Nutrition 2005; 81: 859-63
Evaluating the effectiveness of a dietary dose of vitamin C in preventing premature rupture of membranes.
Taking vitamin C throughout the second half of pregnancy can significantly lower the likelihood of premature rupture of membranes (PROM), research confirms.
As vitamin C plays a role in the synthesis and degradation of collagen, it is important for maintaining the chorioamniotic membranes. Consequently, it has been proprosed that vitamin C deficiency during pregnancy may be a risk factor for PROM.
To evaluate the protective effects of vitamin C supplementation, Esther Casanueva (National Institute of Perinatology, Mexico City) and colleagues randomly assigned 109 pregnant women at 20 weeks' gestation to take 100 mg vitamin C or placebo daily. Vitamin C levels were assessed every 4 weeks, and the participants were followed-up in case of PROM.

Plasma levels of vitamin C declined throughout pregnancy in both groups. In contrast, leukocyte vitamin C levels decreased in the women given placebo, but increased in the supplemented women. Meanwhile, 14 out of the 57 pregnancies in the placebo group involved PROM, compared with just four of the 52 pregnancies in women given vitamin C.
Noting that PROM is thought to trigger 40 percent or more of all preterm labors, Casanueva et al say: "supplementation could be a valuable tool in sustaining pregnancy to term."
Posted: 19 April 2005
post #16 of 22
sweetpea, thanks so much for that link!

I think I will supplement with some vitamin C once I hit 20 weeks. I'm already taking tons of supplements (d3, calcium, etc.), so one more won't be an issue!

May I ask why you suggested 500-1000mg?
post #17 of 22
The other link I had that I cannot find right now referenced a study with 500 mg Vit C, with similar/better results. And Vit C boosts immunity, which is all to the good. Since Vit C is water soluble, you just excrete what is not absorbed and cannot "overdose" on it unless you take some insanely huge amount.
post #18 of 22
I would look into making sure you are GBS - this time around. Have you checked out some of the supplements and thing you can do to try and get a negative test on record.

http://www.joyousbirth.info/articles...lapproach.html
post #19 of 22
Thread Starter 
Quote:
Originally Posted by MyBoysBlue View Post
I would look into making sure you are GBS - this time around. Have you checked out some of the supplements and thing you can do to try and get a negative test on record.

http://www.joyousbirth.info/articles...lapproach.html
That is my ultimate plan. I have researched a lot on this, but not this link. Thanks so much for the additional info.
post #20 of 22
I tried to get GBS- last time I was pregnant, but to no avail. My OB, who is pretty natural-minded, said that almost all women keep the GBS (at manageable levels) in their flora for life, and that even if you can manage to lower your levels for a passing test (which he said was not likely), the GBS will likely return and could be a factor at birth. Still, I asked that he repeat the testing. And yup... GBS+

I'm sue it works for some women, but not for me. I'm okay with that. The whole GBS thing doesn't really bother me. None of my three kids had problem with the IV antibiotics, neither did I, and they used a heparin lock so I was still able to be completely mobile during labor. In general, though, we're big into probiotics (even for newborns), so I think if there were going to be antibiotic issues, we probably avoid some of them.
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