water breaking/internal exams/infection

[Magali]

Can we talk about time frames and risk here? From what I *think* I know, hospitals give a shorter time to get baby out after water has broken, than is perhaps warranted. How long is safe to labor with broken waters? And, how do cervical exams change that time frame? What are the risks of being given exams after water has broken? I went to the hospital way to early with my son and this time around I plan to labor at home as long as possible, even if my water breaks. I would like to be better prepared this time in case my water breaks early again. I have researched all this before, but I can't really remember any of it and would like to get my facts straight.

[nia82]

In CA they gave me 18 hours before antibiotics and 24 before baby has to be born. It never came to that, first we lied about when the water had broken and we refused the abx and DS was born anyways basically 1 day exactly after my water broke (however they thought it was 19 hours).
Internal exams are the thing that really poses the risk of infection here. No matter how sterile those gloves are, the exam pushes bacteria up that is already outside of the vagina / in the lower part of it. Knowing what I know now, I will totally refuse internal exams after my water breaks. For a matter of fact I'm not allowing any internal exams throughout pregnancy and labor unless medically warranted (like to exclude cervical dilation with PTL at 30 weeks).
I'm not cool with routine use of abx for no good reason. If I develop a fever, then it might be warranted, but just because there is some arbitrary time line, I refuse. Especially when there are no internal exams, the risk for infection remains relatively low.

[MammaB21]

I think the average in hospital is 12 hours. 24 hours for time of labor (even if the water hasn't broken). I had DD in a hospital in the birth center section with midwives last time. It was a 22 hour labor with my waters intact until the very last half hour. I got threats starting at hour 18. Not necessarily threats of the dangers, but threats about hospital policy. Something about insurance not covering it and yada yada. Every hospital will be different, but I'd say in general I wouldn't count on being able to labor more than 24 hours with broken waters.

I would recommend staying home as long as possible. The risk of infection is actually higher at a hospital where your body isn't accustomed to the germs and you're being checked constantly. Yes, cervical checks increase your risk of infection at any time but especially when your water is broken. You can put it in your chart that you don't want any checks. Also, you can always lie when you get there and say your water just broke to buy yourself more time. I'm having a home birth and my midwife will let me go as long as needed with broken waters. I think the longest she said she's seen is 6 days and she was okay with that. There are things to keep an eye on though. Of course make sure nothing goes into the vagina. Take your temp every 2 hours to watch for a fever. Check for blood or miconium in the waters. There are also things you can do to strengthen the bag of waters. I've heard vit C and some other supplements can help.

[BirthTender]

how long after rupture of membranes?

Most important is: KEEP everything, anything, and definitley fingers, even sterile gloved ones out of your vagina!! & wash real well after every bathroom trip.

[Black Orchid]

In PA, they give about 12 hours before ABX with ROM if mom is GBS+. I have never witnessed abx be given for ROM at any time unless mom has a fever.

There also doesn't seem to be a limit that they let moms go with ROM before induction/CS. Of course, I have never supported a mom whose ctx didn't start within a few hours of ROM. The concern seems to be more staying on the curve than infection...