Please advise ASAP - water broke 20 hrs ago, still no labour

[christacular]

Hey all,

I'm posting on behalf of my very good friend who has been planning a midwife-assisted homebirth throughout her pregnancy. She is, by their calculations, 36.5 weeks along and her water broke yesterday, but was not followed by any signifigant contractions. At 8am this morning she had a verbena beverage but still nothing. They have not done an internal to check dilation. Midwife is subtly pressuring her to be admitted to the hospital even though baby's heartrate is fine and there is still lots of fetal movement.

This is her first birth and she's understandably uncertain. I am not convinced that putting her in the hospital is neccessary or desireable at this point, especially since there appears to be no fetal distress and she is still comfortable.

I advised that she try blue and black cohosh, nipple stimulation, and a light walk around her neighbourhood, but can anyone else offer advice?

The fear appears to be that the baby is 'too early' and the water has broken. She's already had several antibiotic injections because they LOST her strep B swab results.

Help?

[JamieCatheryn]

She needs to take probiotics to counter the negative effects of the anti, there are suppements at heath food or supplement stores. Yogurt is another source but she needs lots more quickly that that. Garlic pills, Vitamin C, and Echanacia will all help immune function too. Was the break a trickle or a splash? If it was only a little it might repair and she could go to term. She should monitor her temperature and watch for a spike. If she can get an ultrasound done to check the status of the fluid and everything that'd be good. Cohash sounds like a bad idea to me. A little too rough a start to labor, forcing contractions like that, they might start and not continue. What does her intuition tell her about the baby's development, does she feel the baby would be ready now?

[Romana]

At 36.5 weeks this is technically PPROM, isn't it? Not just PROM?

What kind of break is it? Total gushing, tons of fluid, or just a trickle or leak?

I would probably resist hospitalization, especially because I know they'd start sticking stuff up "there" and my chances of infection would skyrocket, but there are a lot of factors at play and I can't say for sure.

[christacular]

i should have been more clear: she and the midwife agree that labour should begin - they are not trying to stall it, they are trying to bring it on.

the water breaking was a gush, it is almost 24 hours later and she is still gushing regularly and having mild, mild contractions - ones she can still sleep/rest through.

they are saying that if she hasn't started active labour in the next 2.5 hours they are going to send her to be admitted...

i am worried that it will start the snowball of interventions that lead to c/s

[sambelina]

This is what happened to me and it did end in a c/s. If her m/w is ok with it, maybe she should stay home. If she's not doing a whole lot of internal checks, I would think it's ok. I would also make sure the m/w stays with her in the hosp if she transfers.

[Romana]

Okay, if they are trying to get labor going and are agreed that that is the best course at this point, I would . . .

~ Put nothing in/up there

~ Rest, hydrate, eat, sleep as much as possible during normal sleeping hours or more if tired

~ Try taking a walk or nipple stim, as you suggested, although I know sometimes nipple stim can cause a few irregular, painful contractions but nothing regular, so it would really be a just try it and see sort of thing

~ Talk to baby about being born (ok, this is just me here, but I think it also helped *me* feel ready and release any lingering anxieties I had about birth)

~ Watch carefully for signs of infection (fever, etc.) and keep an eye on FHT

~ Stay home and wait, up to 78 hours after water breaking, for establishment of regular ctx (provided no signs of infection and baby and mama doing ok)

I know in some states and in many midwifery practices it's auto-transfer at 12 hours post water breaking unless active labor is established. I'm not comfortable with this rule and think it's at least partly based on the fact that infections are much more likely to set in within 12 hours in a hospital because of all the introduction of foreign germs etc. in that setting.

Your friend may be uncomfortable waiting at home much longer, especially if the midwife is pushing transfer, but personally I would monitor myself/baby carefully for signs of danger and stay home as long as possible. The hospital scenario under the circumstances is not a good one, and of course involves VEs and pit.

Good luck to your friend. I hope things go smoothly for her, regardless of whether she chooses to stay home longer or go to the hospital now.

[xelakann]

What about acupuncture or acupressure?

There are points that can trigger labor for some people... it is most effective if the persons water has already broke.

This is a tool I plan on using.

I can imagine she is feeling a lot of stress, poor gal!

[AKmoose]

Any update? Just wanted to chime in that my water was broken for 41 hours before contractions started...of course, I didn't have a midwife, but so long as no vaginal checks were performed and nothing was inserted in the vagina, she should be A-OK. I hope for her sake the hospital wasn't the next step...

[XanaduMama]

I would do nipple stimulation--but you have to do it seriously, not just a bit of playing. Ideally, use a breast pump, and pump for 15 mins on one side, rest, then do 15 mins on the other side, take a break, then try again. A couple minutes or some light stimulation isn't going to help.

Orgasm could be helpful, too, if she's in the mood (which I know I wouldn't be!).

[pixiepunk]

this happened to me (though at 38 weeks). what worked for me was castor oil. i mixed 4 oz with peanut butter in the blender and slurped it down. 45 minutes later i pooped my insides out, and about 5 minutes after that i had my first real ctx which was followed by another 15 minutes later and that was that. DD was born 8 hours later.

[christacular]

hey all, thanks so much for your kind, thoughtful, helpful responses.

my friend was indeed taken to hospital and at 8pm was started on oxytocin. at 11:30pm she was only 1cm dilated but having nearly unbearable contractions and the midwife reccommended an epidural (?!), which she accepted. once that kicked in she dilated to 9 cm by 3am. at 3:30am she began (assisted) pushing and at 5:07am the baby was born. healthy but dozy.

it was a rather traumatic thing to watch happen to my friend, who wanted so much to have a natural home birth. she struggled so much with feeling guilty about not living up to her own expectations and with being intimidated by the medical professionals. i also had a hard time with it but was in an awkward position trying to support her, worrying about the baby, and questioning the med professionals around her.

i came home after the all-nighter, slept for a few hours, and woke up and had a good old cry. feel a bit better now. the baby is lovely and healthy, i'm trying to remember that.

[pamamidwife]

I'm so sad that she was pressured into a transport for a non-emergent reason. I'm glad you were there with her.

[christacular]

i'm pretty sad too.

she is at least at home now, 24 hours after being admitted, and sounds good. i, however, feel completely traumatized.

[SublimeBirthGirl]

It sounds like her midwife really sucked. Transfer, pressured her into an epidural. Nice. Not exactly what she signed up for.

[AKmoose]

Rats...so sorry to hear. She's lucky to have you.

[Robinna]

We're seeing this in Ontario too. If you get an "old school" ie pre-regulatory practicing MW who is now registered, you're in good hands. If, as I did, you get one who has come into practice SINCE regulation, you end up with a c/s for breech because she let you believe she did homework that she didn't do in trying to find referral practitioners to catch the baby. (hmmm. that sounds pretty bitter, doesn't it? go figure...)

[Romana]

I'm glad she has a healthy baby and sounds like she is doing well. I'm sorry it was traumatic for you to witness. She may need a lot of time to process everything that happened, as well as you. s