What causes natural PROM - Page 2

[onlyboys]

Originally Posted by MsBlack

One last---

It is very likely that labors which begin with ROM will end in csec...IF you planning a hospital birth, or if your homebirth provider has a medicalized approach to pregnancy and birth.

I have not seen this in my hb practice, however! Never have had a csec occur for prolonged rupture.

Can you tell me more about this?

I just had a client with SROM without contractions that were discernible until she was "augmented" with pit. We waited at home for about 20 hours for any sign of ctx, but it was clear her water was ruptured (she kept leaking). She would have ctx when she used the breastpump, but they would stop immediately upon removal of the stimulation.

She was a hopsital client, and so with much debate, we went in. She was induced with pit, and even 24 hours later, she was at 4cm. Sigh.

You can guess, it resulted in cesarean birth, but not for fetal distress or infection but rather maternal exhaustion. The epidural that she received (as my suggestion) was not effective and resulted in ridiculous bouts of shaking and muscles twitching (even in her facial/jaw area. She couldn't even hold her head up or open her eyes at the end.

Not that I am questioning what happened, or would like it to have happened another way necessarily, but I wonder, what would you as a care provider have recommended? Waiting? No induction?

[XanaduMama]

Apparently lots of vit c can help make a stronger bag of waters and possibly prevent PROM. I've also heard that serious GBS infection can cause it too, and/or a very low-lying baby.

With ds, my waters broke at 40+2 but no cx's for about 18 hours until we started pitocin. I was GBS+ (which may or may not have had anything to do with it, though it did mean that the ROM turned out to be an issue earlier than it might otherwise), and ds was at zero station for about 2 weeks before this happened.

This time (HB), I'm taking loads of vit c and probiotics, and planning to work to test -ve on GBS. I'll also feel more comfortable waiting for cx's to start (this wasn't something I'd prepared myself for before ds's birth), and keeping EVERYTHING out of there until I feel pushy.

[Robinna]

Mrs. Black - PROM as a blanket term really bugs me too.

FWIW next time I will be telling nobody except DH that my waters broke, because as long as all else is well I'm prepared to walk around indefinitely with leaky waters. It seems to be "what I do" and since it was 10 hours with my last birth, it could easily be longer yet with the next one. I don't think there's anything abnormal about it.

[MsBlack]

Without knowing more, it is hard to say, but generally with ROM I am content to wait longer...one mw I know says her limit is 7days, as long as mom has no fever, baby is doing well and there are otherwise no signs of infection.

Remember that prolonged ROM does not mean that an infection is *inevitable*....just that *more* women/babies get infections after 18-24hrs ROM than women/babies whose ROM happens in active labor/not many hrs before birth. This is what we call a 'risk factor'--since more women/babies experience infection w/ROM after that time period, even though it's not all that many more, it is medically considered a possibility that should be controlled-for through interference such as induction/augmentation/surgery.

To me what is sad is that hosp care providers want moms to come in soon after ROM, with or w/out contrax--but the hospital is the least safe place to go, for people who may be vulnerable to infection! The most virulent superbugs grow in hospitals, AND, while I do no VE with ROM at home, at least until active labor, when VE is far safer in terms of infection risk, in the hospital they freely and sometimes frequently perform VE on ROM moms. Before active labor starts, for every VE done on a ROM mom, the risk of infection is multiplied...so I don't get why anyone would feel safer in the hospital with ROM than at home, waiting and taking good care of self/baby until labor starts or bag reseals.

Being at home and comfortable, keeping all things out of the vagina, using a peri bottle to rinse after bathroom use, use of vit c and/or echinacea to boost immune system, drinking plenty to help replace amniotic fluid, monitoring mom's temp and smell/color of water are some things that can be done to help prevent infection and monitor it's possible onset...and again, the 'risk' of infection is a 'risk', a numbers/statistics thing, NOT a certainty. There are also, we (and drs) seem to forget, risks--even unto life-and-health-threatening risks to both moms and babies--in the use of pitocin and cytotec for induction, and in caesarian surgery also.

I recently had a mom request transport for augmentation after 30hrs ROM (at 40wks + 4days, her 'usual' time of birth). There was no reason for this except "I want this baby out"--which was a perfectly valid reason and so we went--just saying she and baby were both fine and she was also gbs neg. The birth was only 7hrs later after a few hours of pitocin and a few more of natural labor, and all was more or less well (don't get me started on the nursery protocols tho!). But this worried me because I knew all that *could* go wrong for her, and result in surgery or other interventions. I hear these tales all too often--ROM happens and labor doesn't, and the mom and baby are fed into the medical mill based on these presumed risk factors. Too often moms end up with caesarians--mainly because mom is tired...or docs are tired of waiting.

[aikigypsy]

I have two friends whose recent labors started with ROM. The first wound up with a c-section for exhaustion and prolapsed cord, and the second had an epidural to deal with the pain of back labor, but did deliver vaginally. Both babies were in less-than-optimal positions, which I think might have been related to the PROM (or whatever you want to call it).

I read, somewhere out there on the internet, about a study that was done in Mexico about the effect of vitamin C on PROM. They found that the women who didn't take a vitamin C supplement were twice as likely to have PROM. I have been craving citrus through this whole pregnancy, so I hope that means that my amniotic sac is nice and strong!

to you, flapjack. I cannot immagine, that must have been so traumatic. I hope that you and baby are well, despite the assault.

[4C-mom]

P-PROM is 'preterm premature rupture of membranes' which to me sounds a bit repetitive. Preterm rupture of membranes, to me, is the only ROM that might accurately be called 'premature' (say, before 36wks or so).

no, not repetetive. if you are preterm (before 37 weeks) and your water breaks and you start laboring/contracting then then its preterm labor, imo.

pprom is more like, you are preterm and your water breaks. and you dont labor. your water stays broken for days/weeks. this has both the preterm(b/c you are preterm in your preg) and the premature (labor has not started).

[~*~MamaJava~*~]

Just from personal experience: with both sons, my waters broke with a splash and a gush previous to any other labor signs. Labour commenced immediately with #1, and about 13 hours post-rupture with #2.

Didn't really enjoy that experience, because it gets care providers all in a tizzy.

So with #3 I supplemented with better quality vitamins, a few herbs including RRL, and EPO for a few months.

Bag of water was super tough, ended up getting it broken by my midwife, and postlabour was told it was a really strong bag.

Hoping to land somewhere in the middle this time

MW said she recommends moms with previous PROMs to take salmon oil or something of the like.