I have a question about PROM and when/if to induce

[Amila]

With my DD this was the ONLY thing I didn't research and I want to be sure for this next one what course of action to take should it happen again. My waters broke intermittently through the day on a Tuesday. There was slight green meconium staining, I had a NST and everything was fine. No "real" contractions just a few ones here and there. Went to the hospital around 10 p.m., MEDwife gave me some herb to get things going and said if nothing happened by 7 am the next day (24 hours by that point) they would give me Pit to augment. Well nothing happened, I got crazy amounts of Pit, IV Abx, epidural, the whole shebang. Luckily baby was fine, I was fine, went home 24 hours later.

I felt everything done was justified because I really thought the chance of infection, etc would warrant an induction. Now I am not so sure. What is the standard time that can pass after PROM? I was 3 days before my due date btw. And was the mec a real problem? We are planning a homebirth this time and would like to avoid the hospital at all costs. I have a different midwife (same practice, previous midwife was fired)

TIA!

[SublimeBirthGirl]

I believe in the lower intervention countries, induction is begun around 48 hours after the water has broken. I'd feel okay going on indefinitely as long as I had zero exams, baby was moving, and I was staying hydrated with no signs of infection.

[JanetF]

http://www.joyousbirth.info/articles/isthataleak.html This has quite a lot of research and info on this. I don't believe there's a reason to induce simply for a ROM. It's just a time and motion issue in hospitals, there's no evidence for it and all it does is increase the c/s rate.

My last birth in brief
Hindwater leak 3 July
week of gentle labour, leak resealed
labour started in full 11 July
membrane rupture about 8.30am 13 July
baby born about 9am


I'm so glad I don't do hospital birth

[UmmSamiyah]

Umm, in my experience women have been allowed to wait approximately 48 hours before any augmentation. I think stimulating contractions naturally as with nipple stimulation have been the safest most effective mechanism I have seen.

[hippiemom]

If it was a hospital birth, the mec is what prompted their actions... even if baby is fine at the time, it can be disconcerting or herald trouble down the line (though certainly not always), this is the train of thought. Had you ruptured and had clear fluid I doubt the midwife would have been as hasty. A doc yes, a midwife, no... 48 hours seems reasonable as long as baby is doing fine. Remember, how you and your baby are tolerating labor (or prelabor) is the determining factor, not the calendar or the clock.

good luck! I had my second at home, lovely. With my third my water broke but it was 13 hours before I felt even a twinge of a contraction,and then BANG he was born in 2 hours (10+lbs). SO ya never know...

[mwherbs]

so it is a balance here we have waited a long time 5 days with one gal-- but and I say but- she had no mec staining-- the presence of mec does change things amniotic fluid has some anti-bacterial activity-- but in the presence of mec the anti-bacterial activity is greatly diminished and for some bacteria it actually becomes a growing medium (GBS) -- the thing is that often the presence of bacteria is the reason that ROM occurs before labor and the earlier in pregnancy it occurs the more likely bacteria is the cause- so ROM at 36 weeks is of greater concern than someone at 40 weeks ...

I am recommending this as preventive not something you can do much about after ROM

here is a web address on a study of flora and vaginal pH -- pH monitoring and treatment with introduction/recolonization of healthy flora can change outcomes -

http://www.saling-institut.de/eng/04infoph/01allg.html

[DoomaYula]

With my last babe, my water broke on a Friday morning and she was born on a Sunday morning. No mec though, and a :

[mendomidwife]

I read a number of studies a few years ago that said that after 24 hours the risk of infection goes up, while the onset of spontaneous labor goes steadily down. I don't know if these still hold up - I would have to do a literature search.
In our area induction is recommended after 24 hours of ROM without active labor - although it usually ends up being 36-48 hours.
Also considered - GBS status, presence of mec., AFI if available, other prenatal factors....

Carla

[maxmama]

Agree with above re: mec. MEc is usually not a problem, but there are situations in which it is, and it does decrease the antibiotic nature of AF.

PROM in a GBS negative mom doesn't generally worry me, but 90% of women will go into spontaneous labor by 24 hours after rupture. For me, waiting after that isn't going to give you much of an upside.

That said, 24 hours is when we usually start induction. When it results in a birth is a whole other issue.