cord prolapse and water breaking?

[kltroy]

Just got back from an appt with my FP (I'm planning a hospital VBAC). She said that if my water broke I should come in and get monitored to make sure the baby was fine and there was no cord prolapse. Said that *technically* the hospital recommends that you stay there after that, but that you can sign yourself out "against medical advice" and go home to labor if you want.

This seems like a pretty conservative policy to me, but since I live 5 mins from the hospital I don't *really* have a problem with running in to check if it makes them happy (plus my doc has a toddler son and appreciates a "heads up" when I go into labor so that she can make sure her sitter gets there in time!) Damned if I'm going to spend my entire labor there though!!

I guess my question is, with a head-down baby does anyone know what the risk of cord prolapse with water breaking actually is? It seems to me that if you go in and they monitor for 20 minutes and everything looks fine, there's no reason to think the cord would randomly get caught later on...? Wouldn't the head keep that from happening?

[JessicaS]

Is there a reason you would be at risk for cord prolapse?

Unless you have excess amniotic fluid or some other issue the risks of prolapse are extremely low. If the baby is head down the risks are practically non-existent.

I can understand your Dr wanting a call if your water broke, but if you go to the hospital with ruptured membranes they are gonna want you to stay.

You can always tell your Dr you will call them when they break, but you are not going to the hospital

[AmyLaz]

With my first, my water was broken for 5 days before I went to the hospital (thought I was peeing on myself - didn't realize my bag had broken - no contractions). Baby was head down. When I went in, my doctor, who is very conservative, was just worried about infection - he never even mentioned possible cord prolapse.

[amyjeans]

Im not sure about the stats, but most babies are head down and engaged during the last few weeks of pregnancy- so you're right, the head should prevent prolapse.
My opinion- this is nothing more than a scare tactic from your dr. look what he made you do? worry!
I would start by questioning their reasons for making such a statement. do they have any concrete evidence to support that? you need to ejoy your pregnancy- not worry.
sorry for the rant- I dislike birth doctors.

[patchynurse]

I went in to get checked when my water broke because my son was not engaged. If you have a transverse or breech baby the risk of prolapse is higer but it's still uncommon.

[kltroy]

Originally Posted by amyjeans

I would start by questioning their reasons for making such a statement. do they have any concrete evidence to support that? you need to ejoy your pregnancy- not worry.
sorry for the rant- I dislike birth doctors.

Yes I think I will bring this up with her when I see her next time. FWIW, I completely dislike OBs (why would you want a surgeon delivering your baby?) - I had a great group of MWs lined up for my VBAC, but they lost their backup doc, who they require for VBACs. So I had to transfer care to my family practice doc, who is actually quite excellent and also very hands-off. This [go in when your water breaks] was the one thing she said to me that perplexed me - in every other regard she has been great and very much had the attitude that "it's your day and within reason you can do what you want."

I just looked up the stats and the rate of cord prolapse is about equivalent to that of uterine rupture - about 0.5% or less. ...I think I just need to clarify with her when we talk in a couple weeks.

[SophieAnn]

This question is in relation to your situation, but also in general (sorry if it's a stupid question)...

Cord prolapse is when the cord comes out before the baby's head (or bum/foot, etc.), right?

If the cord comes out.... wouldn't you see it.... dangling? Or is it possible to not be aware that it's happened?

[clutterbug]

Originally Posted by SophieAnn

This question is in relation to your situation, but also in general (sorry if it's a stupid question)...

Cord prolapse is when the cord comes out before the baby's head (or bum/foot, etc.), right?

If the cord comes out.... wouldn't you see it.... dangling? Or is it possible to not be aware that it's happened?

Yup, that is what a prolapse is. I think whether or not you could feel it would depend on how far down the cord came - I think it's possible for it to get "caught" between head and cervix, so not in the vagina, but still getting compressed. Or it can come right down into the vagina and then, yes, you would likely notice it was there.

At the hospital here they tell you to come in if you suspect your water has broken. I don't know how common it is to send people home again after they confirm it. My water broke a couple of hours before contractions set in when DS was born. I struggled with what to do...I knew he was engaged and wasn't worried about prolapse, and I also worried that going in would just set the clock running for them wanting to speed things up, even if they did send me home. So I stayed home till labour was in full force. The admitting nurse was less than impressed about this (she was less than impressed with lots of things I did!!) but no-one else even mentioned it.

[Astrogirl]

They are pretty careful about it here in Germany, which in my opinion and experience, is much more liberal about birth in general than in the U.S. I was strongly warned about it too, they advise that if your water breaks and you know the baby isn't engaged, to lay down. I'm no expert, and usually shun OBs 'advice' but I am VERY vigilant about the possibility of cord accidents and considering the previous conversations I had with my doctor about his views on birth, I paid heed. So when my water broke, I went to the hospital. They checked everything, deemed to be ok and I was free to go back home to labour.

Although somewhat rare (cord accidents being estimated to result in anywhere from 1 in 100 to 1 in 1000 stillbirths in the US, depending on who you believe/ask), I still feel the need to advocate that cord prolapse can and does happen and is very dangerous. In other words, i can't dismiss the fact that I would hate to be that 1 in 1000. HOWEVER, I did give birth at a very highly regarded yet homeopathic hospital here in Germany (Filderklinik, for those who like Google), and when I went to them to have it checked out, they weren't NEARLY as concerned as my doctor was. I do give them more credibility to the staff there then to my doctor (who rarely attends births, as is normal with OBs in offices in germany), so my final conclusion is that I need not have worried as much as I did.

[alegna]

I would not allow any vaginal checks after water breaking personally, unless there was a reason to suspect problems like prolapse.

-Angela

[veganf]

Never heard of water breaking as a risk factor for cord prolapse.
Mine has always broken as my first real sign of labor and I've never experienced anything like that.

[kltroy]

Originally Posted by alegna

I would not allow any vaginal checks after water breaking personally, unless there was a reason to suspect problems like prolapse.

-Angela

Right - I was told that they'd want to monitor the baby (EFM presumably) but that they would NOT do a vaginal check because of risk of infection. I agree with some PPs - it sounds like cord prolapse, when it actually does happen, is very very bad. Fortunately, it also seems to be pretty uncommon. Who knows... hopefully this won't be an issue and by the time my water breaks I'll be well into labor Just trying to figure out what a reasonable "plan of attack" is.

My FP actually said to me (when we were having this conversation yesterday) that she recently delivered a baby to a mom... mom went in b/c water broke. Had the kid 30 hours later after being told to go walk around the hospital for several hours. In my doc's opinion, mom should have checked herself out "against medical advice" and come back later. But technically she can't give that advice to a mom in labor.

[courtenay_e]

I would find out from her what the hospital's clock is for broken water...after how long are they going to be pushing for you to have the baby out, if they know your water is broken?...

[alegna]

No way I'd do that. That's just silly IMO.

-Angela

[Kidzaplenty]

Most hospitals or docs will not "let" you leave once the water has broken. And though you can leave AMA, they will give you a lot of flack about it, as well as potentially calling CPS (or at least threatening) and possibly even messing up your insurance payments because of it.

If you can avoid leaving AMA, I would, if possible. Though prolaps is a minor risk, I really believe the risks of going to the hospital early are higher. But that is just my opinion.

You may be strong, but I know too many women that were convinced to do what they had not wanted to do. And many or most docs, as well as nurses, are very good at coercing patients to do what they want them to. (Not necessarily a bad thing, because they have to deal with non-compliant and reluctant patients a lot, but at times it can be.)

[Jane]

If the baby's head is "Well applied" - ie, down into the pelvis, the way most babies are - the risk of cord prolapse is very low. The usual way midwives check is to ask you if you feel the baby moving. As in pregnancy, a compromised baby doesn't move any extra amount. A kicking baby is a healthy baby, very generally.

The scenario for a cord prolapse is that the baby is not down in the pelvis - perhaps a premature baby, and the water breaks with a big gush. Little trickles don't wash down the cord. And well-applied heads don't allow the cord to sneak through.

I wouldn't head in after my water broke if it was clear, didn't smell bad, wasn't premature, head in pelvis at last check, etc.

[mommathea]

To my knowledge, the risk of cord prolapse is if the head is not engaged at the time of the water breaking. The flush of fluid can wash the cord down. But if the head is down, and engaged, I wouldn't worry about it.