How long can one wait on antibiotics with leaking amniotic fluid?

[skg_7]

I've been leaking amniotic fluid -- little by little in the arena of maybe 1/4 teaspoon every hour or so that I'm up and walking around (it doesn't happen when I'm laying down) -- since Tuesday evening.

I am in early labour with mild contractions since about 10pm Wednesday evening, and the contractions have bee strengthened somewhat but not really significantly by Blue & Black Cohosh at my midwife's request. Started that at about midnight and have just taken the last dose. She started me on it due to concerns about non-progressing labour with a small rupture in the membrane. She's concerned about infection. We did not do the GBS test. I'm 38.5 weeks.

I know she'll want to do IV antibitoics every 6 hours starting a few hours from now when daylight rolls around and she comes back to my house.

My question to all of you is, with a slow leak, would you be comfortable foregoing the antibiotics for longer to give labour a chance to progress, or no? My m/w seems to say that the results of an infection could be devastating and thus it's better to play it safe. I feel uninformed. I just know that I'm not crazy about the antibiotics idea for obvious reasons.

Oh -- and secondly, what can I do to avoid ending up in the hospital with a pitocin drip? I'm discouraged because I haven't had a good contraction in over an hour now, in spite of the cohosh.

Thanks, all. Really respect and appreciate your input.

[MamaHen2J&J]

No good advice... My mind is jello with irregular, strong contractions...

I had a slow leak with my first and it lead to a pitocin drip... I don't recall if they started antibiotics...

Anyways, sorry rambling...

I sure hope things pick up... Labor vibes coming your way...

I'm not sure how long I would feel comfortable...but I would think if your careful, keeping the area clean, no vaginal checks and you monitor any slight changes in temperature you could go awhile... I had a girlfriend just recently go three days...under the care of a midwife.

BEST wishes, keep us updated!!

[StacyL]

Personally, I would not worry about a slow leak nor try to "speed" things along. But that's just me.

I also would not worry about antibiotics.

The percentage of women who are positive and pass on the infection is extremely low, and the effectiveness of the anti-biotics given prophylactically is very poor.

Here's an article you can look at to be more informed and discuss with your MW:

http://www.mothering.com/articles/pregnancy_birth/birth_preparation/group-b.html

A study of 43 newborns with blood infections caused by GBS and other bacteria found that, when the mothers of the ill newborns had been given antibiotics during labor, 88 to 91 percent of the infants' infections were resistant to antibiotics. It is unlikely to be a coincidence that the drugs to which the bacteria showed resistance were the same antibiotics that had been administered during labor.24 For the newborns who had developed blood infections without exposure to antibiotics during labor and delivery, only 18 to 20 percent of their infections were resistant to antibiotics.

In the absence of the first three risk factors (fever during labor, PROM, or labor before 37 weeks), the risk of a newborn developing GBS infection is very small. The CDC estimates that, without the use of antibiotics during labor, only one out of every 200 GBS-positive women without these risk factors (0.5 percent) will deliver an infant with GBS disease. Some studies have found even lower rates of transmission.

[Twwly]

Can she test you for GBS now to see if the ABX are warranted?

[klink2]

Regarding the quote from the Mothering article, it seems that the concern in this case is that the OP does have one of the three risk factors--PROM, since she's been leaking since Tuesday.

[madiesmommy]

There are many ways to try to speed things along naturally. Black and blue cohosh are one way, there are several others. I would avoid those that involve getting anything near the open amniotic sac, like sex, but surely some nipple and lower stimulation might help.

Good luck! I know you will feel the pressure to get abx from your mw, but you have the decision.

[mousebandit]

Hey there! I'm in your ddc and came over here from there. This is pretty close to what I just went through. The problem with doing the GBS now and waiting on the results is that they take 48 hrs for even a preliminary result, and most midwives (certainly all docs) would want you delivered before then - usually WAY before then.

We broke our water, with significantly more fluid loss than what you're describing, and went ahead and did the abx (IV) for 48 hrs while waiting on a GBS result. It came back negative, and we went another 6 days (8 days total) before I had any infection set in. And I had NO labor whatsoever until about 8 hours AFTER I started showing signs & symptoms of infection. We were super careful with hygeine - bathroom and bedroom scrubbed til they shined (by hubby, not me - I was confined to bed), lysol spray everywhere LOL, NOTHING touching me down there except water with a little betadine from the peri bottle, and wiping after potty as needed. NO baths, NO exams, NO sex, etc. Fresh pad every two hours whether I needed it or not (I usually did).

You CAN certainly go more than 24 or 48 hours without getting an infection, without antibiotics. There's no guarantee, though, and that's why medical practitioners get antsy, and want you to just deliver - because they know the baby will do fine once out (as long as you're term or close to it). It's definately a personal call - I've heard stories that infection can be set in and baby in trouble long before mama shows any signs or symptoms, and I've heard just as many about mama waiting for labor to get rolling on it's own and never did have any infection. In my experience, I had plenty of time, and it made all the difference in the world (our LO was born at 34w6d and got apgars of 9/9).

I would say trust your instincts - we were all about going home from the hospital and waiting it out, until about 3 days before she was born. Then all of a sudden, we got really anxious, felt like we were pushing our luck, second guessing ourselves, etc. Turns out, that's most likely when the infection started setting it, and it just took 3 days for me to show any sign of it and for it to start impacting the baby. If you feel really confident about waiting, then wait! If you feel really nervous, then kick those natural induction techniques into high gear. If you've been having some contractions, there's a good chance that you're close to being ready anyways, and they'll work. Look up the Gentle Birth archives for lots of natural induction ideas, and share them with your midwife. If you're COMMITTED to delivering within a certain time frame, she may want to do an internal exam and put some EPO on your cervix, etc. BUT, only consider that if you're prepared to hit the hospital and pit drip in a certain number of hours, because internals are exactly how women DO get infections.

Anyway, I hope it all goes the way you want and can't wait to hear about your new little baby!

Tracey Mouse