How long after water breaks is baby safe in utero? - Mothering Forums

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#1 of 25 Old 11-08-2007, 11:30 PM - Thread Starter
 
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I've been wondering this since my 1st birth, which was C-Section. I gave in and got an epidural (not doing this again) and after DD was not out 30hours past my water breaking, the hospital said they were afraid of infection setting in and it would be best to deliver via C-Section. Is this really true, or were they feeding me a line to get me "out"? Does anybody know?
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#2 of 25 Old 11-09-2007, 12:23 AM
 
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That's a line, yep. Sorry
http://www.joyousbirth.info/articles/isthataleak.html
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#3 of 25 Old 11-09-2007, 12:42 AM
 
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The risk of infection increases the longer your membranes are ruptured.

If your membranes rupture prematurely, it is generally accepted that it's better to wait until actual signs of infection show up vs. delivering a premature baby unnecessarily.

If you are term, current standard of care typically is that intervention is appropriate immediately with signs of infection and after 24 hours otherwise. The thought behind this reasoning is that baby is term, therefore almost assuredly 'ready' in terms of lung maturity, so the increased risk of infection is not worth prolonging pg further.

That said, there are plenty of women who have ruptured membranes at term for several days without complications. I think if a woman wishes to avoid intervention once her membranes have ruptured, it is *critical* that nothing enters the vagina. No vaginal exams period. That alone reduces the risk of infection tremendously, combined with careful monitoring for signs of infection, and it's certainly reasonable to 'manage' prolonged ruptured membranes without pulling out the big guns.
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#4 of 25 Old 11-09-2007, 01:21 AM
 
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Well I can tell you is mine was ruptured for 72 hours before ds was born VBAC and we had no infection. The first 36 hours were spent at home and the second at the hopital with some vaginal exams.

Angie wife to Joe and Mom to Lucas(10) and Alex (7), Elizabeth (4), Joey (2), and #5 due May 29
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#5 of 25 Old 11-09-2007, 01:29 AM
 
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With DS2 my water was broken over 4 days before they took him. It was fine.

~Marie : Mom to DS(11), DS(10), DD(8), DD(4), DD(2), & Happily Married to DH 12 yrs.!
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#6 of 25 Old 11-09-2007, 01:58 AM
 
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Another factor would have been if you had had a group B strep test that showed positive. Or if you had any symptoms of fever. They would not have wanted to wait at all. It varies state by state it seems, with bylaws or hospital procedure policy. I believe in one state it is 24hrs and mom must be in active labor proving birth imminent, and definitely no vag exams or baths even until active labor. And then on the other hand I have known several womyn who have had small leaks, or tears that have seemingly resealed or gone 36hrs, or more with water broken and never had a problem. I think it's hard when policy states a hard and fast rule when everyone is so different and that may have been a perfectly normal part of your process.
Wifeandmom hit it when she said:
" No vaginal exams period. That alone reduces the risk of infection tremendously, combined with careful monitoring for signs of infection, and it's certainly reasonable to 'manage' prolonged ruptured membranes without pulling out the big guns."
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#7 of 25 Old 11-09-2007, 06:43 AM - Thread Starter
 
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Awesome... I can't thank you ladies enough for this great information! I have been wondering this since my last birth, and it's nice to finally put it to rest, and relax a little if this happens again. It will be tough not to get any exams to confirm how many cm I am, but I am sure they'll be able to tell (as will I) when I'm transitioning, ready to push, etc..

THANK YOU!!
Cindy
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#8 of 25 Old 11-09-2007, 03:19 PM
 
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The big thing to remember is nothing in the vagina after the h2o breaks. Most often signs of infection will show up in the first 12 hours. I did have iv antibiotics with my last after my h2o was broken for over 18 hours but this was really just a precausionary measure and my MW now will not even consider it until after 24 hours of ruptured membranes and no active labor, otherwise its a wait and see kind of thing.

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#9 of 25 Old 11-09-2007, 08:32 PM
 
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Current NICE (National Institute for Health and Clinical Excellence) guidlelines state that women should be monitored for infection only after 96 hours. This is the guideline followed throughout Europe, but American doctors seem to be far more cautious. I totally agree that the risk of infection is from vaginal exams, not from the membranes rupturing.

I'm sorry; I know how it feels to realise that you've been "duped" into a c-section. Big hugs to you.
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#10 of 25 Old 11-09-2007, 09:05 PM
 
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I was also "duped" ... but for swelling, not for ROM.

-Iris
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#11 of 25 Old 11-10-2007, 12:54 AM
 
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Originally Posted by PixieStix View Post
Current NICE (National Institute for Health and Clinical Excellence) guidlelines state that women should be monitored for infection only after 96 hours. This is the guideline followed throughout Europe, but American doctors seem to be far more cautious. I totally agree that the risk of infection is from vaginal exams, not from the membranes rupturing.
.
A quick Google turned up this link:

http://www.nice.org.uk/guidance/inde...wnload&o=28988

If you click on the full PDF file, on page 20, it says the following:

Quote:
Women with prelabour rupture of membranes at term (over 37 weeks) should be offered a choice of immediate induction of labour or expectant management.

Expectant management of women with prelabour rupture of membranes at term should not exceed 96 hours following membrane rupture.
This is straight from the NICE website, though it lists this particular set of guidelines from 2001 for induction guidelines. Have the guidelines changed so drastically in 6 years that they now say what you suggested...that you need not even MONITOR for signs of infection until 96 hours have elapsed?

Compared to the 2001 guideline that expectant management should not exceed 96 hours, I'd say that not doing anything at all until 96 hours has elapsed would be a drastic change and would be interested to know what research led them to making such a change.

I'd guess that they haven't made such a change, but perhaps I'm wrong.
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#12 of 25 Old 11-10-2007, 04:57 AM
 
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Those are some of the guidelines in the link I posted HWL here 8 days before labour, resealed, membranes went with a POP at transition two days later. Timetables are not helpful to anyone.
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#13 of 25 Old 11-10-2007, 03:08 PM
 
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Originally Posted by JanetF View Post
Timetables are not helpful to anyone.
Even when those timetables are supported by research?

Fact is, there comes a point when expectant management of ruptured membranes carries significant risk to both mom and baby. If *you* are cool with taking those risks, so be it. But there DOES come a point where the risks outweigh the benefits, assuming of course that a healthy baby and healthy mom are more important than 'the perfect birth'.

For those women who believe that 'the perfect birth' is more important than anything else, I suppose it wouldn't matter WHAT research said, they'd rather take whatever chances necessary to achieve their goal. That's certainly their perogative, but for someone to come on here claiming that current guidelines suggest not even monitoring for infection for 96 hours post ruptured membranes is completely untrue.
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#14 of 25 Old 11-11-2007, 08:38 PM
 
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Originally Posted by wifeandmom View Post
but for someone to come on here claiming that current guidelines suggest not even monitoring for infection for 96 hours post ruptured membranes is completely untrue.
Whoa. Obviously I was mistaken - I was careless with my wording and research.

My waters went three days before I gave birth. My midwife gave me some photocopied documents from NICE outlining current recommendations for ROM at term, and these documents stated that the "limit" should be 96 hours.

So I will reword my previous message. In my personal experience, I was advised that I could consider going into hospital to be montiored (NST etc) after 96 hours, which accoring to my midwife, was in accordance with NICE guidelines.
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#15 of 25 Old 11-11-2007, 09:07 PM
 
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Even when those timetables are supported by research?
No timetable can be supported by research. Each woman is unique and thus there is only the timetable of her own body and baby. It doesn't make any sense and it's peddling misinformation.
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#16 of 25 Old 11-11-2007, 09:35 PM
 
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Originally Posted by PixieStix View Post
Whoa. Obviously I was mistaken - I was careless with my wording and research.
I figured as much, but there are people that read stuff here and take it for gospel. It's important, IMO at least, to have correct information. It could save someone's life.

Quote:
So I will reword my previous message. In my personal experience, I was advised that I could consider going into hospital to be montiored (NST etc) after 96 hours, which accoring to my midwife, was in accordance with NICE guidelines.
Clearly your midwife was wrong.

I am happy that you ultimately had a positive outcome. Others have not been so fortunate, and it truly disgusts me to see people being so incredibly supportive of actions that are clearly not supported by research of any kind, any where.
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#17 of 25 Old 11-11-2007, 09:40 PM
 
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Originally Posted by JanetF View Post
No timetable can be supported by research. Each woman is unique and thus there is only the timetable of her own body and baby. It doesn't make any sense and it's peddling misinformation.
That's BS and you know it.

What's the point of research if it's useless in giving us timetables?

I did not suggest that ALL women would follow a certain timetable to the letter every single time, but to say that timetables are useless and can never be supported by research is crazy.

Let's see, off the top of my head, research has given us a timetable for the average length of pregnancy, the average time it takes for hcg to rise in early pg, the average hcg for a viable pg, the average time to expect cardiac activity via transvaginal u/s, the statistical chance of serious complications if a pg is allowed to continue past 42 weeks, etc etc etc. All timelines, all clearly supported by research.

You may not LIKE that there are timelines for ensuring the best outcome, but that certainly doesn't make the facts go away.
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#18 of 25 Old 11-12-2007, 01:20 PM
 
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There's a reference about this in Jennifer Block's book "Pushed". The ACOG guideline is 24 hours, but that is because docs tend to meddle and do internal exams at some point. And when that happens the risk of infection DOES go up after 24 hours.

A paper referenced in Pushed says that there's no increased risk of infection for up to 4 days AS LONG AS no internal exams are done. That said, if there's meconium, I'd personally be a little concerned about the baby.

Incidentally, for those of you who are research- minded, you might be interested in the following paper, titled "Why Most Published Research Findings are False" (this is a serious paper)
http://medicine.plosjournals.org/per...d.0020124&ct=1

Makes you take ALL clinical studies with a grain of salt

Mom to James (ribboncesarean.gif 5/2006), Claire (vbac.gif 6/2008), furry kitties Calvin and Bob, and wife to Dennis. 

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#19 of 25 Old 11-12-2007, 10:18 PM
 
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With my ds, my water had been broken for 44 hours before he was born, once I arrived at the hospital 24 hours after my water broke (based on my midwife's rec.) they just gave me antibiotics for the possibility of infection, but weren't real concerned.

Kenzie & Jesse (WA 8-14-2009) : Kimmy (BD 3-5-00) & Josh (BD 7-28-05) :::
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#20 of 25 Old 11-13-2007, 01:55 AM
 
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Originally Posted by wifeandmom View Post
But there DOES come a point where the risks outweigh the benefits, assuming of course that a healthy baby and healthy mom are more important than 'the perfect birth'.

For those women who believe that 'the perfect birth' is more important than anything else, I suppose it wouldn't matter WHAT research said, they'd rather take whatever chances necessary to achieve their goal.
Which women would those be? I'm sure there are those who think that's what I did. But, you know...for some of us, crippled up by pain for weeks, limited by nerve damage for months (or years or forever), unable to parent properly due to PPD and PTSD...that's not a healthy mom.

One of the biggest problems with the whole "healthy baby and healthy mom" mantra is that it's based on the assumption that the best person to assess whether or not the mom is healthy is a third party. The mom's opinion on the subject is considered irrelevant. Why on earth would any mom pursue a "perfect birth" at the expense of her own health??

Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

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#21 of 25 Old 11-13-2007, 01:58 AM
 
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my moms water broke at 34 weeks with my sister, and they let her keep her in for 4 days before using pitocin for non-progression. They kept trying to stop my moms labor because they wanted the babys lungs to develop in utero before she was born.. but i dont think thats common practice in a hospital... i think at like 24 hours they start telling you its dangerous

Artie, mom to Riley 3/22/08 and a surprise due Oct 2011!
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#22 of 25 Old 11-13-2007, 03:21 AM
 
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my moms water broke at 34 weeks with my sister, and they let her keep her in for 4 days before using pitocin for non-progression. They kept trying to stop my moms labor because they wanted the babys lungs to develop in utero before she was born.. but i dont think thats common practice in a hospital... i think at like 24 hours they start telling you its dangerous
Treatment protocol for premature ROM is drastically different than term (37+ weeks) ROM. Research supports attempting to keep baby in utero with ruptured membranes if the pg is less than 37 weeks. Research does not support the same for term pg.

From the links provided, it seems that research indicates delivery should be imminent within 24 hours of the first vaginal exam (there's a good reason not to do an exam, only I question the issue of potential prolapsed cord with SROM going undetected until it was life threatening) and/or delivery should be imminent within 96 hours of SROM.

I've yet to see anything advising that it's prudent to wait more than 96 hours post-SROM in a term pg.
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#23 of 25 Old 11-13-2007, 03:23 AM
 
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Which women would those be? I'm sure there are those who think that's what I did. But, you know...for some of us, crippled up by pain for weeks, limited by nerve damage for months (or years or forever), unable to parent properly due to PPD and PTSD...that's not a healthy mom.

One of the biggest problems with the whole "healthy baby and healthy mom" mantra is that it's based on the assumption that the best person to assess whether or not the mom is healthy is a third party. The mom's opinion on the subject is considered irrelevant. Why on earth would any mom pursue a "perfect birth" at the expense of her own health??

I sent you a PM. I will not address your questions here under the circumstances.

I am very, very sorry that your son died.
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#24 of 25 Old 11-13-2007, 06:34 PM
 
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Quote:
Originally Posted by wifeandmom
But there DOES come a point where the risks outweigh the benefits, assuming of course that a healthy baby and healthy mom are more important than 'the perfect birth'.

For those women who believe that 'the perfect birth' is more important than anything else, I suppose it wouldn't matter WHAT research said, they'd rather take whatever chances necessary to achieve their goal. That's certainly their perogative, but for someone to come on here claiming that current guidelines suggest not even monitoring for infection for 96 hours post ruptured membranes is completely untrue.
Most of this sounds like your own value judgements on other people. It's fine that YOU don't agree with what others might find perfectly acceptable, but to make the above statement is only your interpretation of the way things are as an outsider.

Quote:
Originally Posted by wifeandmom
I am happy that you ultimately had a positive outcome. Others have not been so fortunate, and it truly disgusts me to see people being so incredibly supportive of actions that are clearly not supported by research of any kind, any where
That's certainly your opinion. YOU may not be comfortable with taking actions that are "clearly not supported by research of any kind, any where", but that doesn't mean that others walk the same line you do.

Quote:
Originally Posted by wifeandmom View Post
Let's see, off the top of my head, research has given us a timetable for the average length of pregnancy, the average time it takes for hcg to rise in early pg, the average hcg for a viable pg, the average time to expect cardiac activity via transvaginal u/s, the statistical chance of serious complications if a pg is allowed to continue past 42 weeks, etc etc etc. All timelines, all clearly supported by research.

You may not LIKE that there are timelines for ensuring the best outcome, but that certainly doesn't make the facts go away.
The key to the above paragraph is the word "average"...meaning:

Quote:
a single value (as a mean, mode, or median) that summarizes or represents the general significance of a set of unequal values.
I don't see how that "ensurres" the best outcome. And fwiw, I think it's ridiculous that anyone tries to "ensure" anything when it comes to birth - talk about trying to control the unpredictable.
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#25 of 25 Old 11-13-2007, 06:50 PM
 
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I've been wondering this since my 1st birth, which was C-Section. I gave in and got an epidural (not doing this again) and after DD was not out 30hours past my water breaking, the hospital said they were afraid of infection setting in and it would be best to deliver via C-Section. Is this really true, or were they feeding me a line to get me "out"? Does anybody know?
IT'S DEF TRUE! MY WATER BROKE AND MY BABY WAS BORN 38 HOURS LATER, WE BOTH GOT INFECTIONS AND HE WAS IN THE NICU FOR 6 DAYS IF I WAS IN THE SITUATION AGAIN I WOULD IMMEDIATELY ASK FOR PITOCIN TO SPEED IT ALONG!

me, dh and 2 boys = our family (oh and a cat...who is also a male...lol)
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