Info on PROM with meconium & inductions? - Mothering Forums

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Old 01-20-2007, 01:37 AM - Thread Starter
 
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This is what happened with my last birth, and one intervention after another it ended up with a c/s. I'm hoping someone will be able to answer whether they believe it was necessary to induce (pitocin) after PROM at 41 weeks?

Though I had been contracting the whole week prior (painfully with no consistency) my cx stopped just before my water broke (with meconium) and I was induced 3 hours later when we arrived at the hospital.

I know there are risks with meconium, and I think it was probably necessary, but I just want to make sure for future reference.

Thanks!!
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Old 01-20-2007, 02:12 AM
 
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I would have waited to start pitocin for at least 12 hours and possibly 24 if the baby's non stress test was ok. Meconium in and of itself is not a danger sign, especially at 41 weeks.
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Old 01-20-2007, 11:49 AM - Thread Starter
 
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I read somewhere else on this board that clean water can prevent infection for 24 to 48 hours (or longer), but if there's meconium in it, the amount of time is reduced significantly (I believe 4 hours was given?).

Is that at all accurate or were they talking out of their butts? :P

My c/s ended up being for fetal distress ultimately... his h/r was below 70 for a couple minutes, but I can't help but wonder if that had to do with the pitocin, eventual epidural and the fact that I already have blood pressure on the average to low side (110/55 is normal for me) and it just really dropped afterward. Oh, the cord was around his neck 3 times too... so I guess I'll never know what REALLY happened.
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Old 01-20-2007, 12:17 PM
 
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Simple broken waters with slight mec is not particularly worrisome, but that's only a small bit of the entire picture. Broken waters with no labor and mec staining makes me think, Hmmm, what else is going on with this baby?

How much mec?

How dilated/effaced a cervix after a week of on/off contractions?

Was there a fever? Infection?

How was baby's heart rate, before contracting and after contractions were induced?

How low did baby engage?

How dilated/effaced after pitocin was started?

How did you feel, physically, after a week of contracting?

The pregnant body is very wise and self-preserving, and it wants to keep the baby safe. Was the mec the baby's response to not tolerating the contractions well, and did your body stop contracting because it wanted to protect your baby from harm?

PROM can sometimes be a sign of an infection, healthy membranes are not supposed to break without significant pressure from good, strong contractions. Meconium is sometimes a response to maternal infection, even low grade fevers can cause distress in a baby, causing release of meconium and tachycardia.

I could'nt possibly say if the induction and ultimately the c-section were necessary or not without seeing the whole picture.
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Old 01-20-2007, 03:53 PM - Thread Starter
 
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Thanks so much for looking at this. This is really part of the healing process for me I think. I know I tend to overanalyze things (it's my nature), but I really feel like I need to know what the chances are that the c/s could have been prevented and I'm really beating myself up thinking about "what if" I hadn't had the epidural...

Here are the answers to those questions from my previous birth....

How much mec? Can't really answer because I have nothing to compare it to, but I had a lot of water (I think my BPP said it was at 24 or something) so it was probably not too concentrated.

How dilated/effaced a cervix after a week of on/off contractions? .5 cm dilated and zero effacement and -3 station, when we got to the hospital...

Was there a fever? Infection? Nope, no fever, no infection (that I'm aware of). I felt perfectly fine and they never mentioned anything.

How was baby's heart rate, before contracting and after contractions were induced? His heart was going up and down fairly randomly (between 110 and 160) before they gave me pitocin (the nurses said it was a good thing though)... afterwards it continued to get worse consistently and pretty much crashed once I got the epidural.

How low did baby engage? I believe he ended up getting to -1 or 0 station, 12 hours after induction and 15 hours after my water broke - he was born posterior and asynclitic though... the nurses called him a BRAT! LOL!

How dilated/effaced after pitocin was started? When they wheeled me in for the c/s I was at 5.5-6cm and had been stuck there for 5 hours (3 of those being with an epidural). My "transition" like contractions ended up starting when I was 4cm, one on top of the other, with tremendous back labour that didn't let up between contractions... hence, epidural after only two hours of this esp. since there was absolutely no progress being made (though I had VERY poor support- none actually... I wouldn't "let" anyone touch me or talk to me...)

How did you feel, physically, after a week of contracting?
I felt alright... at that point I was totally filled with adrenaline because the day was FINALLY there. I only truly laboured for about 12 hours in total before the c/s though, so it wasn't that long.
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Old 01-20-2007, 04:50 PM
 
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Honestly, from what you have said, it seems like you didn't have a very happy baby in there. My first thought would be he was really gift-wrapped in the cord and your body was really working hard at keeping him high (-3) and safe. I don't think the epidural caused the crash, (and an exhausted, unrested, stressed out mama isn't good for baby either) but rather the force of the contractions which brought him lower and compressing his cord. His position at birth is also typical of a baby hung up in his cord and unable to move into a good position. Whether you had labored naturally or with pitocin wouldn't have made much difference with a baby that was wrapped very tightly in his cord. Maybe the distress and c-section would have been delayed without pitocin, maybe you wouldn't have had a section at all. But there are, as always, a lot of "what-ifs".

I think that your body, in it's innate wisdom, kept your baby safe and high by not progressing (don't for a minute think your body wasn't working properly! It was, but in a way that kept your baby safe!). And it seems your hospital staff and yourself did everything possible to help you have a safe, vaginal birth and acted appropriately. Be proud of your wise mamabody and be comforted knowing that it's very, very unlikely to happen that way again.
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