Water broke, options limited, any advice? - Mothering Forums

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#1 of 14 Old 03-22-2009, 04:27 PM - Thread Starter
 
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Hi All,

I'm feeling nervous so I'm just looking for any advice you may have:

I was set to birth at a birth center with CNMs near my house. It's the best alternative that my insurance would cover. This is my first pg. My confidence in them waned each time I went for an appointment as I learned more about natural childbirth.

Thurs: My 38 week appt at the birth center. Midwife cannot find heartbeat with doppler. I feel baby crawling away from doppler each time she pokes it into my stomach. Also, baby hates it when I lie flat on my back and flails around. Midwife acts a little panicky, then finally finds heartbeat, but says the position of the heart is too high on my belly and fears baby may be breech. I assure her that baby has not turned breech. She feels belly and agrees, then says she needs ultrasound to be sure. Does ultrasound. She says baby is head down but not engaged in my pelvis. Oh, by the way, your lab came back GBS+, so you have to have IV antibiotics during labor, blah blah blah... (other stuff too not worth writing out here).

Friday: I developed hemoroids during 3rd trimester, and the pressure on my bum tonight is very uncomfortable. I'm pooping very often. It hurts to walk very far. I take a warm bath and go to bed at 2am.

Saturday: At 4am my water breaks with a gush. No contractions. Pressure on my bum is relieved and I can walk just fine.

It is now 32 hrs later, water is still leaking periodically in small gushes. No contractions. I feel that the birth center is out of the picture now, because their policy is abx during labor for GBS and I am not going to do that. They also have a 24-hour limit for ROM to delivery, after which they transfer to hospital. Of course I could lie about the time, but the abx is already the major problem.

Now I think my only good option is UC but I'm very nervous because I haven't planned for it. What do you think the chances are that if I showed up at the birth center in late stage of labor and refused abx, that they would A) refuse to treat me and send me to the hospital or B) deliver the baby there but threaten or try to send the baby to the hospital for observation? I am just looking at this as a back-up option but should I just forget it and consider the hospital my back-up? It's making me worried because this all happened so suddenly and now my water has been broken a long time and I still am not sure what to do.

Also I thought the discomfort on my bum was due to the baby's head engaged. Seems like it was just my bag of water since that went away when my water broke. Now I am concerned that I am nowhere near labor, head not engaged just broken water, and I have no one to turn to for medical advice. Any thoughts?
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#2 of 14 Old 03-22-2009, 04:35 PM
 
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It sounds like labor is going to happen soon.

Honestly, I'd be uncomfortable going to the birth center without following their protocol. If they think you need abx in labor, and you show up too close to birth to recieve them, they're likely to ship the baby over to the hospital "for observation" where they might give the baby propholactic abx just because you're GBS+. If you refuse, the may contact CPS.

IMO, either you birth in their space and follow their rules, or you stay away completely, and bring the baby for a newborn evaluation when he or she is past the GBS worry zone (unless, of course, you really do see signs of the baby needing help.)

Ruth, single mommy to Leah, 19, Hannah, 18, and Jack, 12
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#3 of 14 Old 03-22-2009, 05:27 PM
 
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Oh lady, I'm sorry for this last minute stress....were I in your situation, I would stay put and have that baby at home...IF IF IF IF I really felt comfortbale with a UC.

You really need to turn inward right now and examine how you are feeling about this, your gut will tell you what you need to know...it's okay to trust your own judgement, you are this LOs mama, you HAVE to trust your own judgement when it comes to making decisions for your body and babe.

I know you will find peace in whatever you do....breath really deep, remember that your body knows EXACTLY what to do...are you feeling good movement? My waters broke 31.5 hours before my babe was born....the first 30 hours of labor were long and uneventful...I thought she would never come. At 30 hours, I was dilated to about 5cm (that was the only time we checked, so I don't know how long that really took) and then 1.5 hrs after that, I was holding a baby. The last hour, she came so hard and fast.

So, don't worry....your body is gearing you up, your baby is getting ready...this long wait may not mean a long long "active" labor! (I say "active'" with a bit of sarcasm, because even the less "interesting" stuff your body is doing is actually active, it is moving you closer to breathing that baby down and out...even the smallest thing, is your body making a safer and more comfortable way out for that babe of yours!)

GL Mama, we're here for you. REally listen to your heart....find a quite place and listen to your heart....listen to your body, do a "systems check"...how does everything feel? Is every part of you sure of what you want?

You're going to be great, no matter what you choose! ::

Me and DH ...lovin' DD dust.gif(6/08) and DS kid.gif(11/09) Plus NEW BABY!! DD baby.gif (UC-5/12) We heartbeat.gif Water Birth/Homebirth/No Vax or Circ/BF/BW/Country Livin'! chicken3.gif

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#4 of 14 Old 03-22-2009, 07:32 PM
 
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Do you know what to look for in your baby in case he/she gets infected with gbs? Do you feel comfortable watching for signs of it yourself or do you feel like you need a professional to keep an eye on the baby? How do you feel about UC'ing? Are you considering it just because you don't like your other options, or does something about it appeal to you?

At the very least. follow the protocols for having your water broken (vitamin C, temperature checks & *nothing* in your vagina) until you figure out what you want to do.

mom to all boys B: 08/01ribboncesarean.gif,  C: 07/05 uc.jpg, N: 03/09 uc.jpg, M: 01/12 uc.jpg and far too many lost onesintactlact.gifsaynovax.gif

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#5 of 14 Old 03-22-2009, 08:52 PM
 
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I would be very, very concerned about the GBS with pre-labor rupture of membranes. Infection can be a reason for the membranes to rupture, and even in cases where it isn't the cause, infection is made more likely by prolonged pre-labor rupture. GBS doesn't cause neonatal infection very often, but when it does, it's quite serious. Especially considering you are not prepared, mentally or emotionally, for a UC, I would recommend going to the birth center and getting the antibiotics there. It's not that big of a deal, and it stands to relieve a great deal of anxiety, which should facilitate your birthing.
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#6 of 14 Old 03-22-2009, 09:47 PM
 
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Originally Posted by kaylee18 View Post
I would be very, very concerned about the GBS with pre-labor rupture of membranes. Infection can be a reason for the membranes to rupture, and even in cases where it isn't the cause, infection is made more likely by prolonged pre-labor rupture. GBS doesn't cause neonatal infection very often, but when it does, it's quite serious. Especially considering you are not prepared, mentally or emotionally, for a UC, I would recommend going to the birth center and getting the antibiotics there. It's not that big of a deal, and it stands to relieve a great deal of anxiety, which should facilitate your birthing.
I completely agree.
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#7 of 14 Old 03-22-2009, 09:49 PM
 
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I was just trying to figure out... what would the negatives of antibiotics for GBS be? The reason I am wondering is that GBS is like the ONLY reason I have in mind right now for being in the hospital when I birth. A homebirth midwife told me that one of the babies she delivered got GBS and ended up dying, so for me that was a big one that would send me to the hospital and I plan to get tested... yes I HOPE that I won't have it but I was wondering if anyone knows reasons why NOT to get antibiotics if you are GBS+????

To Butters..... GOOD LUCK having the non-interventive birth you want! I am thinking of you!

Angela lactivist.gif, married for 14 1/2 years to DHtwins.gif, mother to DD 8-5-97homeschool.gif, DS 8-5-09 uc.jpgbabyf.gif, and SURPRISE!!! pos.gif due 2-17-12

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#8 of 14 Old 03-22-2009, 10:02 PM
 
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If you haven't already read the mothering Article on GBS you really should.

http://www.mothering.com/articles/pr...n/group-b.html

I had a UC while I was GBS +. My labour was much different. But my plan was to watch my temperature. In some countries they only give ABX under certain circumstances not to every GBS+ mother. One was if the mothers temp was up and if they were delivering before 36 weeks and if the waters were broke for more than I forget how many hours.

Wife to DH, Mom to my Intact Boys DS1: Born 02 Pain Med Free Hospital Birth, BF'ed for 9 Months, Partially Vax'd DS2: Born 06 via UC, BF'ed 3 years 10 months, and UnVax'd
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#9 of 14 Old 03-22-2009, 10:08 PM
 
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PROM and GBS positive is a reason to prophylax. I have seen a baby go from apparently healthy to septic and extremely sick in six hours from GBS. It's not a plot. It really can cause severe illness and death. Please reconsider not contacting your providers. Birth experience is one thing. A badly-damaged baby is another.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#10 of 14 Old 03-22-2009, 10:55 PM
 
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Originally Posted by maxmama View Post
PROM and GBS positive is a reason to prophylax. I have seen a baby go from apparently healthy to septic and extremely sick in six hours from GBS. It's not a plot. It really can cause severe illness and death. Please reconsider not contacting your providers. Birth experience is one thing. A badly-damaged baby is another.
I'm gonna have to agree here.
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#11 of 14 Old 03-23-2009, 12:34 AM
 
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I've read the article. ButtersChloe, you've had broken waters for far longer than the 18 hour interval that the article lists as a risk factor for GBS infection of the newborn, meaning that you're not in the group of candidates for routine prophylaxis anymore. You're in the group for which prophylaxis is indicated.

The article mainly discusses routine prophylaxis of all GBS+ mothers, not those with other risk factors. Other risk factors change all the numbers and make the benefits much greater than the risks.

The article is also misleading in a few areas when it discusses the research on GBS. For example, this study:

nature.com/jp/journal/v19/n5/abs/7200191a.html

is given as Reference 11, and characterized in the article as finding no significant difference in infection or fatality rates between infants of treated and non-treated mothers. When you read the study, you see that only 55 mothers total of infected babies were included: 35 in the control group, and 20 in the study group.

Over 14% of the babies in the non-treated group who got GBS died.

None of the babies in the treated group who got GBS infection died.

The groups weren't big enough to determine whether that change could have been due to chance: 20 treated patients was too small for the researchers to say with 95% certainty that there was a significant difference - they could only be 91% certain that the drug saved those babies' lives. Still, to characterize that 0% fatality rate as definitely not different from a 14% fatality rate is misleading at best.

The article also didn't discuss effects of GBS infection other than death. GBS infection can cause lifelong disability as well.

I don't support the policy of universal routine treatment of GBS+ mothers, but I think the article swings too far in the opposite direction. I can share more of my thoughts on this if anyone is interested, but this is probably too long of a post already.
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#12 of 14 Old 03-23-2009, 12:37 AM - Thread Starter
 
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Originally Posted by gossamerwindweb View Post
I was just trying to figure out... what would the negatives of antibiotics for GBS be? The reason I am wondering is that GBS is like the ONLY reason I have in mind right now for being in the hospital when I birth. A homebirth midwife told me that one of the babies she delivered got GBS and ended up dying, so for me that was a big one that would send me to the hospital and I plan to get tested... yes I HOPE that I won't have it but I was wondering if anyone knows reasons why NOT to get antibiotics if you are GBS+????

To Butters..... GOOD LUCK having the non-interventive birth you want! I am thinking of you!
Here is a quote from the mothering article that MyBoysBlue refers to below: "Approximately 0.5 percent of women found to have GBS bacteria in their genital areas at 35 to 37 weeks into their pregnancies will go on to deliver a baby who becomes ill from GBS. This is 0.5 percent of women who receive no antibiotics during labor and delivery. "

I am allergic to penicillin. At the birth center they said they would give me some substitute - whatever they have on hand. I have read that if not giving penicillin, for it to be effective they have to culture your specific type of GBS to find out what is most likely to knock it out. They are not going to do that. The birth center midwives don't care about studies, research, or actually lessening my chances of infection, they just care about their policies and procedures being met.

I have read some threads on this message board about the consequences of taking the antibiotics being greater than the risk of infection. Thrush and secondary infections in mother and baby. I also wish they had bothered to pick up the phone and tell me that I tested + for GBS so that I could have had time to do some herbal and homeopathic remedies before my water broke.
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#13 of 14 Old 03-23-2009, 12:49 AM
 
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In your situation, I would either call the birth center and insist on a culture, or (more likely) go to the hospital for a GBS culture to determine what antibiotic to use, and for monitoring to ensure that your baby is all right. It doesn't sound to me as if the CNMs were taking it seriously enough, if they were unwilling to do the culture. With almost two days elapsed since your water broke, your baby's risk of contracting the infection is no longer 1 in 200. That 0.5% includes many women whose water doesn't break until minutes before delivery, who don't have the risk factor that you now have.

Thrush is treatable and not life-threatening. GBS is much less treatable after it occurs and is potentially fatal.
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#14 of 14 Old 03-23-2009, 01:26 AM
 
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Hello,

I am sorry but I have to close this thread. We can no longer host threads for individuals in active labor.

Please read the forum guidelines.

Quote:
The Unassisted Childbirth (UC) board is a forum of support, respectful requests for information and sharing of ideas and experiences. While we will not restrict discussions only to those who birth without professional attendants, we will actively discourage individuals from posting with no sincere interest in exploring UC. Proselytizing against UC will not be permitted. Controversial subjects of discussion related to UC can be found elsewhere on the internet, and we invite you to seek out other venues for that purpose.

While we wish to support women throughout the birthing process, we cannot host threads seeking advice during active labor. We encourage you to share your birth narrative afterwards in MDC's Birth Stories subforum. Discussions at Mothering.com, MotheringDotCommunity and the Birth & Beyond boards are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a midwife, physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.

It is our goal to maintain a helpful and welcoming atmosphere for everyone. You may contact a Moderator if at any time you are unsure about the Forum Guidelines or if you have any questions, concerns or comments. Please make sure your posts are in accordance with the MDC User Agreement.
I am sorry, this wasn't an easy decision.

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