lets talk about PROM - Mothering Forums

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Old 12-14-2007, 03:36 PM - Thread Starter
 
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I found this from an old thread on here... this is pamamidwifes words...

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Pre-Labor (or Prolonged) Rupture of Membranes

Any rupture of the membranes (water bag) constitutes the general distinction of ?labor?. While you may or may not be contracting, the simple fact that your membranes are ruptured dictates a change in daily hygiene routine and supplementation. The bag of water provides more than a cushion for baby ? it also serves as a barrier from bacteria and infection. Prelabor (meaning no uterine contractions present) rupture of membranes occurs in about 6-19% of all term pregnancies. Epidemiological data shows that about 86% of all women with prelabor rupture of membranes go into spontaneous (not induced) labor within 24 hours of their water breaking. Only 6% of the remaining go longer than 96 hours without any sign of labor starting.

Some membranes rupture high up in the uterus. This is called a ?hind leak?. Typically, water will come out slowly, perhaps gush once and trickle here and there. Hind leaks may be caused from baby?s foot breaking the bag, or a positional change. As there are two layers of the membranes (the amnion and the chorion), sometimes leaking may be caused from the outer layer of the bag (the chorion) breaking. In both cases with a hind leak and a leak from the chorion breaking, there is a good chance of the bag ?resealing? itself with cessation of any sort of leak.

A ?full leak? is a break in the lower part of the uterus, particularly over the cervix. This sort of leak rarely re-seals. While it may be difficult to know what type of rupture has occurred, the following guidelines should be followed any time there is suspicion or confirmation of a rupture.

Currently, the medical literature shows that expectant management (waiting until labor starts with the following guidelines) is an effective and safe course of action, provided NO VAGINAL EXAMS ARE DONE. Of course, you do have the right to choose to be induced in the hospital at any point during this prelabor period. However, by being in your own home, you already are much more protected from bacterial infection than if you were in a hospital (the overall infection rate is four times higher in a hospital, hence the need for more rigorous antibiotic regimes). The bacteria present in your home are bacteria that your body is familiar with and acclimated to.

? Absolutely, positively, NOTHING in the vagina. No fingers, tampons, penis, oral-genital contact, etc.

? Drink plenty of water to help replenish amniotic fluid ? at least 64oz of water a day

? Wear something loose-fitting with no panties when you can

? If you are leaking and need something for sitting, use clean towels fresh out of a hot dryer

? Take your temperature every 4 hours while you are awake (record on a sheet of paper).

? Take 250mg Vitamin C every 3-4 hours while you are awake

? Eat foods that are unconstipating and easy to digest

? Be meticulous about toileting (wipe front to back, clean toilet tissue, etc.)

? After showers, use a clean towel fresh out of a hot dryer or oven to dry your vulva

? Do fetal movement counts twice a day after eating (looking for 10 movements in an hour)

? Notice any change (color, odor) to the fluid and report results to your midwife immediately

? After a full 24 hours since rupture, the addition of Oregon Grape Root and Echinacea tinctures to your daily supplementation regimen is recommended. Take a dropperful of each tincture four times a day.

? REST, REST, REST, REST
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Old 12-14-2007, 07:25 PM
 
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Any misspellings or grammatical errors in the above statement are intentional;
they are placed there for the amusement of those who like to point them out.
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Old 12-15-2007, 01:24 AM
 
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I had a "leak" at 31 or 32 weeks. I was previously informed in my last pregnancy before this one that it was okay to wear panties but to change the pad frequently and change your panties frequently throughout the day. I just layed on the couch and drank lots of water and it resealed by the end of the next day. Thank goodness!

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Old 12-15-2007, 01:32 AM
 
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Ahhh, this is a sweet spot topic of mine. I got a lot of flack and a TON of support during my 3rd pregnancy when my water broke at 31/32 weeks and I chose care at home instead of going to the ER. I would stay home a 1,000 times over having all behind me.

Here's my story...
My 3rd pregnancy was a rough ride for me (and probably babe, too!). I had Hyperemsis and was very sick. It was the first time I'd ever been admitted to a hospital except when I was born. I continued to vomit all through my pregnancy. One night after a particularly pukey day at 31/32 weeks, I stood up from the couch to go to bed & water gushed down my legs & onto the floor. I was shocked.

The first thing I did was I called a MW that we'd worked with before. She told me everything she knew about how to handle the PROM & then in the next hour when pre-term labor started, we called her again. We did pretty much everything that Pamamidwife recommended in the OP.

This is what worked for me.
- Wine for ctx. I drank a small glass every few hours until the ctx were gone and then whenever needed after that.
- Inversion. My DH propped one end of the couch up with 6 inches worth of books under the legs.
- Bed/Couch rest for the first week.
- Raw nuts to encourage testosterone
- Lots of water with lemon.
- Herbal Tinctures: Wild Yam Root, False Unicorn & Red Raspberry Leaf
- Vitamin C, a ton of it ever few hours. (this was immediately to reseal the bags. It's been that long for you, they might not reseal. But, either way, it'll ward off infection.)
- Probiotics (yogurt, acidophilus, bifidolphilus)
- Homeopathics, Ruta & Arnica
- Bed rest (I did this for the 1st week and then very modified from then on)
- Decision to get steriod shot for lung maturation - We couldn't find anyone to give this to me without me going to the hospital. We opted not.
- Avoid Soy and any other estrogen rich foods.
- Nothing in vagina (finger, penis, etc)
- No baths, hot tubs or swimming pools
- Taking temp
- Watching for movement

My bags of water ended up resealing & refilling. I ended up birthing my baby at 41.5 weeks & she was pink & so healthy! She had plenty of water & I was so thankful that we were able to tune inward to do what was best for her.

Blessings.

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Old 12-15-2007, 01:37 AM
 
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awesome story!

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Old 12-15-2007, 01:55 AM
 
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My water likes to break at 35 weeks, no one knows why. I have been in that 6% to not go into labor on my own. WIth #3 I was kept in hospital for a week until I hit 36 weeks and demanded to be induced.

#4, I was novernight and them told them I was leaving and wanted oral antibiotics(as opposed to continuous IV. They complied and 36ish hours after my water broke I was in labour. I think the fact I could go home and relax in my own surrounding, sleep in my own bed etc is what helped me go into labour instead of sitting around until 36 weeks again.

The above story is amazing, personally I know that waiting for an extra 10 weeks with my water broken would drive me insane. I already dealt with lots of infections this last pregnancy so wouldn't risk it but I am in awe, it gives me home for #5 that if my water breaks at 35 weeks again I don't necessarily have to have another prem baby.

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Old 12-15-2007, 12:37 PM
 
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Originally Posted by swellmomma View Post
The above story is amazing, personally I know that waiting for an extra 10 weeks with my water broken would drive me insane. I already dealt with lots of infections this last pregnancy so wouldn't risk it but I am in awe, it gives me home for #5 that if my water breaks at 35 weeks again I don't necessarily have to have another prem baby.
I'm sorry you've experienced this so much.

I think the real key was immediate action to reseal the bags. I didn't have broken water for 10 weeks. Within a couple of days I stopped dribbling. And, I was not showing any signs of infection. My bags refilled over the next week as well.

I really think the way that hospital's treats PROM encourages premature birth and infections, plus we all know germs/bacteria/viruses in our own homes are much safer for us than what's in the hospital. The CDC reported May 30th of this year, "In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year." http://www.cdc.gov/ncidod/dhqp/hai.html

You're absolutely right, if your water breaks with #5, you DO NOT have to have another premature baby or an infection. You absolutely don't have to.

Oh, I should address, that while I didn't necessarily WANT to almost go to 42 weeks (my other babes came at 38 weeks), I was just so pleased that I had created an environment for birth that trusted my body to gestate & birth my baby when it was totally ready. Having gone through PROM and needing to tune inward to find the best path for my baby, I was very tuned in the rest of my pregnancy. I knew everything was fine & my baby just needed some catch up time. I was tuned in enough to know that she would come in her own time when it was for the highest good. I really believe my body rewarded me with a quick & relatively painless 1 hour, 40 minute labor.

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Old 12-15-2007, 01:20 PM
 
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This is what I am trying to do. Create an environment here at home that is relaxing and condusive to birthing so that baby can be fine even if my water does break early again. (I really think my OB accidentally stripped too much the last time she did it with DD). And I am refusing all internal exams at this point. I am more educated this time around to prevent an early baby and any long hospital stay. (I stayed 5 days with both of my previous kids for one reason or another. I was going CRAZY in there!) I am hoping that drinking the RRL tea will help me labor at home where I can handle it since I won't be having epidurals this time around!

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Old 12-15-2007, 03:09 PM - Thread Starter
 
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here's a website that has a lot of information on PROM from a 'natural' perspective...

http://www.childbirthsolutions.com/a...prom/index.php

some gems..



... PROM is when the membranes rupture before labor begins. Unfortunately, most doctors still make no distinction between true PROM and a leak.

pelvic examinations during the last three months of pregnancy have been shown to contribute to the incidence of PROM ..

...When a woman's amniotic sac suddenly ruptures, there is a real danger that the cord might be swept out with the fluid. However, doctors do not recognize that such an occurrence is very unlikely if the woman merely has a leak.

...the maternal complication of most concern with PROM is chorioamnionitis, or inflammation of the fetal membranes... the incidence of chorioamnionitis in the general obstetrical population is 0.5-1%; but it is 26-28% in women with a latency period (time between PROM and onset of labor) of 24 hours or more.


Because of the high risk of infection in the hospital, doctors have tried to counteract it with antibiotic treatment while the woman is still pregnant. In a study conducted by Owen, Groome and Hauth on 117 women, half of whom received antibiotic treatment and half who did not, they found antibiotic treatment after PROM to benefit the mothers, but not the infants.
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Old 12-15-2007, 04:31 PM
 
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One of the rare occasions when I'll say anything good about hospitals, but my local has FINALLY stopped treating PROM as a high risk situation. I think the medical tide may finally be turning.

Spark, thankyou for sharing your full regime of what you did. EVERY time I want to complain about the baby being low at this point, I remember the panic I felt when your waters went I can't imagine what you must have been through.

Helen mum to five and mistress of mess and mayhem, making merry and mischief til the sun goes down.
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Old 12-15-2007, 09:19 PM
 
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Thank you for this thread! I'm not a UCer (I hope its ok that I'm in here!), but the topic caught my eye as I was browsing.

Just out of curiousity, would you take the same route with a pre-viability pPROM? My water broke at 20 weeks with ds, we think b/c of heavy 1st and 2nd trimester bleeding, but we can't be sure.

I got the full round of hospital care, including IV abx, oral abx, several rounds of steriods, weekly u/s, and a 2.5 month hospital stay. Ds was born at 30 weeks when the placenta began abrupting.

I am hoping to avoid all this stuff in my next pregnancy, including the pPROM.

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Old 12-15-2007, 09:57 PM - Thread Starter
 
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liberal chick~ sorry to hear you went through all of that. But you have your baby now, that's the important thing. I would think that these same ideas to not get an infection are appropriate for earlier as well.

I think vitamin E and C helps to create a thick sac as well.
http://books.google.com/books?id=cwY...nKSzszZUGncMjI

Just eat really well before during and after pregnancy. Make sure you get lots and lots of fresh veggies and fruit, the protein that you digest best, lots of good water (spring, reverse-osmosis...etc)

The sac is made out of collagen, and the more foods that help produce collagen you get from your diet the better it will repair, or not rupture at all. ie, raw veggies and fruits

I also found this on copper depletion/collagen connection
http://www.alive.com/4722a12a2.php?s...read_cramb=122
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Old 12-16-2007, 02:08 AM
 
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I had SPROM with my second kiddo.. Sudden Premature Rupture Of Membranes.... My waters broke at 27 weeks.. He was born not even 12 hours later... I was already dilated to 3-4 when they broke..
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Old 12-16-2007, 02:14 AM - Thread Starter
 
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That must have been hard for you!! Do you know why you went into labour so early?
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Old 12-16-2007, 02:18 AM
 
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Me? I have an incompetent cervix.. As long as I dont labour early this time Ill get the birth I want (UC)
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Old 12-17-2007, 05:11 PM
 
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wow, I have a very similar story to Spark. I had pPROM at 30.5 weeks. I was very medicalized at this point in my life. I had been having constant contractions since about 26 weeks, had an appt, got sent to L&D to be monitored and I felt a leak after I peed in a cup for them. They did a fearning test (which I really don't trust for some reason). First test was inconclusive, second test was kind of positive, third test was very positive. Since my hospital didn't have a NICU, I was shipped to another hospital. After 24 hours at the other hospital, I was sent home because they couldn't find a leak. I stayed off work till 35 weeks, then went back full time till she was born at 39w, 5d.

I had no idea what to do in that situation. i love all this info I am finding here. Now, if it happens next time, I know what to do. Better yet, I know what I need in my diet to PREVENT it from happening again. I am not yet TTC, but I am currently planning at least a HB, possible a UC for next time.

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Old 12-18-2007, 03:09 AM
 
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Bumping for a mama who needs it...

Helen mum to five and mistress of mess and mayhem, making merry and mischief til the sun goes down.
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Old 12-18-2007, 03:56 AM
 
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Old 12-19-2007, 06:29 PM
 
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Man, I wish this thread had existed two weeks ago.
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Old 12-19-2007, 09:01 PM - Thread Starter
 
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Originally Posted by joliara View Post
Man, I wish this thread had existed two weeks ago.
I know!! I saw the need after you went in to the hospy. I really wish it was somewhere on here before too! There have been numerous women w/ PROm and not much info about it here.

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Old 12-19-2007, 09:05 PM
 
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Well I'm glad the info will be out there now for others. FWIW I'm pretty sure I had a leak as opposed to full rupture, and neither Jude nor I ever showed any signs of problems.
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Old 12-20-2007, 01:08 PM
 
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Quote:
Originally Posted by majazama View Post
I know!! I saw the need after you went in to the hospy. I really wish it was somewhere on here before too! There have been numerous women w/ PROm and not much info about it here.

There are actually a LOT of threads here on PROM. I've posted my story to about 3 or 4 of them over the last year alone. Maybe we just need to sticky one of them so others can find them quickly?

I wish they were easier for you to find, too, joliara, but you were guided so well by tuning in. Welcome to your sweet Jude! (My Jude is in my siggie, he's 6!)

Edited to add search terms for others to find this info easier: PROM PPROM partial premature rupture ruptured rupturing of membranes contractions water waters break broken broke breaking how to know if leak leaking leaked leaks did my ameotic amniotic sac sack fluid flood

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Old 01-03-2008, 05:05 PM
 
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bumping for easy find again! GREAT INFOZ!!!

I'm dealing with this as of last night and hoping for the best! :

Different drummer dancing with 3 kids in 3 decades.
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Old 01-07-2008, 09:40 PM
 
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Bumping

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Old 01-08-2008, 01:07 AM
 
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I've been paying attention!
Here's what I've done so far:

Absolutely, positively, NOTHING in the vagina. No fingers, tampons, penis, oral-genital contact, etc.

Drink plenty of water to help replenish amniotic fluid at least 64oz of water a day

Wear something loose-fitting with no panties when you can

Change pad at EVERY SINGLE potty break! Use a peri bottle to rinse.

Take your temperature every 4 hours while you are awake

Take 1000 Vitamin C 3x a day.

Eat foods that are unconstipating and easy to digest

Be meticulous about toileting (wipe front to back, clean toilet tissue, etc.)

After showers, use a clean towel fresh out of a hot dryer or oven to dry your vulva

Do fetal movement counts twice a day after eating (looking for 10 movements in an hour)

Notice any change (color, odor) to the fluid and report results to your midwife immediately

REST, REST, REST, REST

EAT WELL!

COMPLETELY RELAX during bowel movements... no pushing or straining activities of ANY KIND!!!

I have chosen to sit in the hospital and because I chose to bedrest in the hosptial, abx seemed like the "wise" thing to do, hospitals being the filthy places they are, lol, for a couple of reasons:

1. I live SO FAR AWAY from the hospital that I decided my baby was just TOO YOUNG right now to risk being in a snowstom (likely) and on the road trying to GET to the hospital in case labor started. I labor/deliver quickly. Another reason I had been preparing to UC anyway, my midwife lives 2 hours away.
2. This is the only place I can get the true rest/tlc I need. I would never get the kind of bed rest and food and care that I am getting now, at home.

I'd love to be at home right now with my own germs, but I just don't think I would be able to carry her longer if I did... I don't have the physical support to help me with bed rest there.

My story (so far) is:
31 weeks PROM
I've had a hard last month. I haven't felt emotionally or physically supported so much by my dh, which has caused me a ton of stress. The day before my water broke, I had been moving furniture (yeah, yeah, i know ) I had been sick and coughing SO MUCH for the entire previous week, mucus causing me to gag and vomit, as well as the pressure from coughing and sneezing... I felt like I really was going to pop something.
We argued the day my water broke, and after we sorted a few things out, about an hour later, I moved positions and POP... wow. I said out loud, "oh now that's not what i need."
I went cleaned up, put on a pad and went straight to bed. I didn't even start looking into it until afternoon the next day. I really didn't want to get out in "other germs" right away, because I knew the risks.

I too have done these things:
- Vitamin C, a ton of it ever few hours.
- Probiotics (yogurt, acidophilus, bifidolphilus) because I chose to get abx.
- Bed rest
- Decision to get steriod shot for lung maturation
- Nothing in vagina (finger, penis, etc)
- Taking temp
- Watching for movement

I HAVE showered.

After the first 2 days, (which there was TONS of fluid) I have had very little leaking. I am still hoping to refill the bag and hoping to continue this process a few more weeks so I can go home to deliver!

Different drummer dancing with 3 kids in 3 decades.
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Old 01-29-2008, 04:16 AM
 
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Bumping again

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Old 03-29-2008, 09:40 PM
 
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bump for the two July '08 UC-minded mamas dealing with PROM.

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Old 03-30-2008, 10:44 AM
 
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So I have a question about inversion. I've been avoiding lying down, because then the flow is heavier. Most changes of position involve a small gush of fluid (and blood in my case) So wouldn't that also be the case if I lay inverted for any period of time? At this point I'm trying to avoid any leakage at all, and being upright seems to be the main thing helping. I slept sitting sideways on the couch last night to avoid direct sitting and I haven't lay down since I was at the hospital yesterday getting an u/s. I'll have to do that agian today to see how the fluid levels changed, as well as to get my second steroid shot, but until then I want to avoid it. So after all the rambling, how important do you think inversion really is?
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Old 03-30-2008, 12:00 PM
 
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Oh, I posted in your DDC thread about you sitting upright to sleep last night before I saw your post here.

IMO, inversion is best. You would crank your hospital bed up high in the feet, medium in the middle and low in head. Like this, but maybe not quite so intense of an incline and you'd be on your side, not on your back like the picture. http://www.livingincomfort.com/image...r10751_pic.jpg

Chances are the reason you're not leaking while upright is because the head or butt is engaging putting pressure on your cervix... that can cause effacement/dilation/irritation and it may impede resealing the bags since there's a body part where the bag would be.

The reason I asked in the DDC thread if you felt drawn to be upright or if you were told to be upright was because ultimately I do believe that when we feel safe and centered we're drawn to do what is best for our bodies.

While inclining with ruptured membranes, I didn't feel gushes unless I got up to the go to the bathroom, but after a while, I noticed the gushes felt less & less until finally it was just normal pregnancy discharge.

I've had two friends IRL who have dealt with ruptured membranes as well. One did homecare techniques (including inversion) while working with her provider. She was 16 weeks when her water gushed & after a week doing homecare techniques, she was on modified bedrest & then fine & now at 31 weeks she's as normal as can be. My other IRL friend was 21 weeks when her water broke & her hospital admitted her, didn't tell her to go on bedrest, advised her to stay upright & walk around so her water didn't leak so much, and she lasted just under a week before her baby was born. It was so utterly sad to hear about especially knowing that other hospitals and other care providers and other wisdom went against everything they told her to do. Some hospitals just have their own policies about how to handle PROM, some work, some don't.

Other opinions on being upright vs. inclining? Don't let my opinion be the only one! I only talk from my own experience, knowledge & research!

Spark and her four firecrackers.
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Old 03-30-2008, 12:13 PM
 
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Being upright is something I feel inclined to do. I was given surprisingly little guidance as I left the hospital yesterday about what I should or shouldn't do. The only thing said was to drink tons, obviously. But nothing about my activity level, or how to sleep, or what. I realize though that I'll have to sit eventually, and then this will have to be dealt with. Maybe I'll try the inversion and see how it goes. It's going to be complicated though managing this as an outpatient, and having to get in the car and drive to downtown, nearly 45 minutes away. In that respect being in the hospital would be better, but in every other respect, I don't think it is. So many questions.
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