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Discussion Starter · #1 ·
I get the idea behind it, But does it really make a difference? Is it truly needed I guess is my question... I got the abx w/ DD2, but if I have a 36 hour labor again and do end up at the hospital I'd rather not have the abx again.
 

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Certainly not telling you what to do - but this is what I did...

My water broke around 8 PM on a Friday night. I had no contrax, so I put my mom and doula on notice, then went to bed. Woke up refreshed and ready to give birth the next day, willed contrax to begin, did some super fast walking, etc. Got a steady contrax pattern going, then went into my hospital. I conviently 'mis-remembered' the time of my water breaking when speaking with them, told them it was earlier that morning. I went in around 11:30 or noon, let them check me ONCE and then pushed the baby out by 12:30 pm.

I figured the chances of infection were much smaller since I wasn't having anyone's hands shoved up there - and this seemed much more relaxed to me...

Total time with ROM was about 16 hours - so I never reached the 24 hour limit, but they would have started me earlier than that at my hospital anyway...
 

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I too would be careful about just how precise I was in telling them when my waters broke, and equally careful about how many vag exams I permit.

fwiw, there is at least one other conventional protocol for dealing with broken waters, even with strep B+... I know it's conventional because I saw it on A Baby Story LOL. anyway... the mama was homebirthing, strep B+, ruptured membranes. Transferred for augmentation, not abx, in order to get babe birthed by 24h. Then they watched baby for symptoms (of which there were none). But I thought it was very interesting that clearly there is another conventional protocol for dealing w/ "prolonged" membrane rupture.
 

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definitely--if your water breaks before active labor (not just mild 'early' labor, but really *active* labor), just don't tell your HCPs and don't go into the hospital. Rest, eat, drink, and if labor hasn't started (or gotten pretty consistently strong) by next day, then maybe start doing things to promote contrax. Keep everything out of your vagina, maybe take extra vit C and some echinacea to boost your immune system. As long as water is clear and has no foul or funky odor, no worries. When you finally do go to the hospital, just don't say when your water broke.

But who knows, maybe your water won't break this time until transition or even later....or it will still break first/early, but labor will be too short to worry. Main things to remember are these: the more you let people put their hands (or anything) inside you, the greater your risk of infection--so no sex, and no Vag exams until labor is quite active. If you are not actively laboring, what is the point of checking dilation anyway? And second, no need to worry about infection as long as waters remain clear and smell normal.
 

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Discussion Starter · #5 ·
Last time I insisted I didn't want to be checked but DH convinced me to cooperate w/ the nurse (who I seriously pissed off in fact I never saw her again after she checked me and I know it wasn't shift change time)

This time he is on board. This time there will be NO checking for dilation at all. Its pointless, when I hit transition then its time. I just wondered if the abx were just yet another cover their ass thing or had a true purpose. Sounds to me like a CYA thing, glad you agree, thanks ladies!
 

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They gave me prophylactic a/bx last time because my water had been broken for more than 12 hours (nearly 22 from water breaking to birth). We had thrush for two months. No infection. The thrush was NOT worth the proactive a/bx. Not a whit.

This time I won't allow prophylactic a/bx. I will simply not tell them how long my water's been broken. But I agree it's wise to avoid potential infection but not allowing multiple cervical checks, not taking a bath with anything other than water, no sex, etc., once water's broken. Otherwise there is truly risk of infection and that's no good.
 

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Weird, I've only heard of giving antibiotics in case of strep B, & even that seems to be stricly a North American thing, other countries just monitor the babies, since abx are known to cause as many problems as they solve.

My water broke before labour with both boys. Ds1, the only 24 hour limit was the one they'd cut me open for. I probably got some abx due to having a cesarean, but I don't know. DS2, I had a UBAC. No contractions at all for about 88 hours after my water broke. Took Vitamin C, monitored my temp to make sure I wasn't getting an infection & no exams until after I'd been pushing for awhile & wasn't making progress (ds2 was stuck). The health nurse who saw us after the birth tried to tell me how 'dangerous' it was to wait that long, but when I pointed out it was only dangerous if people were sticking things up there, she actually backed down & agreed with me.

If you don't have an infection that caused your water to break in the first place (rare, but it does happen), & you keep everything out of you, especially if you're in a hospital, infection is really unlikely.
 

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There is very little consensus as to how to treat ruptured membranes before the onset of labor - it varies hugely from practice to practice! Some practices/hospitals demand immediate induction, some say 6 hours, some 12, 24, etc. The practice where I worked as a nurse and student midwife allowed clients to go up to 72 hours without labor before they were risked out of the birth center, and even then they were *offered* induction at the hospital at that time. Most women will start labor on their own within 24 hours of ruptured membranes, and nearly all within 48 hours. There is some evidence that *in the absence of vaginal exams* it's safe to wait up to 96 hours (4 days) for the onset of labor!

In 1996 a group of researchers conducted the TermPROM study that looked at immediate induction vs expectant management (waiting for labor) after ROM - they concluded that outcomes were about the same either way, so the choice should be left up to the woman. Unfortunately the study had some pretty significant flaws, and has been used to argue against a mother's choice. Henci Goer does a pretty good review of the study here. This article is a pretty straight forward read and discusses the complexity of deciding how to deal with rupture of membranes (ROM) before labor.

I'm most familiar with *prophylactic* antibiotics for group B strep. I'm not sure their are guidelines indicating prophylaxis for other infections associated with rupture of membranes (ie chorioamnionitis), though that doesn't mean they aren't ordered by some practitioners! CDC guidelines (scroll down to table 2 for the summary of recommendations) recommend abx for GBS+ moms at onset of labor, or at 18 hours post-rupture of membranes for moms with unknown status. They do not comment on GBS+ moms with ROM before labor, though many practices interpret the recommendations in a way that they want to induce mom right away and start abx at that time. Antibiotics are not recommended for GBS- moms no matter how long their water is broken (unless they have other symptoms of infection - then the antibiotics are for treatment, not prophylaxis).

So, a long winded comment all to say the "24 hour rule" for prophylaxis isn't particularly evidence based, especially outside of the GBS arena
 

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Well, for what it's worth, I was GBS negative, and they specifically said the penicillin was "necessary" because my water had been broken for more than 12 hours.

It is odd -- because when the subject comes up now, it seems people assume I must've tested positive for GBS. I'm assuming the birth center (which is really just an L&D-dedicated hospital) has some ridiculous policy regarding a/bx and ruptured membranes.

I wish I'd known ahead of time. I'd have made a conscious point to avoid looking at the clock when my waters went. I won't make the same mistake this time.
 

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Discussion Starter · #10 ·
GBS- here, they just told me that for fear of infection once we hit the 24 hour mark that I needed ABX, I wasn't thrilled, but was happy they weren't going to try to insist I needed a repeat c/s, so I said whatever. Thanks for the links wittyone
 
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