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baby's head down, what happens if water breaks?

2117 Views 10 Replies 6 Participants Last post by  lorijds
I am not sure whether to post this here or in the pregnancy forum, but I am hoping that someone can help me out.

Yesterday I had an internal exam, and the doc said that my baby's head was down. I am "full term" (37.5 wks). She told me that if my water breaks, I should go to the hospital. I am unfortunately not having a home birth, but had planned to stay home for as long as I could during labor, even if my water did break. (My water broke with my first baby before actual labor started.) What would be the danger of staying home given that the head is down? The way she explained it seemed to make sense yesterday, something about the cord getting in the way, but the more I think about it, the more I don't get it. Can anyone shed some light on this for me? Thanks so much.
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They want you in the hospital so they can induce if labor doesn't start spontaneously within 24 hours of the water breaking, lest infection set it.

If it were me, I'd still stay home after my water broke, at least for the 24 hours, unless I developed a fever.
Is there an increased risk of a prolapsed cord or complications due to the position of the head though? The doctor seemed to be alluding to this, though I can't remember exactly what she said. (My regular doc who is very supportive of natural birth is on holidays for the next 2 wks so I am hoping that I can hold off until she is back!)
I am not certain (and probably shouldn't even be answering since this is the mw and doula forum!), and hopefully Pam or someone else will be by to answer, but I don't think that the head being down in and of itself increases risk of prolapse or other complications (particularly since some 97% of babies are head down at this stage). I think, however, that there is a slightly increased risk of prolapse if the baby's head is *not engaged* in your pelvis (even though it is head down). This was my situation with my first -- baby's head did not engage until 40 weeks or so -- and I seem to recall my mw mentioning a slightly increased risk of prolapse should my bag break before the head engaged.

So, IOW, it is not the baby's position that impacts the risk of prolapse, but the degree to which the head is or is not engaged in the pelvis.

Again, I may be wrong -- I'm just speaking from my personal experience with my first pg.

Good luck!
Having a head down baby DECREASES the chance of cord prolapse. When your water breaks, that heavy head usually slides down against the cervix and effectively blocks the opening, preventing the cord from sliding around it. How high the head is in the pelvis doesn't matter terribly, as long as the head is against the cervix. It is not uncommon, especially in non-first time pregnancies, for the head to be high until labor, and isn't really a concern.
I usually tell moms that if their water breaks, and they get clear fluid out, and baby is otherwise moving around, there's no need to rush.
Thanks for posting, doctorjen. That makes sense!

Here is another piece I found at gentlebirth that addresses this issue:

I don't know who the author is...I assume a midwife. It sounds in line with what my first mw told me. And I should clarify that she never told me it was a huge worry or that I should call her immediately if it happened -- just that (at least she believed) there was a slightly increased risk of prolapse under those circumstances (head not engaged).

Cyneburh, I believe I remember learning in Bradley that prolapse most often occurs with AROM.

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That Hyde maneuver for reduction of a cord prolapse on that site is just too funny. I can't imagine what that poor woman must have been thinking!
OMG, that is too funny.

I like the one about dancing a baby out of an android pelvis. I imagine that the sight of me dancing during labor (or any time, for that matter) would do nothing more than put everyone present in stitches.
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Here's how cord prolapse with a head-down baby happens: baby is floating (like doctorjen said), mama is lying down, and waters rupture with a gush. Since she is not in a position where gravity will bring the baby's head down first, the cord (which is lighter) can be swept along with the gush toward the cervix first. If the mama is in a vertical position when the gush occurs, the baby's head (since it is heavier) will be brought down first and plug the cervix.

But think about it: how likely are the waters to break with a gush naturally while the mama is lying down? Usually the reason the waters break is because the head is applying pressure to the cervix. If the baby is floating, it's unlikely that the waters are going to break, more unlikely they will do so with a gush. So when *do* we see the waters breaking with a gush when the mother is lying down and the baby is not engaged? When the bag is broken artificially -- in other words, the doctor or midwife intentionally breaks it.
Thanks so much everyone.
Here is what we tell our clients.

TACO: time, amount, color, odor. These are the things to note when your water breaks. The time it broke, the amount of fluid (was it a gush or is it a trickle) the color (clear with white flecks, or green like pea soup) and odor ("earthy smelling" or malodorous). In addition, note the baby's movement. Is the baby moving normally, or alot, or not at all?

If the fluid is clear, it doesn't smell foul, and baby is moving okay, then we usually recommend clients wait until something is happening (ie, strong contractions!) before coming in. If the water has been broken for a long time and nothing is happeneing, or if mom is developing a fever or fast pulse, or anything feels unusual to mom, we want her to come in.

Keep everything out of the vagina after the water has broken. No exams (not even your own clean hands), no intercourse.

Head down is a great way to be! The best for birth!

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