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Membrane rupture question
(I'm just sitting here hoping nobody's noticed that I'm obsessing over every
little thing right now. ;-) I should take my midwife's advice and stop reading about childbirth!) I read another parenting/pregnancy group that, IMHO, often tosses around some pretty big bits of misinformation. This makes me tend to question every little thing I read there, justified or not. One woman this morning said that "they" will need to make sure the baby is born within 24 hours of your water breaking, because after 24 hours there is a high risk of infection. Someone else said that if your water doesn't break, "they" will do it for you at the hospital. The AROM I know can be useful in many situations when labor has stalled; but is it really SOP if labor is progressing normally? And is there really a legitimate 24-hour "deadline" after your water breaks? I feel so ignorant sometimes! TIA, Liz EDD 5/22/04 -- "No problem of human destiny is beyond human beings. Man's reason and spirit have often solved the seemingly unsolvable - and we believe they can do it again." -- John F. Kennedy, 6/10/1963 |
#2
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Membrane rupture question
Elizabeth H Bonesteel wrote:
One woman this morning said that "they" will need to make sure the baby is born within 24 hours of your water breaking, because after 24 hours there is a high risk of infection. Someone else said that if your water doesn't break, "they" will do it for you at the hospital. The AROM I know can be useful in many situations when labor has stalled; but is it really SOP if labor is progressing normally? I don't know whether it's SOP or not. With my first, I was induced with pitocin and normal practice for pitocin induction calls for AROM (pitocin apparently works better when the sac is broken). With my second, when I was checked by the OB 45 minutes after arriving at the hospital, she found me to be at 8cm and asked if she could break the water to be sure there was no meconium because the baby would be coming (she guessed) within a half an hour. That seemed reasonable to me at the time, although I now realize it wasn't really necessary. And my third was induced solely by AROM. That said, there's no *need* to alllow AROM during labor at all and a very few babies are actually born with their sacs intact (considered very lucky in some cultures). And is there really a legitimate 24-hour "deadline" after your water breaks? There is a good deal of argument over this guideline nowadays. Although most practitioners still seem to want to adhere to the ROM--birth within 24 hours rule, current evidence suggests that if internal exams are kept to a minimum and the mother has tested negative for GBS, there is no greater risk of infection if birth does not occur for anywhere between 36 and 72 hours of ROM. In my case, when my last was induced by AROM, we knew one of the possible downsides to the method was that I had not been tested for GBS (we were going with risk-based management) and, as a result, if I hadn't gone into labor within 18 hours, I would need pitocin. Fortunately, it didn't come to that. Personally, if I knew I was GBS- and experienced spontaneous ROM, I wouldn't consider accepting augmentation or induction for at *least* 24 hours after ROM and possibly not until 36 hours (assuming all other indications were good). IOW, I would be totally comfortable with watchful waiting for well over the 24-hour minimum commonly adhered to by most practitioners. -- Be well, Barbara Mom to Sin (Vernon, 2), Misery (Aurora, 4), and the Rising Son (Julian, 6) Aurora (in the bathroom with her dad)--"It looks like an elephant, Daddy." Me (later)--"You should feel flattered." All opinions expressed in this post are well-reasoned and insightful. Needless to say, they are not those of my Internet Service Provider, its other subscribers or lackeys. Anyone who says otherwise is itchin' for a fight. -- with apologies to Michael Feldman |
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Membrane rupture question
Elizabeth H Bonesteel wrote:
(I'm just sitting here hoping nobody's noticed that I'm obsessing over every little thing right now. ;-) I should take my midwife's advice and stop reading about childbirth!) I read another parenting/pregnancy group that, IMHO, often tosses around some pretty big bits of misinformation. This makes me tend to question every little thing I read there, justified or not. One woman this morning said that "they" will need to make sure the baby is born within 24 hours of your water breaking, because after 24 hours there is a high risk of infection. Someone else said that if your water doesn't break, "they" will do it for you at the hospital. The AROM I know can be useful in many situations when labor has stalled; but is it really SOP if labor is progressing normally? And is there really a legitimate 24-hour "deadline" after your water breaks? Many caregivers will rupture your membranes in a perfectly normal labor, but you can say no. A common reason for rupturing membranes is to install an internal monitor, but you can decline that too unless there's some situation that makes internal monitoring a good idea. Yes, your risk of infection does increase if you go a long time without delivering after your membranes rupture. If you're GBS+ or if your GBS status is unknown, it's more worrisome. Different caregivers have different policies about how long you can go, with some getting very antsy at 18-24 hours, and others willing to wait longer. I think 24 hours is closer to what is standard in most hospitals. Avoiding internal exams helps lower the risk of infection. Best wishes, Ericka |
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Membrane rupture question
"Elizabeth H Bonesteel" wrote in message ... The AROM I know can be useful in many situations when labor has stalled; but is it really SOP if labor is progressing normally? And is there really a legitimate 24-hour "deadline" after your water breaks? I can't answer your first question, because I don't know, but as for the second one, everything I've read independantly, and what I've been told by my OBs and the hospital all agrees with the 24 hour rule after your water breaks, due to an increased risk of infection. Donna |
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Membrane rupture question
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#6
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Membrane rupture question
Thanks for the data, everybody. It helps keep my natural skepticism from
blinding me to actual facts! ;-) Liz, grumpy pregnant lady EDD 5/22/04 -- "No problem of human destiny is beyond human beings. Man's reason and spirit have often solved the seemingly unsolvable - and we believe they can do it again." -- John F. Kennedy, 6/10/1963 |
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Membrane rupture question
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#8
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Membrane rupture question
Elizabeth H Bonesteel wrote:
(I'm just sitting here hoping nobody's noticed that I'm obsessing over every little thing right now. ;-) I should take my midwife's advice and stop reading about childbirth!) I read another parenting/pregnancy group that, IMHO, often tosses around some pretty big bits of misinformation. This makes me tend to question every little thing I read there, justified or not. One woman this morning said that "they" will need to make sure the baby is born within 24 hours of your water breaking, because after 24 hours there is a high risk of infection. Someone else said that if your water doesn't break, "they" will do it for you at the hospital. The AROM I know can be useful in many situations when labor has stalled; but is it really SOP if labor is progressing normally? And is there really a legitimate 24-hour "deadline" after your water breaks? I feel so ignorant sometimes! TIA, Liz EDD 5/22/04 As far as the 24 hour deadline, it is really a hospital policy thing. Check what your hospital policy is. Vaginal exams increase the risk of infection if the waters have been broken. I think I have read stories of waters being broken for a few days without issue, before a normal labour and delivery. I was GBS + and was given antibiotics after my waters broke, the OB hoped I would go into active labour within 24 hours. Larissa |
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Membrane rupture question
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#10
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Membrane rupture question
"Vicki S" wrote in message
(Elizabeth H Bonesteel) wrote: One woman this morning said that "they" will need to make sure the baby is born within 24 hours of your water breaking, because after 24 hours there is a high risk of infection. Someone else said that if your water doesn't break, "they" will do it for you at the hospital. ... is it really SOP if labor is progressing normally? And is there really a legitimate 24-hour "deadline" after your water breaks? When I gave birth in a hospital, I was quite close to delivering my son in an intact bag of waters -- something I really wanted purely for the romantic and "cool" aspect -- when my OB said she wanted to break the bag. So I asked my doula (who is usually a homebirth midwife and caught my second child) what she thought, and she said it was ok to let the doctor break the bag. So I let them. I still don't know why the Dr. wanted to. They didn't install a monitor, that's for certain! I should ask my midwife about this the next time I see her. :-) At any rate, the woman who said that "they" will break your bag for you if it doesn't break on it's own, is probably almost always right -- at least in US hospitals. rant--certainly not directed at you Vicki, just this issue in general I find it interesting how it seems like you can't win with how ROM occurs--if it breaks on its own, its "too soon" and hospital personnel get worked up about infection, but if it doesn't break early enough in labor, then it needs to be broken to "speed things up" or to "help things along" (even if labor hasn't really begun yet). Seems like quite a contradiction! I'm fairly cynical/pessimistic/negative about the hospital birth climate, so take this fwiw, but my observation is that the ROM issue is yet another way of taking control away from the laboring woman and making her feel like something is "wrong" with how her baby is doing things (either breaking the water too soon or not soon enough--apparently only a doctor knows when the precisely "right" time is. G*d forbid it should be the woman's own body and baby that decides!). /rant I think it would have been neat if your son was delivered in the caul--doesn't happen very often! My water didn't break in labor until I was fully dilated and pushing (at which time it broke quite forcefully!). By that time, I had basically forgotten that there was even water to break and it was fairly startling to me! -- Em mama to L-baby, almost 8 months old! |
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