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Membrane rupture question



 
 
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  #1  
Old May 5th 04, 07:36 PM
Elizabeth H Bonesteel
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Default 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  
Old May 5th 04, 07:59 PM
Circe
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Default 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


  #3  
Old May 5th 04, 08:18 PM
Ericka Kammerer
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Default 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

  #4  
Old May 5th 04, 08:32 PM
Donna
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Default 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


  #6  
Old May 5th 04, 09:55 PM
Elizabeth H Bonesteel
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Default 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
  #7  
Old May 6th 04, 03:00 AM
Cheryl
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Default Membrane rupture question

On Wed, 5 May 2004 18:36:27 +0000 (UTC), (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 haven't actually had a labour where contractions started before ROM
so I can't answer the second question. However during my third
labour when I presented at the hospital with PPROM (pre-term premature
rupture of membranes - this is not actually as redundant as it
appears, pre-term means before 37 weeks but premature means before
labour started in this instance) the OBs merely started me on
injectible antibiotics since I hadn't yet been tested for GBS statue.
The vaginal check they did to see if I actually did have ruptured
membranes was a speculum exam rather than a digital exam which is
supposed to decrease the chance of introducing infection. And they
monitored my temperature regularly to see if I was showing signs of
infection. Other than that they were perfectly happy to play a wait
and see game until I either went into labour or stopped leaking
amniotic fluid. As it turned out I went into spontaneous labour
almost exactly 24 hours after my membranes ruptured and the midwife I
spoke to said that this is pretty normal. According to her 80% of
women who have a spontaneous rupture will go into spontaneous labour
within 48 hours of the rupture.


--
Cheryl
Mum to Shrimp (11 Mar 99), Thud (4 Oct 00)
and Mischief (30 Jul 02)
  #8  
Old May 6th 04, 03:41 AM
Larissa
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Default 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

  #9  
Old May 6th 04, 02:59 PM
Vicki S
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Posts: n/a
Default 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.
... is it really SOP if labor is progressing normally? And is there really a
legitimate 24-hour "deadline" after your water breaks?


I get the very strong impression from reading this newsgroup that "how
long" you will be "permitted" to labor after ROM depends on your
caregivers. Different doctors, midwives and hospitals seem to have a
fairly wide variation in opinion about how long is "safe". It's
definitely the sort of thing that bears independent research before
one goes into labor.

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.

--
-- Vicki
Married DH May 21, 1995. Ima shel Sullen, born 11/16/99; Chatty,
born at home 5/19/02, and Expected, "due" September 4, 2004.
  #10  
Old May 14th 04, 03:42 PM
Em
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Posts: n/a
Default 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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