Obstetric Lie #99- You Must Deliver Within 24 Hours of Water Breaking


Ahh, this one is close to my heart. Let me tell you a little story.

First time mama wakes up one night (the night of her due date in fact) with mild contractions. They are about an hour apart and 30 seconds long and wake her up but she can sleep between them. By morning she notices that she is leaking fluid.

This is a Sunday night. Contractions continue through Monday, gradually increasing to maybe 30 minutes apart. They are not hard and relatively easy to relax through. She continues to leak fluid. It does not gush. It is clear. She drinks lots of fluids and takes her temperature (so that she will notice if a fever begins). Mama feels totally comfortable with this. She accepts that labor may be "long".

She stays home Monday night. Tuesday contractions continue. They are regular and gradually increasing through all this time. Mama wears maxi pads to catch the leaking clear fluid. Mama feels lots of movement from the baby who seems happy- and possibly most important, mama feels totally at peace and free of fear in her decision to stay at home until labor is hard and close.

By Tuesday evening her Bradley teacher tells her she better go on a walk to get things going. She goes on a walk with her hubby (two walks in fact) and things really speed up. Hubby decides to take mama to the hospital when she has a contraction that lasts three minutes. Mama is not making any decisions at this point but agrees to go.

On the elevator up to the labor and delivery unit dad says "We will have our baby tonight!"
Mama doesn't say anything but thinks he is crazy. She is pretty sure she is at four centimeters.

But!!!! Miracle of miracles once checked mama finds herself to be a whopping eight centimeters! She is pushing withing two hours and baby is born after four hours of pushing (but I will save the pushing story for another post. Can anybody say CPD!?).

Mama gives birth to a healthy eight pound six ounce baby boy with apgars of 8 and 9. No infection, no pitocin, no c-section. Waters broken for over 50 hours. He is born on Wednesday morning.

You got it- that was me. It was my first lesson in the power of birth, the power of trusting the process, and the power of avoiding the routine vaginal exam in labor an arriving at your birth place later rather than sooner.

But you shouldn't just believe me. Here is the abstract from a study done comparing induction groups with groups of women who were allowed to wait up to four days after membranes ruptured (though the induced women were happier!? UGH!) And this study showed that there were no adverse infections in the baby as long as vaginal exams were avoided.

The truth is most women, when left alone, will have their water break at the very end of labor, right before pushing.

Some common sense ideas for avoiding the stress of water breaking first-

~Eat right while you are pregnant. Dr Brewer claimed that a healthy diet high in protein (80-100 grams of protein a day) and fruits and veggies would help mom have a strong bag of water.

~Avoid routine vaginal exams while pregnant. (Did I mention that mine broke shortly after a pregnancy VE?) They serve almost no purpose in the non -laboring woman, and some risk is assumed when you are simply shoving bacteria up there with a gloved hand. Things normally come out not in. (Except for "you know what", but semen has natural properties that make it non-harmful if water is intact.)

~Avoid the routine vaginal exam while in labor, especially if water has broken. At that point also avoid all things in the vagina.

~Have a care provider that you can trust. Don't assume going into your birth that they are on the same page as you are with everything. Ask questions. Make a birth plan and TALK about it. The birth plan is almost totally useless if you just think it is a shield to magically protect you. It only serves to start a dialogue and find out if you are on the same page as your care provider. "How long are you comfortable with me laboring once water has broken?" is a good place to start.

~Pay attention. How are you and baby? What are your instincts telling you? I would never tell anybody what to do in this situation. But I KNEW what I should do in mine.

Birth is normal. Your body works. It is not a textbook or a study. You can not listen to your intuition if all you hear is your own fear. Tune in to one and tune out the other.

Comments

Archaeology cat said…
With my first, my waters broke before contractions started. Because of that, they had me come in for a NST, and then sent me home with instructions to take my temp twice a day to check for fever and come in for a NST daily. The induction was scheduled for 4 days later. As it happened, none of that mattered, since contractions started a few hours later and my son was born 12 hours after that.
Lisa said…
My water was broken for over 24 hours before labor even STARTED with my last one. 29 1/2 hours from water breaking to first contraction. I know if I'd gone to the hospital I would have ended up on pitocin and antibiotics at the very least, most likely a C-section soon after. Instead I had a homebirth with a midwife who knew enough to keep her hands out of me and just monitor us.
My theory as to why the induced women were happier was because both groups were kept in the hospital, and since the induce group birthed sooner...less time spent twiddling their thumbs.

Also our society has failed to teach women the value of waiting for their baby to be born without interventions, so those that were randomized to wait--even if they had been sent home--might have been annoyed not to just "get the show on the road."
Lyndsey said…
What evidence are drs and nurses using to say that babies have to be born within 24 hrs or infection sets in? When I was induced, baby had to get out because of pre-eclampsia, but I do remember the nurse saying once they broke my water, I had 24 hrs. Thank God I didn't have to worry about that because I didn't have the knowledge I do now to fight it.
Whatever their "reasons", it is a long-ingrained mentality because my mom told me that 30-some years ago, a friend of hers had her water break at home. She didn't go to the dr until several days later because contractions didn't start with her water breaking. They discovered the baby didn't have a heartbeat, and told the mom it was because she didn't come in after her water broke and infection had killed the baby. Whether that's actually true, I don't know, but I know my mom still holds this belief because of her friend. How sad.
Sara said…
My friend at work ended up with a c-section after only 8 hours of induced labor after her water broke. I was so sad for her, but she just thinks that her pelvis wasn't big enough. If she had stayed home, as you did, maybe she wouldn't have had a surgical birth.

I still don't know when my water broke...it's possible that it was when I was in the tub...funny that I couldn't identify it, though!
Lisa said…
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Lisa said…
My oldest got cut out of me 22 hours after my water broke because, even with enough pit that I nearly hemorraged after because my uterus refused to contract down, I still didn't have contactions. I had planned to wait until labour started to go to the hospital, but was bitched at by a nurse when I called to get some information. I'm not sure I'll ever forgive myself for not trusting my knowledge & instincts.

My 2nd was born 110 hours after my water broke & 20 hours after contractions finally started. At home. My 3rd was born 22 hours after my water broke after about 5 1/2 hours of labour.
Joy said…
I'm just curious because my water broke first and came gushing out and am pretty sure it was 99% all out in that first half an hour. Does that make a difference? My contractions started straight away and my baby was born 24 hours later. Unfortunately they put me on pit after about 16 hours to "speed things up". I'm going with a midwife this time but she says unfortunately she has to adhere to the same 24 hour standard (this is Canadian law). Any thoughts on how different it is if you water all gushes out straight away?
Lisa said…
Joy a) You're being lied to. There is no "law" It might be her practice standards or some idiotic regulation she has to adhere to in order to keep her license, but that's her problem, not yours. Second, if you keep up your fluids the water replenishes. It's not like it come out & that's it. I gushed huge amounts every time I changed positions with all 3 kids, but there was always more & a huge amount of fluid came out behind my 2nd baby too.
Sarah C said…
Lisa is correct Joy, the water replaces itself. Our bodies and our ability to birth them are truly amazing and designed to birth.
I am not advocating not telling your care provider (though I did not call mine). There are risks to water breaking, especially if the baby is high an the cord can prolapse. I think it is important to pay attention to your body and your baby, trust your instincts, and have a care provider you can trust and who trusts you. Then do what you feel is right for you.
Joy said…
Thanks Lisa and Sarah for your knowledge and advise. I had no idea the water replenishes itself. I am learning a lot from this blog since I stumbled upon it a few weeks ago! Here's hoping my water doesnt break as my first sign of labour this time but if it does at least I know the facts now! Thanks!
jclaus said…
Thanks for posting this :) My second daughter (who was also a "high risk" VBAC)was born after 58 hours with my water broken (Joy if you are reading this - this was in Canada and we weren't breaking any law). After 48 hours of no labor and water broken we did finally decide to go with Pitocin to get things going (and yes I did get Pitocin with a VBAC). I don't know if I would have wanted to wait much longer, but I was so glad to have my doctor on my side and understanding my desire to avoid another c-section. My fears told me that once my water broke and contractions didn't start I was doomed for another c-section, but I had chose my provider carefully and she worked with me all the way. :)
My mother's water broke a week before she started labor with me. When she went to her doctor, he told her that she had two choices - she could go home & monitor her temperature closely, and come in immediately if she started running a fever; or he could do a vaginal exam but in that case if the baby didn't come naturally she'd have to be induced (or something like that). Mom chose to go home, saying I'd come when I was ready.

I don't know a single doctor who would offer that choice nowadays - too worried about potential lawsuits.
Russ said…
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Russ said…
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Carrie said…
I woke up because my water started leaking but decided with my husband and doula to stay home as long as possible. I started to vomit some, but waited it out knowing that that sometimes happens. Finally when I thought I was getting dehydrated 6 hours later we went to the hospital. I was strep B+, but didn't remember to tell this to my doula. I was dialating consistantly with contractions a few minutes apart but ended up spiking a fever within a few hours and the amniotic fluid started showing a fair amount of meconium. I ended up with a c-section before I even reached 10cm, because of my fever, elevated bp and baby's heart rate of 190 for 3 hours. So when I try to VBAC next time does being strep b+ (if I am) mean I absolutely need to go to the hospital as soon as labor starts to avoid the same scenario?
Mama Birth said…
Carrie-
I am not a health care provider and don't pretend to be- so there is no way I could tell you what to do.

You may find info researching your options relating to strep b, including avoiding spreading the infection to the baby, keeping waters intact (which I covered in the blog article I think) and conventional and alternative methods of avoiding getting sick from it (things range from iv antibiotics to hibiclense to garlic tampons to probiotics).

A healthy diet may prevent premature rupture of membranes, as can avoiding the routine VE.

"gentle birth, gentle mothering" by Sarah Buckley has lots of info on options relating to strep b and how to deal with it and the true dangers of it, both real and imagined.

Good luck-
sewhappy said…
I had a slow leak over a week before going into labor. It was consistent but I thought I was just peeing myself as it was yellow in color too. I went into labor well over a week later when it was discovered that the water was yellow - meconium. I had no idea that is what it meant. I was a vbac and the story ended with c/s due to the lack of staff support. But baby was absolutely fine.

My sister had the same story a year later. But she called her doctor and the 24 hour clock started. Her body never went into labor and she as well went from being a vbac to a c/s.
About the group b strep - you can preemptively run a course of treatment prior to the gbs testing and the birth to prevent gbs. You can have antibiotics (which is all my hospital wld offer), hibicleanse (which is what I wld choose this time), or choose to do nothing if you are positive. Also, the risk of infection after your membranes rupture goes up a) if you have vaginal exams, and b) go past 18 hrs and still no baby yet. I chose a modified gbs protocol - I agreed to have iv abx after 18 hrs of prelabor rupture of membranes, then chose an abx that lasted 8 hrs instead of the usual 4 (they had to test my strain of gbs wih the abx to be sure it wld work) so that I cld go to the hospital, get my iv, and go home. That's what I ended up doing. But that meant loads of abx, and thrush 2 weeks after my baby was born bc I bought it wld be ok to stop taking my probiotica at that point (don't make my same mistake!). And the doc still put in my chart that I had a uterine infection(how is that possible???) and they tried to take a CBC from my newborn. Ugh. Anyway, my membranes were ruptures at least 36 hrs before my daihter was born.
ElDi said…
I was hoping for a homebirth with my first. My membranes ruptured on a sunday afternoon and I adressed that with my medwife the next morning and she doubted my story, it was watery discharge according to her. It was not. Two days later I discovered meconium and that, unfortunately, meant a hospital birth (a Dutch policy) and I had to come in to discuss my induction. Lucky for me my labor started that evening and I had a healthy baby girl 6 hours later, some 67 hours after my membranes ruptured. I had a natural birth up until pushing. That's when I got a routine episiotomy, wasn't allowed to birth in the position I wanted and received a shot I didn't need.

Second baby, my membranes ruptured on a Thursday afternoon and I labored on and off for a couple of hours until she was born on a Sunday morning, about 63 hours later. I had a very different midwife for this birth but I worried about going to the hospital so when I told her my water had broken, I didn't say exactly when. And I had a most wonderful home birth.

Both times baby and I were completely healthy. I did monitor my temperature and drank plenty of fluids. Luckily, it's not standard practice here to do a lot of cervical checks, I had 1 at my first birth when I announced I needed to push and none at my second birth, which was completely intervention-free.

When I had my 3rd baby, I expected my membranes to rupture a few days before his birth, but it happened minutes before crowning in stead! Another intervention-free birth, but a UC this time since medwives are very common in this country, but true midwives are not, and they're expensive.
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