Wednesday, December 8, 2010
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.