Friday, April 26, 2013

What Happens When Your Water Breaks and You Don't Deliver in 24 Hours:Part 1

First and foremost, I'll be honest; I am not a doctor or a midwife. I'm not giving you medical advice just sharing my experience and some of the resources I used in making my medical decisions with the support of my midwives. Only you can make your medical decisions based on your body and your unique pregnancy, but this general information is not that well known so I want to share it.

Most women (about 85-90%) will have their water break during the course of labor usually close to delivery. For about 10% of women, however, their labor begins with their water breaking. Be it a warm trickle, a series of squirts, or a big gush, the sensation of having your water break outside of active labor beckons the more familiar feeling of accidentally wetting yourself (in fact there are occasions when babies drop hard on their mother's bladder and cause the bladder to release making the mother wonder if her water has broken when it hasn't). A good rule of thumb is that if you can squeeze your kegels and the flow stops, it is probably urine, if it doesn't, it's probably amniotic fluid. You can also usually tell by the smell. Urine is pretty unmistakable in its smell. Healthy amniotic fluid is clear and either has no smell or only a light smell that is not gross at all. (If the fluid is yellow or greenish and does not smell like urine but does smell bad, call your practitioner because those are signs of meconium in the fluid and that is a sign the baby is in distress. Another time to call immediately is in the case of your water breaking prematurely before you are term (before 36 or 37 weeks) this is called PPROM and there are different risks associated with it.) If your water does break pre-labor, you may be tempted to rush in to your birth place immediately, but you don't have to medically. For mothers whose water breaks when they are term before contractions start, it is not a real emergency and studies have repeatedly shown that you do not have to go in right away. Women who deliver up to 72 hours after their water breaks show almost the same infection rate as those who deliver within 24 hours if they do not go in and get their cervix checked immediately. The studies that did show that it is a great risk of infection to not deliever within 24 hours were actually timed AFTER the first cervical check (an action that introduces outside bacteria into the area and it is that cervical check that actually makes the risk of infection jump). If you don't go in and get a cervical check right away, the clock is not really "ticking" on infection, yet. In fact my midwives confirmed, you are safer staying at home with bacteria you are accustomed to while you wait for labor begins. Although I already knew this when my water broke with my first labor four years ago, what I didn't know then was that even if you do not deliver your baby within 24 hours it STILL is not an emergency. And am I ever glad I did my homework because this time my water broke really early and all my research after my last baby was absolutely critical in the success I would eventually have with my VBAC. Most women (somewhere between 80% and 90%) who have their waters break before labor begins will go into labor and deliver their babies before 48 hours have passed, so chances are that you will be having your baby soon and quickly without augmentation if you do choose to wait for labor to begin naturally. Another 6%-9% will go into labor and deliver between 48 and 72 hours. Then another 1%-4% will go beyond the 72 hour mark. I was part of that small percentage with my recent VBAC.

I want to say that having the right kind of support team in place before your water breaks is an absolutely necessary piece of the puzzle. If your provider has a hard and fast rule about "having" to deliver within a certain time period, and will not respect you if you decide to make a researched medical decision and a calculated risk to give yourself more time, than you are left with two choices (A) not letting them know when your water broke/that your water broke before labor began or (B) go in when they tell you to (often as soon as your water breaks) and hope that your body complies to whatever time constraints are placed on you. However, if you are in the enviable position (as I was) of having a provider who not only believes in the body and its intrinsic ability, but also believes in women and their ability to make decisions than there is a third option, you can wait until labor begins with the knowledge and support of your provider. Even though I ultimately chose to go in to get my labor augmented with pit (after not going into active labor for almost 63 hours after my water broke), because the choice and the timing were clearly mine, I felt stronger in facing the augmentation and the (very slight) increased risk of repeat c-section and uterine rupture it represented for me and that is what made me capable of getting through the fifteen hours of pit labor including over four hours of pushing it took for me to have my successful VBAC. Yes, you read those numbers right. My provider believed in me enough to support me coming in over 60 hours after my water broke, supported me in an additional 11 hours of dilation, and then over four hours of pushing and did not take me in for an "emergency" c-section as many providers would have and considered it a true emergency. I was even "allowed" to get into the tub to ease my discomfort during labor and was not placed on "preventative" anti-biotics because I and my baby showed no sign of infection and never did come down with any kind of infection.

You should also know that there is a slightly increased chance of some serious infections if you do decide to wait after the 24 hour mark even if you don't go in for a cervical check, but the risk is way lower than going in for an immediate cervical check and then going over that same mark. If you do make the decision to wait it out (as I did), you should follow these guidelines to limit your chances of infection and keep both you and your baby healthy.

1. Stay hydrated, you will be making a lot of fluid to replenish the fluid that is leaking. (Note: You will more than likely never run out of fluid. Your body will constantly replensih your amniotic fluid as long as you stay hydrated. It will also continue to leak throughout your pre-labor and labor until you have the baby. If it is a really long time before you go into labor, you might form a "pocket" where the flow slows down or even seems to stop (as happened in my first labor where my water also broke before labor began) or it can even seem to stop altogether for days if it is a high leak and the baby moves into a position that blocks the leak as happened in my VBAC labor) .
2. Do not go swimming in a public pool or bathe in a hotel bathroom. You do not want to introduce any bacteria that your body isn't used to because that is the kind of bacteria introduction that is most likely to cause infection.
3. Do not allow anything to enter your vagina after the water breaks. No tampons, limit or avoid cervical checks, and no intercourse as an induction method.
4. Monitor your temperature. Any fever is a sign of possible infection and you should go in immediately.
5. Monitor your baby's movements. Any significant decrease in movement should be taken seriously, particularly if you are not yet in active labor and under the direct supervision of your care provider. Alert your care provider to any changes.

Most of all, try to stay calm and rest. You are going to meet your baby very, very soon although the time between your water breaking and active labor beginning may seem to drag on forever. I know because I've been there. Twice. The second time for days. My personal story that led me to this resource will make up part two!

Thank you for reading!


Anonymous said... [Reply to comment]

I found this 8 months too late. Would love to know your sources. I'm a victim of the so called midwife taking advantage of my lack of knowledge in this exact situation. She is very much more geared to push medical intervention and let the nurses be her boss. I ended up laboring 30 hours after it all but I also ended up with every medical intervention I did not want.

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