Pre-labour Rupture of Membranes: impatience and risk

wateroncarpetAmniotic sac and fluid play an important role in the labour process and usually remain intact until the end of labour. However, around 10% of women will experience their waters breaking before labour begins. The standard approach to this situation is to induce labour by using prostaglandins and/or syntocinon (aka pitocin) to stimulate contractions. The term ‘augmentation’ is often used instead of ‘induction’ for this procedure. Women who choose to wait are often told their baby is at increased risk of infection and they are encouraged to have IV antibiotics during labour. In my experience most women agree to have their labour induced rather than wait. I wonder how many of these women would choose a different path if they knew there was no significant increase in the risk of infection for their baby?

The rush to start labour and get the baby out after the waters have broken is fairly new. When I first qualified in 2001 the standard hospital advice (UK) for a woman who rang to tell us her waters had broken (and all else was well) was: “If you’re not in labour by [day of the week in 3 days time] ring us back.” Over the following years this reduced from 72 hours to 48 hours, then 24 hours, then 18 hours, then 12 hours and now 0 hours. You might assume that this change in approach was based on some new evidence about the dangers involved in waiting for labour. You would be wrong.

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Membrane release before birth sensations begin, what to do?

wateroncarpet1. Drink plenty of fluids. Minimum: 8 glasses spaced throughout the day. Purified water with lemon squeezed in it is good.

2. Allow nothing in vagina. No fingers, no tampons, no oral-genital contact, no bath water, no swimming pool water, no speculum, no penis, nothing whatsoever!

3. Wear something loose-fitting with no panties.

4. If you are leaking and need something for sitting, use clean towels fresh out of a hot dryer.

5. Take your temperature every 4 hours while you are awake. Normal range is 35.5 to 37.3 Degrees Centigrade or 96 to 99 Degrees Fahrenheit. If it goes above the upper ranges, drink some water, retake it and if your temperature remains up call your medical person. It could be a sign of infection.

6. Take 250mg Vitamin C every 3 hours while you are awake. Oranges, grapefruit, kiwi fruit, red peppers are all good sources.

7. No baths. Shower as much as you like.

8. Eat foods that are non-constipating and easy to digest. Especially avoid foods with MSG or nitrates, such as pizza, Chinese food, or deli meats. These foods can make you vomit in the birth process.

9. Be meticulous about toileting. Wipe from front to back, and wash hands carefully after.

l0. If the water is colored green or brown (meconium), or if it has a bad smell (sign of infection), let your medical person know.

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A nuchal cord is rarely a problem: dispelling a common myth

Midwife Rachel Reed assesses the risks of a common condition which many parents fear.

“Only very occasionally will a nuchal cord prevent the baby descending once the head is born, in which case the midwife can use a ‘somersault’ manoeuvre to free the baby so that the cord can remain intact.19 If this manoeuvre is unsuccessful, the worst case scenario is that the cord snaps as the baby descends, and requires clamping.”

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Cord around the neck – what parents & practitioners should know

somersault image
The Somersault Technique promoted to assist births where the cord is short and/or tight

Nuchal cords are rarely found to be the cause of adverse outcomes in studies of pregnancy and birth. Several authors have concluded nuchal cords “ordinarily do no harm” (5,6,7).

Some studies have associated nuchal cord with an increased rate of variable fetal heart rate decelerations during labour, and tight nuchal cords to a higher proportion of fetal distress and low Apgar scores. (3,4,8) However, in these retrospective studies the definition of tight nuchal cord were those ‘clamped and cut before delivery of the shoulders’ – therefore short-term morbidity was more likely caused by the interventions rather than the presence of nuchal cord (3).

 

(To learn more about nuchal cords, how babies can and are born with loose/tight/multiple nuchal cords, and why they aredisproportionately associated with risk and adverse outcomes, please read Nuchal Cords: the perfect scapegoat.)

……..

Practitioners that respond clinically, not routinely, to a nuchal cord – and with the least intervention possible – are more likely to protect normal physiology and anatomy and avoid iatrogenic injury.”

**Trigger Alert: Hospital Images**

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Home birth also safer for ‘higher risk’ women

“The rate of oxytocin augmentation, epidural analgesia, and postpartum hemorrhage was significantly lower when labor started as a planned home birth. Differences in the rates of other primary outcome variables were not significant. The home birth group had lower rates of operative birth and obstetric anal sphincter injury. The rate of 5-minute Apgar score < 7 was the same in the home and hospital birth groups, but the home birth group had a higher rate of neonatal intensive care unit admission. Intervention and adverse outcome rates in both study groups, including transfer rates, were higher among primiparas than multiparas. Oxytocin augmentation, epidural analgesia, and postpartum hemorrhage rates were significantly interrelated.”  (Halfdansdottir et al 2015).

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