Posted by My OB said WHAT?!?.
Dec
2
Posted by My OB said WHAT?!?.
“The Longer Your Membranes Are Ruptured, The More The Risk For A Cesarean Section Increases.”
“The longer your membranes are ruptured, the more the risk for a cesarean section increases.” – OB to mother whose membranes had ruptured spontaneously and who was dilating slowly.
There are 30 comments to this post.
Jespren had this to say,
Dec 2, 2011 @ 4:16 am (Quote)
This is threatening, and mean, and doesn’t follow evidence based care…but at least the doc is (currently) being honest. I bet when it comes ‘time’ for that c-section the doc wouldn’t be so honest. Instead of ‘your membrane have been ruptured longer than I’m comfortable with and I want to do a c-section to get this labor over with’ it will likely turn into ‘you’re going to kill your baby if you keep hopelessly trying to do this the old fashioned way, I’m sectioning you’.
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The problem here is they skipped a couple of steps. First of all the risk is of infection. and the risk of infection comes from being in the hospital and permitting them to check you every hour on the hour and twice at shift change. So if you stay home until you feel like you are at 7-9 cm and don’t tell them that your water has been broken for hours you will be in a much better place. But yes they freak out.
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I would like to ask this doctor how often s/he comes into a laboring mom’s room ready to use the amniohook.
Because unless the doctor says “Oh, I never rupture the membranes — that increases the risk of a C-section!” then the doctor is admitting to causing crises in labor that lead to surgery.
THey want to have it both ways: that breaking the water is good and breaking the water is bad.
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Bonita Reply:
December 2nd, 2011 at 1:31 pm (Quote)
I think it comes from a much deeper place than reaking water. It comes from a “natural bad- dr good” place.
“labor started by dr-good labor started naturally allowing the woman to labor at home-bad”
“episiotomy-good tearing-bad”
“IV fluids-good Hydrating naturally-bad”
and so on, and so on…
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Yes it does. Only because this doc (and so very many others) don’t know enough about the dangers or safety of membrane rupture, and also, because their findings are skewed by the many unnecessary VEs that lead to the infection of which they are so scared.
I always tell my ladies not to say when their membranes ruptured. Give a vague estimate – 2 AM? Sometimes this morning. And not to go in until they’re way further into labor, no minimize VEs.
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Have a question. My membranes ruptured at 33 wks on the dot. To my luck I was able to give birth in 4 hrs, only 15 minutes of pushing. Thankfully I had a doula. They did check me often though and I hated it, it hurt so much more when they did that. I was unmedicated but they insisted on an IV and fetal monitor. In cases like this would be it be risky to stay home until you are more dilated? We lived 10 minutes from the hospital. I would like to know for future reference, hopefully my future pregnancies won’t be premature but I know the possibility is there.
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Jane Reply:
December 2nd, 2011 at 5:26 am (Quote)
In a prematurity situation, you go immediately to the hospital. There hsouldn’t be any debate about that. Then when you arrive, you demand they not do a digital vaginal examination but a visual one so they don’t introduce bacteria.
I know of a woman who remained with ruptured membranes (confirmed) for about 15 weeks. Total bed rest, nothing in the vagina, careful monitoring for the slightest signs of infection or any sign that the baby was compromised. Lots of hydration so she could make amniotic fluid to replace what was leaking out.
But moms can’t do that on their own. Rupture at 33 weeks is a perfectly appropriate time to seek medical care because it’s not a healthy situation.
Rupture of membranes at term is not a medical catastrophe no matter how the obstetric establishment wants to make it so.
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Lisa Reply:
December 2nd, 2011 at 5:44 am (Quote)
Agreed. Mine ruptured spontaneously at 31 weeks and I immediately went to the hospital, and was immediately transferred to another bigger hospital with a NICU. I don’t know the cutoff, but at 31 weeks they were trying to *keep* me from dilating and delivering (didn’t work).
On the other hand, with my 3rd my water broke on a Monday afternoon but labor didn’t start until Tuesday night. By that time we (midwife and I) were getting a little worried, but for the first 18 hours or so we had no problems chilling around the house trying to get labor started.
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Lisa in Texas Reply:
December 2nd, 2011 at 7:11 pm (Quote)
Agreeing with you both. You don’t mess around with prematurity. My midwives wouldn’t (and weren’t allowed to by state law) attend a homebirth before 35 weeks. With my 5th child I had confirmed PROM at 21 weeks and spent the next 10 weeks on bedrest at home. An emergency situation arose at 31 weeks (thankfully while I was at my weekly doctor’s appointment) and I had a c-section. But I did go to L&D triage several times during that pregnancy because of concerns about a fever or spotting. After having a baby at only 31 weeks I can say without a trace of doubt that prematurity is NOT something to mess around with.
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Details Reply:
December 2nd, 2011 at 5:47 am (Quote)
In my childbirth class was told that you report to the hospital the minute your membranes rupture to be checked for prolasped cord. I no longer agree with that practise since it does result in freak out mode, and mine resulted in my first c-section at the 22 hour mark. I do think you need to be checked for prolapsed cord, but I think you can do that yourself. (And I am open to the opinions of medical staff here -I know we have a ton of midwives, doulas and nurses and the occassional doctor that come here.) Are there cases where the cord prolapses just a little bit and isn’t hanging out of the vagina? Are there cases where the baby’s head is pinching the cord, but you wouldn’t know without the fetal monitor?
Kimberly, I totally agree with Jane at 33 weeks you go to the hospital. But if it happens again at term what should she do? And my water broke first all three times. Then somebody told me that can be caused by a vitamin defiency. So which vitamin was it and who has a link? I didn’t remember to write it down because I’m done having babies, but Kimberly and others should have that information.
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Tina Reply:
December 2nd, 2011 at 6:28 am (Quote)
Prolapsed cord isn’t a huge concern with ROM at term. Baby’s head is big enough that it fills the lower uterus and the cord isn’t likely to prolapse.
At 33 weeks though, hospital is it for PROM because baby is at least a month unbaked irrespective of what’s going on or not with the cord (and incidentally, cord prolapse is a higher risk because a smaller baby means the head and shoulders are less likely to be covering the os.)
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Mama Wrench Reply:
December 2nd, 2011 at 5:51 pm (Quote)
That’s generally only true if the baby is both head-down and actively engaged. AROM can cause cord prolapse even during labor if Mom is supine and baby isn’t engaged yet.
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angela Reply:
December 2nd, 2011 at 9:54 am (Quote)
Regarding checking for prolapsed cord, my midwife had left her birth bag at our house (probably not standard, she’s my MIL) and when my water broke before she had arrived, she had my husband bust out the doppler and listen through a contraction. It was pretty easy, and anyone worried about checking for a prolapse could probably rent a doppler to have on hand for such purposes.
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Mama Wrench Reply:
December 2nd, 2011 at 5:55 pm (Quote)
Just curious, but exactly how does that prove or rule out prolapse? I’m not sure I follow.
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Angela Reply:
December 2nd, 2011 at 8:39 pm (Quote)
If the cord has prolapsed and is being compressed by the baby/uterus during a contraction, the baby’s heart rate usually drops. It doesn’t really prove anything, but if you find the heart rate is slower than it should be, that might be a good indication for a vaginal exam to check for a prolapse. If the heart rate is fine through a contraction, you probably don’t have a prolapse, and you don’t need a vaginal exam.
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Hmm. That’s something to think about there Doc.
Can I see some studies about that so I can make an informed decision please?
*gasp* You don’t KNOW of any let alone have some one hand??? Well, I just can’t make such a big decision without being informed.
Could you find someone who does know about that please?
No?
Hmm… well, I guess then I just have to postpone any decision until I can look it up.
Oh, and it’s an increase in the risk for infection, Doc. ESPECIALLY if things are placed in the vagina.
ONE of us at least did a little research before walking into this room…
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Read the doctor’s words very carefully. S/he did not say what s/he thinks s/he said. What was said is that the risk of a c-section increases. This seems to imply that a c-section becomes riskier and riskier the more time passed. To me, this seems to indicate that since a c-section is more and more risky she should of course be left alone so that she can have a vaginal birth. Not what the doctor meant to say but certainly what the doctor should have meant to say.
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Details Reply:
December 2nd, 2011 at 7:06 am (Quote)
Actually I don’t think that the doctor said what you think s/he said either. What you apparently think s/he said is the the risks “associated” with a c-section increase, as opposed to the risks of HAVING a c-section increase. Which is what the rest of us all heard. The doctor actually said neither. The doctor said something that could be taken either way. And defended either way. It was a CYA statement in addition to being a bullying statement. BTW they are both true. The complications following a c-section after a long labor are higher than the complications following a short labor. I’ve done then both (the short one was a breech) And I’ve done the research, it’s wasn’t just my experience. So both are true, but the presentation as a bullying tactic is the problem.
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I have had PPROM three times. When it happens they don’t do VEs and they try and stop labor until 34 weeks.
I was 33 weeks with my first PPROM and there was not stopping labor. She came fast once it started. Just a couple of hours.
I was a couple of days shy of 31 weeks with my second PPROM and I was in the hospital 4 days before giving birth. Again, no VEs. I was Group B Strep positive though so when baby started showing signs of distress they didn’t want to watch an wait so I was induced at 31 weeks 2 days. There was no infection for him but I did spike a fever while I was in labor (remember, no VE but I did anyway) so it was probably a good thing.
With my 3rd I had PPROM at 33 weeks and a few days. I went to the hospital. No VE again. They stopped labor and at 33 weeks 6 days they didn’t try and stop labor anymore in hopes that I would go into labor on my own. I did and he was born 10 mins shy of 34 weeks. (Give or take since obviously EDD is just that.)
Anyway, I realize that when you have PPROM there are benefits to keeping baby in longer if all looks well and if at all possible but why when you are at or close to term can’t that be the case too? Obviously without doing VEs or other invasive stuff you can go a long time after your membranes rupture. Why not just watch for signs of distress and infection like they do when you are preterm? And with a baby that is full term you wouldn’t even have to constantly monitor. Just keep a close eye on it.
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Bontia Reply:
December 2nd, 2011 at 1:38 pm (Quote)
Because at term the baby becomes a “ticking timebomb” for medical staff. They want to get a term baby out asap because it will look like “they did everything possible to ensure a good outcome” and they want to keep a preterm baby in as long as possible so it will look like “they did everything possible to ensure a good outcome”.
They need to learn to start practicing evidence based medicine with term babies.
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Hmm, I dont’ think that’s what the doctor was saying, but we wont’ know until the OP clarifies. Personally, I think the doctor was being unintentionally honest. “The risk that I’ll cut you open increases the longer it’s been.” That’s true.
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Lori Reply:
December 2nd, 2011 at 11:19 pm (Quote)
The doc was not happy that she had not delivered and was basically putting the fear of “dilate or else” in her. She literally told her she had an hour to change her cervix or she was going to start pit and put in internals. You know, because women can consciously control the dilation of their cervix, so threats like that work. Oh wait! No they don’t! Fear actually slows it down, thereby giving the doc the scenario they needed to get what they wanted in the first place.
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So this was my submission….and the irony of it all, and why I chose to submit it, is because OF COURSE she gets closer to a c-section the longer she is ruptured. WHY? Because she CAN’T unrupture herself, and if she doesn’t deliver, it is inevitable. So what is the point of this threat?? Does she need to reach in and rip her cervix open or something?? It was just so asinine. Anyway — below is the copied and pasted email I sent to the site originally for the back story:
I’m an L&D RN starting midwifery school in January. Last night was a particularly hard night for me because I spent the entire shift defending the patient who desired a natural birth and myself for choosing to advocate for her. Anyway, this morning after the OB came in and told me she was “obviously” not pleased that the patient was still pregnant, she went in and told the patient (Paraphrasing….can’t remember verbatim – too tired and too mad at that point):
“The longer your membranes are ruptured, the more the risk for a c-section increases.”
Really? I mean, really?? LOL. What is she going to do? Unrupture her membranes? Force her 7-8cm cervix open fast enough to please the doctor? Pull the baby out herself? OF COURSE the risk for a c-section goes up in an impatient, intervention happy hospital! DUH!!! Oh, and by the way, the fact that mom had not had any hint of a fever and baby’s heart rate was BEAUTIFUL during intermittent monitoring meant nothing. Only thing that mattered is she was 7-8 instead of delivered. She gave the patient a one hour deadline before she was going to put in internal monitors, thereby tying her to the bed that made her hurt worse. I had sat on the “Pitocin if no change” order the whole night and protected her from it, and I’m afraid it was all lost as soon as I left. I saw the doctor whispering about my “substandard” care with the oncoming nurse as I was leaving. WHOSE care is truly substandard here??
Needless to say the patient, her husband, and I had a talk about next time around….she had Ina May’s book sitting right there and I told her there are other, better ways and gave her my card. This has GOT to stop!
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Lori had this to say,
Dec 2, 2011 @ 11:22 pm (Quote)
Anyone else see the irony – we know it is safe and beneficial to keep a preterm mother with PPROM pregnant as long as possible despite being ruptured and despite the fact that, in theory, their babies are more susceptible to infection than their term counterparts, yet we absolutely must deliver term babies within X number of hours or the baby may DIE!! You can’t make this stuff up! It makes NO sense, and clearly reveals who is to benefit from the expedited delivery….
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Details Reply:
December 3rd, 2011 at 4:50 am (Quote)
I’m so sorry you are dealing with idiot doctors day in and day out. I have an idiot hospital just down the street from me. Is there any paticular title of person you would recommend I talk to to get them to change their ways? Who is in charge of these policies and such?
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Add Your Comment.
I’m not usually one to go against the grain, but I’d have to say that for anyone birthing in hospital – this is the reality.
I’m a doula and I can’t tell you how many times I’ve had OB’s freaking out about ruptured membranes over 12 hours – and every hour after that freaks them out more.
Don’t want to be on the clock? Stay home. No one is going to cut you open because your membranes have been ruptured for 24 hours or more there.
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Mama Wrench Reply:
December 2nd, 2011 at 12:33 pm Mama Wrench(Quote)
Exactly. Your medical NEED for a c-section doesn’t necessarily go up, but your actual RISK of a c-section definitely does.
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