# Water breaks before labor - risk of infection... what infection?



## Jezzielin

I keep hearing - oh risk of infection, risk of infection. Well what infections are we talking about? I just keep reading about it and the 24 hour timeline after water breaks and I just don't get it.

If this happens for me I am going to tell them to stop checking me below and putting me at further risk so I am not put under a timeline... Just another concern I have.

Anyone else?


----------



## dizz

My waters leaked early - they immediately stopped any exams in that area to try to reduce the infection risk - they were taking absolutely NO chances. You might not view it as serious, you might view it as yet another lot of medical meddling but these things kill a heck of a lot of babies when waters rupture prematurely - if you'd have seen just how much their attitude changed when they confirmed I was leaking you might view it a bit less flippantly.


----------



## Fizzyfefe

The vagina and outside tissue contain bacteria that are natural to the body. _Lactobacillus crispatus_ and _Lactobacillus jensenii_ are two of those common bacteria in the vagina, although I'm sure there are many more. I would assume that, if these bacteria (and others) were to travel upwards and into the uterus, that it could cause an infection, as bacteria is not supposed to grow in the uterus. There is also bacteria on penises, toilet paper... basically, anything that is not sterile.

You are right, though, that frequent cervical checks will increase the risk of infection. Sterile technique is used when doing these checks, but there is always the chance that bacteria can be pushed upwards despite that. And, if there is no membrane (amniotic fluid) to protect the baby, then they are that much more susceptible to exposure to that bacteria.

I definitely don't see the need for frequent cervical checks, personally. I feel that thye are done more for the family's benefit (at least in my experiences when I helped deliver babies, they were always asking how dilated the woman was).


----------



## jinglebear

my waters broke before i started having contractions. i had to be induced in the end due to my waters having been broken for 36hrs with no progression after i reached 9cm. they said the baby was at risk of infection. Your waters protect your baby when in the womb from any outside infection entering the womb. the longer the baby is inside with no protection, the higher the risk of bubba becoming ill. Personally i was happy they put a time cut on my labour. x


----------



## NaturalMomma

The 24 hour time line is outdated, and many don't use it anymore. Yes risk of infections can increase, which can range from a number of things depending on where you are (in a hospital it could be MRSA and other staph infections by the enviorment, at home it would be different). However, the infection risk is still low. There really is no need for vaginal checks, and you can do other things to reduce your risk by wiping the toilet before you sit down (if anyone sat on it before you), don't put anything in your vagina, wear a pad and change it often.


----------



## cupcake23

I've seen American programmes and read here where people get induced straight away after their waters break because the risk of infection, in the UK it can be anything from 24-72 hours for a low risk woman- vaginal examinations are a big no no especially if your not contracting, speculum to confirm waters have gone then an induction date, you go home and wait...


----------



## Guppy051708

the risk is mostly if they are doing checks, but of course in the USA everything is considered a liability,thats why they only do the 24 hour thing. Some even only "allow" 12 hours :shock: Just keep taking your temp every four hours. And dont allow anyone to check you. Keep everything out of the vagina. If your temp doesnt go up, you should be fine.
Both times my water broke first. I dont go into active labor until many hours later. In fact with DS2, my water broke 30 hours before labor started! i didn't even begin contracting until like 20 hours in but they were super mild and rare at that point. I had a HB all was well. In most other countries they "allow" a woman to go 4 days or more and just have the woman check her temp and as long as it stays low, its fine...i find the USA to be highly medicinal and typically over worry bc of insurance liability.

with DS1 i had a hospital birth and my water broke first. they wanted to induce....erm...how about no lol. i knew i was fine. trust your instincts! they are rarely wrong! I highly recommend the movie "the business of being born" as well as "Born in America".


----------



## Jezzielin

Guppy051708 said:


> the risk is mostly if they are doing checks, but of course in the USA everything is considered a liability,thats why they only do the 24 hour thing. Some even only "allow" 12 hours :shock: Just keep taking your temp every four hours. And dont allow anyone to check you. Keep everything out of the vagina. If your temp doesnt go up, you should be fine.
> Both times my water broke first. I dont go into active labor until many hours later. In fact with DS2, my water broke 30 hours before labor started! i didn't even begin contracting until like 20 hours in but they were super mild and rare at that point. I had a HB all was well. In most other countries they "allow" a woman to go 4 days or more and just have the woman check her temp and as long as it stays low, its fine...i find the USA to be highly medicinal and typically over worry bc of insurance liability.
> 
> with DS1 i had a hospital birth and my water broke first. they wanted to induce....erm...how about no lol. i knew i was fine. trust your instincts! they are rarely wrong!

Thanks everyone, I am just not sure what will happen first - my water breaking or contractions. Being 3cm right now and my OB can feel my bag of water I am worried it will break and then she will want to do something. I am trying to find the right words to prepare to tell them to bug off when they try to check me! :)


----------



## Guppy051708

They cant make you do anything. I would highly recommend reading patient rights. 
A lot of the mat floor staff were pissy to me because i didn't want the typical american labor and delivery. They kept pushing for every intervention in the book. But i was educated and i knew what i wanted and i knew baby and i were both fine and healthy.
It really depends on what you want but dont EVER let them pressure you into anything!
If i were in your shoes, i would just decline it all unless there is a REAL medical reason and at this point there isn't. And dont let them break your bag of waters. That will put you on a timetable too (which again you can always decline!). the bag of waters is a good thing as it cushions everything and is keeping things less painful for you. ...i really hope my bag of waters remain intact this time around! lol


----------



## Blah11

The sac of water surrounding your baby acts like a seal to keep bacteria from you out so when it breaks theres nothing stopping the bacteria travelling upwards to your uterus and baby.
However, the risk of infection is small and its easy to monitor yourself at home by simply taking your temperature regularly. I'd refuse all examinations to check your cervix as it doesn't do anything or help anyone really. I'd also refuse induction after 24 hours, some NHS trusts happily leave it for upto 96 hours.

When I had my son I had bulging waters on the Thursday when I had a stretch and sweep and by very early Sunday morning I had none (I was examined at 8-9cm for the first time). No idea what happened to them as i had no feeling of them breaking so I reckon it must have been a slow leak over a good few days


Intervention leads to intervention!


----------



## Bunanie

My water was broken 18hrs before I gave birth, I only started to have minor contractions a few hrs after 
Then LO had random fever, the paedi wants to give her antibiotic cos there's a risk of infection due to the "prolonged" ruptured membrane
Luckily her temperature settled down on it's own - it was probably due to dehydration and over wrapping..


----------



## Jezzielin

Thanks everyone for your replies. I suppose my thought was yes, the water is broken but can LO get an infection within 24 hours (as they usually want us delivered by in the US) that quickly???

I am going to try to limit the exams I think when it's finally time to get to the hospital.


----------



## Guppy051708

you would have a fever before any infection got too far off. so if your checking your temp every 4 hours you would have a heads up before it got bad.
and the answer to your question, if your keeping everything out of there, including sterlie gloves, the risk of infection is verrrry low.
the USA is highly medicalized. they are more concerned w liability. im not saying infections dont happen, but they certainly do not occur at the rate the US OBs lead you to believe.


----------



## patooti

Jezzielin said:


> Thanks everyone for your replies. I suppose my thought was yes, the water is broken but can LO get an infection within 24 hours (as they usually want us delivered by in the US) that quickly???
> 
> I am going to try to limit the exams I think when it's finally time to get to the hospital.

It certainly CAN occur, that's not made up. But it isn't as common as the common practice of inducing immediately would make you believe. The thing is, if a baby dies of an infection and people later say it could have been prevented by delivering fast after membrane rupture (and who knows if that would be the case), then that is a MASSIVE lawsuit in the US. So even if it is rare, for doctors that deliver a LOT of babies that risk of lawsuit is a worry so they push to aggressively treat the lot. A traumatic labour due to induction and the small differences in health outcomes for C-section babies isn't something they will get sued over. A baby that dies due to infection, they will. I'm positive that 99% of the birth culture of intervention is driven in this way.


----------



## Guppy051708

patooti said:


> Jezzielin said:
> 
> 
> Thanks everyone for your replies. I suppose my thought was yes, the water is broken but can LO get an infection within 24 hours (as they usually want us delivered by in the US) that quickly???
> 
> I am going to try to limit the exams I think when it's finally time to get to the hospital.
> 
> It certainly CAN occur, that's not made up. But it isn't as common as the common practice of inducing immediately would make you believe. The thing is, if a baby dies of an infection and people later say it could have been prevented by delivering fast after membrane rupture (and who knows if that would be the case), then that is a MASSIVE lawsuit in the US. So even if it is rare, for doctors that deliver a LOT of babies that risk of lawsuit is a worry so they push to aggressively treat the lot. A traumatic labour due to induction and the small differences in health outcomes for C-section babies isn't something they will get sued over. A baby that dies due to infection, they will.* I'm positive that 99% of the birth culture of intervention is driven in this way.*Click to expand...


Totally agreed.


----------



## Bunanie

Jezzielin said:


> Thanks everyone for your replies. I suppose my thought was yes, the water is broken but can LO get an infection within 24 hours (as they usually want us delivered by in the US) that quickly???
> 
> I am going to try to limit the exams I think when it's finally time to get to the hospital.

I'm from Australia, they only did an internal once after my water was broken, that was when my contractions were 1-2min apart (in fact they didn't even want me to go hospital to check until I told the midwife I could feel the pressure of her head!)

My ob told me the risk of infection was 40%higher after 24hrs, I suppose they just don't want to take chances and risk it...


----------



## alicecooper

For my third baby, my waters broke just after midnight on 23rd September '09. I went into hospital and they didn't believe me because it was just a tiny trickle - they said I had wet myself, and sent me home.

I knew that was a load of bollocks, but anyway...

I went back to the hospital at lunchtime because I had an appointment there anyway, and whilst I was there my waters full on exploded all over the floor.

So then they kept me in, but labour wasn't progressing so they had to induce to get things going.

He was born lunchtime on 24th September '09, but because my waters had actually broken more than 24 hours before he was born (they actually believed me in the end), they made me stay in hospital with him for a further 2 nights after the birth "in case of infection".

I was well pissed off coz it was my DD's birthday on 25th Sept and I hadn't wanted to miss it. If they had only believed me in the first place and induced then and there, the first time I went into hospital, instead of telling me my waters hadn't broken and that I was making it all up, I could have been home for DD's bday. 

Instead they only let me go the day after her birthday.

Oooh I was miffed.


----------



## PepsiChic

Jezzielin said:


> Thanks everyone for your replies. I suppose my thought was yes, the water is broken but can LO get an infection within 24 hours (as they usually want us delivered by in the US) that quickly???
> 
> I am going to try to limit the exams I think when it's finally time to get to the hospital.

I had a cervical check at my 38 weeks appointemt, 3cm dilated, stretchy, mucus plug came away all day long after that.

If my waters were to break, I would refuse any more cervical checks untill Im very much near the point of pushing and they can make sure im 10cm. I am opting for a natural hopsital birth again, so Im used to refusing anything and everything.

Just remind yourself that its your body and most of the things they will suggest are because they are procedure like the "24 hours after water breaks = induction" its to cover themselves ina lawsuit, and should you refuse anything, dont be surprised if they wave a form in your face to sign saying you refused it. again its to insure that you dont sue them should somthing go wrong.

I refuse IV, bloodwork, epi, pain killers, cervical checks should waters break, induction. but of course have a back-up plan should I need it.


----------



## justhoping

in had a very bad uterine infection after two of my deliveries, so its not only to protect your baby but you too...those infections knocked me so off my feet and i had a brand new baby to deal with....oh yea it hurts like heck too...


----------



## shx

My waters broke at home and then they kept me in hospital. I had a speculum exam to confirm when i went in. I had a pessary and a sweep 36 hours later (hospital was too busy to induce before :( and then i was induced 2 and a half days after my water went! I was only checked twice during labour and my temp had started to rise towards the end but i had been left a long time but there was no effect on baby whatsoever. She was born 3 days after my waters broke!

I did develop an infection 12days pp but that was due to retained uterine products and nothing to do with how long my waters were broke for x


----------



## Nikki_d72

Guppy051708 said:


> *you would have a fever before any infection got too far off. so if your checking your temp every 4 hours you would have a heads up before it got bad.*and the answer to your question, if your keeping everything out of there, including sterlie gloves, the risk of infection is verrrry low.
> the USA is highly medicalized. they are more concerned w liability. im not saying infections dont happen, but they certainly do not occur at the rate the US OBs lead you to believe.

While I agree with most of what you are saying, this isn't strictly true. When I was in hospital after premature rupture of membranes with my twins, my temp was being checked 2-3 times a day as they were concerned about infection due to the prolonged rupture. In the end I did develop chorioamnionitis (the fancy medical term for infection of the membranes) so my body went into labour to rid itself of the infection but I still showed no elevated temperature and only a very slight elevation on my White cell count (which usually happens in labour anyway) - they said it was a subclinical infection, so basically an infection with no fever or other signs in me. 

Hystology showed Strep B all through the placenta as well as the membranes, so infection was most definitely well underway in my case. If it had developed into sepsis I could have lost my uterus or even my life, they made this very clear, which is why they wouldn't attempt to halt labour. 

Obviously this was preterm so things may be a little different at term and it was 6 days after rupture but the fact remains that monitoring for fever is not that reliable an indicator for infection. I had one sterile speculum exam on admission and that was all. I drank gallons of water every day and took high doses of vitamin C to try to mitigate against infection and was also on oral antibiotics so my risks were kept to a minimum. My Obstetrician told me "it's not a case of _if_ infection will set in, but _when_. I know in the case preterm rupture of membranes, many OB's and hospital's policy will be immediate induction, the fear of sepsis is so great so my Ob was pretty grounded and evidence-based, he also gave me a copy of the peer-reviewed evidence they were making their decisions based on, so he was not at all medically heavy-handed or driven by fear of litigation, thus I trust the information I was given.

In a fullterm baby the risk is primarily to the baby first but also the mother and although it is small, it is there and if you are that one in so many hundred, it doesn't feel any better, believe me.

I do agree that a lot of intervention is driven by fear of litigation though and your choices should always be explained to you properly - the chioce has to be the woman's and you do have the right to question and refuse anything. The other option than early induction can be IV antibiotics in labour, so that may be a better option for some than early induction, if you choose to wait and see. I know a lot of US hospitals can get a bit heavy-handed if you refuse induction for early release of membranes and may try to "threaten" you with taking the baby into Nicu and such if you refuse - I would read up on your rights prior to going in but in the end of the day it may not happen anyway - membranes usually only release prior to onset of labour in about 25% of labours, despite the images in the movies...

Good luck all, I hope it doesn't even become an issue for you, or me, I'm 36+3 at the moment and hoping my membranes stay intact well into labour this time, they released prior to labour with my DD as well which led to lots of intervention in hospital instead of a possibly calm birth-centre birth but I'm a lot more educated now and have an independant MW who will be with me this time to hopefully keep the interveners at bay lol. Having said that, as long as he's alive an healthy I'll be happy, but I still would like as gentle an entrance to the world for him as I can get. xx


----------



## justhoping

shx said:


> My waters broke at home and then they kept me in hospital. I had a speculum exam to confirm when i went in. I had a pessary and a sweep 36 hours later (hospital was too busy to induce before :( and then i was induced 2 and a half days after my water went! I was only checked twice during labour and my temp had started to rise towards the end but i had been left a long time but there was no effect on baby whatsoever. She was born 3 days after my waters broke!
> 
> I did develop an infection 12days pp but that was due to retained uterine products and nothing to do with how long my waters were broke for x

one infection started during labor and my temp did not rise and they broke my water so i wasnt exposed long

personally i think if it can help protect you and the baby then try and do it....btw that is just mho....

i understand the people who are put off by it though


----------



## DittyByrd

My water broke before labor began as well. They checked me a minimum number of times they had to to see how I was progressing. I was induced and ended up on IV antibiotics as a preventative. My membranes were ruptured for 52 hours prior to a vaginal delivery so the 24 hr timeline is not necessarily something every hospital adheres to - I was at a BIG NAME hospital in the USA. The docs told me as long as my water was clear and I had no fever and continued to progress they'd stay the course. And we did!

I don't think the concern is so much the natural bacteria of the vagina but more ascending bacteria from the outside (Staph, etc) that can be introduced via introduction of foreign objects/fingers/penises. Once the protection of the amniotic sac is removed, baby and uterus are now exposed to these pathogens. In non-pregnancy, the cervix is closed and protects the uterus from infection.


----------



## Bay

With my first, i started leaking amniotic fluid at the start of 36 week. It was confirmed in hospital and they only inserted a speculum (no further internals) to see the position ofmy cervix. I was told that elevated body temperature means infection has already occurred and it could be too late. I was under alot of pressure by hospital staff to induce and fed horror stories every day i went in for fetal monitoring. I held out for a week and went into labour naturally right on week 37, and my baby boy was clear of infection and so was i.

I'm not advicating for or against induction, but in this particular instance it was the right choice for us to not go with induction. to be honest if i went through it all with another pregnancy i'm not sure what i would do.


----------

