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When is the "best time" for Dr.'s to break ones water?

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wewantmore Posted: 03-22-2010 8:31 AM

If my water doesn't break on its own (I know sorry for all the water breaking questions), when is the "best time" to have it done?

I don't want it too early (say like 3 cm). Is there a "best time" (or more so best dilation)?

Michelle

Michelle: Wife to Steven (6/13/1999); Mom to Kayla (2000); Joseph (2004); Samantha (2007) and Matthew Johnathan (3/31/10)

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Jewels replied on 03-22-2010 8:49 AM

I would say that the best time is usually when it breaks naturally, in most cases it will break before the birth anyhow.  Obviously there are cases where it is not ideal to have them break naturally (ex. prematurely, etc) and cases where AROM is better indicated than waiting for it to happen naturally.  With my first the OB broke it at 2cm- way too early IME, I did not consent , he just did it.  With my dd my water broke at 10cm on it's own and I pushed her out w/i a couple minutes.  With my 3rd I also got to 10 cm with it intact but my midwife asked if she could break it as my ds was in distress and she wanted to massage his head, he was born w/i minutes.

Jewels Heart Jon - Married 11 Years!  (Endo, PCOS)

Alexander James- 8 (2 Yrs TTC)  05/10/02

Gabriella Rae- 6 (Our Homebirth Baby!)  04/03/04

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citizenpelikan replied on 03-22-2010 9:21 AM

It probably has a lot to do with how fast you are progressing. It is usually a contraction booster so it's done earlier with those who are having slow labor/dilation.

With my first I had a slow labor and the midwife broke my water probably around 4-6 cm to get things going.  That labor was 24 hours long from start to finish but active labor in the hospital took almost 12 hours.

With my second I had a much faster labor and nobody even mentioned breaking my water. It happened when I was pushing my daughter out (she was born with the membranes still wrapped around her).  That labor was 8 hours long and only 4 hours in active labor in the hospital.

 

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Calladona replied on 03-22-2010 9:43 AM

Personally, for me, these are the times I'd consider having my water broken:

1) I am way overdue and we are talking about c-section - I'd rather try breaking the water first than go straight to c-section (though it's not my first-line induction technique and this DEFINITELY assumes baby is engaged in the pelvis).

2) I have been in active labor a LONG time and am not progressing and am wanting pain meds - I'd try the AROM as a last-ditch effort to resume contractions before getting pain meds and trying to rest...

3) I have been pushing for an hour or so and baby isn't making progress.

I have this thing in my head that maybe I can deliver a baby in the bag... Wink  It's considered good luck in some countries.

Susan - 30 married to Chris -31

Catherine Anne born via c-section June 30, 2008

Rebecca Marie born naturally April 18, 2010

expecting #3 January 15, 2012

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citizenpelikan replied on 03-22-2010 10:08 AM

My country is one of those countries.  It's called the cape of victory.

I don't think you need to worry too much about breaking the water only if the baby is engaged in the pelvis, as long as you are in a hospital and being monitored. Cord prolaps is the thing you're worried about, right?  That's much less likely when you are already lying down when the water breaks and a lot safer when you have the monitors to tell as soon as the baby's heartrate slows down. 

My first was not engaged in the pelvis when I went into labor and they didn't even check it before breaking my water. Of course I was fully monitored.

*ETA:  Everyone who's baby is not engaged in the pelvis when the water breaks needs to keep in mind to lie down immediately and call an ambulance. I've read a lot of threads about water breaking on these boards but no where have I seen this discussed. This was a stern warning I was given with my first as she was not engaged in my pelvis when I went into labor.  If you continue to stand up the cord could prolaps and get cought between the pelvis and the baby. If you stay on your back the likelyhood of that happening lessens quite a bit.

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mamarti1 replied on 03-22-2010 11:10 AM

Being born with an intact bag, the bag is also called a "caul" .

I wouldn't want my water broken in most cases, unless perhaps I was well into labor but had stalled a bit (and other things like moving around, etc. weren't making a big enough difference) or if there was some real reason to want to hurry labor along.

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KittyKat77 replied on 03-22-2010 11:16 AM

The only time artificial rupture of membranes is advisable is when the benefits significantly outweigh the risks of:

*Cord prolapse (life threatening emergency, that happens when the water is broken before the baby is deeply engaged in the pelvis, as citizenpelikan mentioned).

 

*Infection, as the membrane provides a barrier that protects the baby from germs introduced by the vaginal exams most hospitals seem to view as an absolute necessity every hour or half hour. Infection in the newborn can be life-threatening.

*Distress, the water provides a natural cushion, and removing it suddenly can in some cases increase the stress on the baby.

 

The only known benefit of artificially rupturing the membranes is a slightly faster first stage of labor (the part before you start pushing) and even so the difference is not enough to justify using AROM routinely.

 

Useful article http://www.childbirth.org/articles/amnio.html

 

Jon  O.  Neher,  MD

Valley Medical Center, Renton, Wash

There does not appear to be a compelling reason to perform amniotomy routinely in laboring patients. While not particularly harmful (the trend toward increased surgical delivery was not statistically significant), amniotomy is not particularly helpful either. It has no obvious benefit in multiparous patients. In primips, it shortens the entire process of labor by just a few minutes. Some family physicians may want to explore the option with their primips. Otherwise, just forget it.

Source

And the ACOG bulletin on induction of labor reports that “the potential risks associated with amniotomy include prolapse of the umbilical cord, chorioamnionitis, significant umbilical cord compression, and rupture of vasa previa.”

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wewantmore replied on 03-22-2010 1:31 PM

Thanks for all the info ladies. I've only ever been induced, so this whole "nature" thing is so new and foreign that I'm starting to stress about the little things. Mainly that my body just can't do it. I know in the back of my mind it can, just with 3 inductions under my belt I have this nagging feeling it can't.

I'd really prefer not to have them broken, but wanted to be prepared if the Dr. suggests it to help things along if they stall.

Michelle

Michelle: Wife to Steven (6/13/1999); Mom to Kayla (2000); Joseph (2004); Samantha (2007) and Matthew Johnathan (3/31/10)

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amg replied on 03-22-2010 3:07 PM

http://www2.cochrane.org/reviews/en/ab006167.html

Cochrane does say that amniotomy with oxytocin for induction has a higher vaginal delivery rate.  Interesting.

As far as water breaking and engagement....according to my medical advisor (I'm a childbirth educator & doula) risk factors for cord compression/prolapse are when baby is at a high station -2 or above AND the water comes out with a huge gush (think Niagra Falls).  That huge gush can bring a cord down, but otherwise if there's leaking the risk of cord compression is quite small.  Other risk factors for cord compression/prolapse--if mom has too much fluid or if baby is in a  footling breech/transverse position.   She also tells her moms who are laboring after PROM to be aware of baby's movements.

This is the first time I've heard that a woman should go in an ambulance if her waters have broken without an engaged baby.  Many practitioners I know recommend coming to the hospital for evaluation after PROM, but not all. 

ds1 3/2004

ds 2 12/2006

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JenniferM replied on 03-22-2010 3:28 PM

amg:

This is the first time I've heard that a woman should go in an ambulance if her waters have broken without an engaged baby.  Many practitioners I know recommend coming to the hospital for evaluation after PROM, but not all. 

 

This is what I thought as my water broke naturally & DD was still high, I showered etc before going in & also walked the halls. No offense but I would silly as heck calling an ambulance b/c my water broke...

I personally have already told myself that if I am induced or while in labor I wouldn't let them in the beginning b/c of infection & the 24hr rule. I won't personally do it till at least 5 cenimeters as you are in it for sure & not going home Wink that's just what is my comfort level.

JenHeartJames &

Faith my pretty girl 01/30/2003Eye

Livia Jo Sue Brand new 06/07/10! 8.6pds & 20.5in!

 

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