"Failure" to Progress in Labor…

My water broke with my son and I eagerly rushed to the delivery room at the hospital where I was promptly told about their hospital policy. Once a woman’s water has broken, she has 24 hours to deliver before she has to submit to a c-section.

Two things are wrong with this policy.

  1. For starters, a midwife later explained to me that as soon as a woman starts watching the clock, her labor will not progress as fast because labor is a “timeless experience” and thinking about time short circuits the progression of labor. She explained that’s why she tells her clients to have the birth coach watch the clock when timing contractions while the woman simply has them.
  2. If they were so concerned about the baby hanging out in a dry uterus for too long, they could have easily checked to see how much amniotic fluid was still there. Yet, they didn’t. There was no point. They had hospital policy to protect them.

Naturally, I wasn’t progressing as fast as they wanted, so they gave me pitocin.  The pitocin lead to a tetonic contraction, which led to less pitocin and an epidural. The epidural led to four hours of pushing and a limp, unresponsive baby boy that thankfully came around. All this seems to indicate that maybe he wasn’t quite ready to come out yet. Maybe he just needed a couple of days…

I can not fathom how all of this intervention seems less risky than just giving me some extra time. The American Congress of Obstetricians and Gynecologists calls for the immediate induction of labor.  But this doesn’t make sense because his vitals were great, I tested negative for Group B strep and they had me on an IV antibiotic anyway, just because my amniotic fluid didn’t gush out all at once and they felt like it.

Here’s some interesting reading.

The study that all of this is based on has some info that they didn’t seem to account for. “Neonatal infection rates were confounded by multiple digital vaginal exams during labor. According to another secondary analysis, the percentage of infections trended upward with the number of vaginal exams independent of other factors, including time from rupture of membranes to labor onset and length of active labor “(Seaward, 1998). The odds on infection roughly doubled when you compared women who were given 7-8 exams (like in my case when they come in every hour or so to check progress) with women having fewer than 3 vaginal exams.

So, you see… this “policy” is based on a study that was highly flawed.

In the huge study that all of this induction is based on, one factor was left out… The group with the fewest infections was the group with the fewest vaginal exams. When they “checked my cervix for progression” they put my baby at a far greater risk than if they had kept their fingers and their medicines out of me.

In the end, after he was given medication to reverse the medication and make him wake up, he ended up with no infection and he was just fine.

Except for the fractured clavicle… his battle wound from a birth my body wasn’t ready for.

We would have been safer with a midwife.

I get told, “You had a beautiful healthy baby and that’s all that matters.”  Well… no. That’s what matters MOST, but that’s not ALL that matters.

 

Cited:
Seaward, P. G., Hannah, M. E., Myhr, T. L., Farine, D., Ohlsson, A., Wang, E. E., et al. (1998). International multicenter term prom study: Evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term. Premature rupture of the membranes. Am J Obstet Gynecol, 179(3 Pt 1), 635-639.

8 Comments

  1. Kenda Wathen

    I ended up with a c-section nearly 48 hours after my water broke with my first and this was partially due to the fact that I spiked a fever which was an indicator of infection. Thankfully my DD did not suffer any side effects from that infection and is today a wonderful, beautiful, creative 9 yr old. I was surprised they let me go that long but I guess that was because I was only 34 wks and they wanted to wait as long as possible.

    • Dawn Babcock Papple

      When you rupture early, it is very often because of an infection in the membrane breaking it down from my understanding, so that makes sense that you would develop a fever and get an infection. I’m very thankful that you had someone looking out for you. Kendra.

  2. Dawn Babcock Papple

    Out of curiosity, Kendra, and if this is way to personal, just don’t respond and accept my apology in advance, BUT… did you get a digital examination at your prenatal visits? Like, did they measure your cervix with their finger at your prenatal exams at all in the weeks before you had PROM?

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  4. kim johnson

    We got very lucky with our Dr and hospital. My water broke at 1130am and I did not start even mild contractions till the middle of the night. At 1 pm the next day they finally decided that they needed to do pitocin. They said that they would give me a while on that if baby was fine before a csection. They baby was facing my hip and had to turn so they had me lay different ways on a roll to turn him. At 3pm he turned, I went from 3cm to him out in less than 2hrs.

    They limited cervical checks unless necessary and only the Dr was allowed to do them. The only time they did anything was the swab to make sure that my water broke, checked me shortly after I was admitted, and check right before I was put on the evil roll which is where they discovered that his head was turned. While I was on the roll the did end up putting on an internal monitor only after they had a student nurse sit there for an hour chasing my son around with the external monitor and his heart rate was starting to dip. I dipped while he was turning an was than fine after. Because I progressed so quick the nurse ended up doing the last check because the doula thought I was in transition and got her.

    So in total I got a swab, 3 checks, and an internal monitor. they did put me on antibiotics some time the second afternoon and I did get an epi shortly after they started the pitoin that wore off in 30min. The Dr also never checked me internally at an appointment.

    I don’t know if the fact that I was at risk for blood clots and was on blood thinners was the reason for this or if it was a combo of that and it was a small hospital, only pt there, and I had the doula there. Either way I am happy they let us have our baby naturally regardless of the clock.

    I now get to see the nurses 3 days a week when I go to the birth place to pump during my lunch:)

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