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Infections after the hospital breaks your waters, is this normal? Experiences in particular from diabetic mothers would be welcome, but also from anyone

(28 Posts)
PavlovtheCat Tue 16-Sep-08 10:25:15

I am writing this on behalf of, or rather about my friend.

She is diabetic (type 1, not gestational) and has had an ok pregnancy, apart from struggling to get proper advice from anyone about what might occur during the birth and diabetes. She knew that a c-section was possible. However she did have an iriittable uterus towards the end so has been having quite regular contractions for about 3 weeks.

She was finally told they would induce her at 37 weeks which was sunday of last week (not sunday just gone). They would give her a trial of labour and if this did not work, or she was labouring too long they would give her a c-section. They would not give her a definitive answer as to how long "too long' would be.

So, she went in for induction at 3pm, and was given a pessary at 5pm. She started having proper contractions after another pessary on the Monday, but was not dialating. She had the max number of pessaries over the next couple days, and continued to have contractions, painful, tiring, stressful, but not dialating.

On the Wednesday they said she would go down to the Labour Ward and have her waters broken. This was due to occur at asap, then 3pm, but did not happen until 3am on the thursday morning as there were no beds. They broke her waters immediately, and nothing happened other than the continued regular contractions.

Obviously by this stage she was exhausted. They let her continue to Labour until midnight on Thursday/Friday when they then decided to give her a c-section. She had been/her family had been trying to ascertain if/when this would happen, but no answers, they just announced this was happening.

Baby was born, sugars were fine. Friend's sugars not so good, but they stabilised.

However her and baby went downhill and had to have antibiotics. She had developed a severe infection, which we found out yesterday was a form of blood poisioning, as a result of her waters being broken for so long, or so she was told.

She has been very unwell, baby has been unwell, but not as ill as she had. She has not been able to breastfeed due to the blood poisoning, has not been able to feed her bottles as too weak/sore, has been unable to hold her for long. She is struggling to maintain her sugars, they are low and she can't get them above 4, but staying at roughly 2 (should be 6? I think), and has been told if she is unable to stabilise them she wont be able to BF at all. Before they knew she had this infection she tried feeding, and her sugars plummetted. She was not allowed visitors until yesterday other than her DP and her mum as she was too ill.

My DH went to see her yesterday (I am not allowed as I have tonsilitis) and he is quite worried. She is better than she was, but a bit distant from the baby, is very negative, and the experience has absolutely drained her - not surprisingly.

So, what I think I am asking is, how common is this infection after your waters broke? Should she have been left as long as she was before have a c-section after breaking the waters? They say this is the reason, if so, if they left it too long, did they screw up? could this have been avoided?

Also, is it standard to leave some-one for 4 days being induced, when they are clearly exhausted, when she was not showing any signs of progress, when a c-section has always been a strong possibility, and without a plan of when they might do a c-section. Ie, Trial of Labour until Wed at 3pm and then if not moving forward a c-section?

I am just worried that this experience has been so traumatic for her it might affect her bonding with the baby.

I just feel so crap for her, and I cant even go and give her a hug and tell her how beautiful her baby is.

PavlovtheCat Tue 16-Sep-08 10:27:55

I do apologise for the essay. I am so not good at summarising blush

PavlovtheCat Tue 16-Sep-08 10:37:28

Bump, I know its long, but only because I used too many paragraphs hmm!

PavlovtheCat Tue 16-Sep-08 10:56:13

bump

fishie Tue 16-Sep-08 11:09:41

your poor friend. my waters broke by themselves but nothing else happened. 24 hours later induction began (pessary). 72 hours later drip. 15 hours later cs. also no sleep, so yes they do torture with exhaustion. no infection though, that really is terrible.

i complained and felt a lot better, was treated very badly in many ways and really let down on the bf side.

there is still scope for her to get bf going but she will need some specialist bf counsellor advice, i have no idea how diabetes and unstable sugars would affect bf.

coppertop Tue 16-Sep-08 11:20:28

Your poor friend.

With ds1 the hospital staff seemed to be very aware of the possibilty of infection. There was a gap of 48hrs between my waters being broken and ds1's birth. Afterwards they told me that they had set a deadline, after which the induction would be abandoned and I would be given a c/s. Ds1 apparently arrived with just 20 minutes to spare. 48hrs seemed to be the maximum they would leave it. I don't know whether or not this is still the case.

Both ds1 and I were started on a course of antibiotics almost immediately after the birth. Their reasoning was that if they started the ABs straight away then they could easily stop them if the blood tests showed that there was no infection.

tigger15 Tue 16-Sep-08 14:18:18

I can't remember but I think the guidelines for how long the baby must be out after waters are broken is about 72 hours. I might be wrong. Infection can get in once the waters are broken. Why it has would probably depend on the environment she was in ie the hospital.

It is common to leave people for 4 days being induced when they are low risk. It is not usual to leave diabetics. I have type 1 and was told the date by which I would be induced if the baby had not appeared, the amount of time they would give me for the induction methods to work (24 hours) after which they would perform a c-section. It does sound rather rubbish.

I found breast feeding very difficult on the blood sugars as it kept on giving me sudden lows with no warning resulting in a coma when ds was about 10 days. The hospital's advise pre and post-birth was pretty useless on this and in the end with the advice of the consultatn I just ran them very high for months after. I ended up feeding more or less exclusively for 6 months (when I went back to work) and ds self-weaned at 11 1/2 months. I had a c-sec and an infection of the wound but not blood poisoning.

I spoke to another diabetic mother who told me she had the same problems with blood sugar and had never managed to bf so I believe it's due more to the hormones etc than the bf itself.

If your friend wants to CAT me, I'm very happy to give any advice I can.

PavlovtheCat Tue 16-Sep-08 15:09:13

Thank you everyone for your advice.

Thanks especially tigger that was very informative. The date by which you were told you would be c-sectioned if needed, that is what she expected - ie, this date you will be induced, if nothing by this date we will do this, and if nothing by this date we will perform c-section.

She has found it so hard as she never saw any end, she had heard so many people say things like it could be a week, others said days, and she vcould get nothing from her Dr, diabetic nurse, midwife etc.

I shall tell her what you said about running sugars high - she used to do that all the time anyway, always struggled to keep them low so she knows how that will feel! She has not been encouraged at all to BF at any point, has been told several times she is unlikely to be able to, so the fact that she is unable to right has just confirmed her fears and she has I think decided it cannot be done. I will not pressure her, it is her choice, but I would prefer it actually be her choice rather than because she feels it is not possible.

So, it seems that it is normal to leave the waters for over 12 hours (I was told 24 by my midwife when my waters broke, but DD was born the same day so did not apply to me!), and that although it can be left, there is a risk of infection once the waters have broken - straight away then?

Ok, so what I sensing here, is they were slack to leave her, could probably have planned it better in terms of managing a c-section more quickly, but, they did not actually do anything wrong. I am sooooo glad things went relatively smoothly for me and DD, and when we had complications after the birth the midwife and consultant were Fab. I think I was very lucky!

Thing is she feared this would happen, she was told by several other people that the maternity unit was crap where she is, and she was anxious. And her fears where proven.

I have been given all clear to see her tomorrow by her Ward.

And I will pass on your offer of advice Tigger.

Thanks x

PavlovtheCat Tue 16-Sep-08 15:11:44

How did it affect your bonding with your babies, having long labours and c-sections/other complications?

How were you straight after? Is it normal for her to feel so low and be a bit distant from her new baby? It is so different from how it was for me and I want to be able to relate/support her, not tell her how different it was for me, that is not what she wants to hear.

Is there anything I can do/say to help her through this bad patch?

dilbertina Tue 16-Sep-08 15:37:38

I have type 1 and was induced with both dc. In both cases it was agreed I didn't need to be induced til 39 weeks. Pessaries did nothing much in my case (no proper contractions), but did dilate me enough to have my waters broken. After that I walked up a million flights of stairs and since no contractions after several hours I was put on drip, and gave birth vaginally few hours later. The pessary stage went on for me for a few days, but once my waters were broken they were keen to get me going reasonably quick with drip if necessary. Whilst the length of time she was left with waters broken does not seem excessive in itself, the overall time she was labouring does given the incredibly difficult task of maintaining decent blood sugars in labour.

Maybe she could arrange a debrief with midwives later about her care and why decisions were made when they were? But that's for a few weeks time maybe for now she needs to get well and get to know her baby.

She must be feeling dreadful with sugars constantly in the 2s...I needed to virtually reduce my insulin to nothing post birth (and drank vast quantities of sugary hot chocolate to prop them up!) and then gradually increase them later. She should have been advised of this post birth blood sugar plunge that many T1s experience.

Is she on a pump? If so she should be reducing basal rate and bolus ratios (in my case to around 2/3rds of pre-pregnancy figures which meant about 1/4 of late pregnancy figures - obviously varies person to person). If on injections she should really back off on background insulin and just bolus tiny amounts and test test test.

Basically my advice would be massively ease off the insulin - test frequently to make sure not horrifically high, but nowt wrong with 7-10 post birth IMO (better than 2s anyways!)It is strange to move from pregnancy mindset of aiming so low though...my diabetes nurse had to tell me to stop testing so much! And remember correction ratio will also be lower than pre-pregnancy....

Sounds like she could really do with some help from diabetes specialists - are there diabetes nurses based at hospital she is in? Else phone her usual one and tell her she is needed!

I was fortunate to have far less traumatic births with both of mine and didn't have too many issues establishing breastfeeding, I do hope she can get her sugars sorted, get breastfeeding sussed, and come to terms with the birth experience.

In the meantime take her lots of tempting med - high sugar snacks, fruit juice for when she's low but not hungry, lucozade tablets cos she's prob. eaten all hers and lots of hugs!

PavlovtheCat Tue 16-Sep-08 15:44:57

Dilbertina - we bought her some diabetic chocolate from Thorntons, she told DH yesterday she could have had the normal ones! So I am going to get her some normal ones and tell her save the others till she gets home!

I am not sure if she is on a pump or injection for insulin, but I am hoping to talk to her this evening so I will ask. To be honest she has been so unwell she has just let the Drs and Nurses get on with it, which means she has had little control/understanding of what has gone on, and now she is getting energy back she is starting to figure out what to do.

I will tell her to ring her diabetic nurse and get some advice, as I don't think there is anyone there advising her.

PavlovtheCat Tue 16-Sep-08 15:45:35

dilbertina Sorry, I did not say thank you posting blush

lulumama Tue 16-Sep-08 15:48:26

the best thing she can do, is when she is feeling a little stronger, have a birth debriefing with the HoM .

blood poisoning implies, in my limited knowledge a severe infection, that has had time to fester...

NICE guidelines now recommend indcucing labour within 24 hours of waters breaking spontaneously, it used to be 96

sorry she has had such a crappy and exhausting experience.

she should be encouraged and helped to have skin to skin contact with her baby as much as possible

PavlovtheCat Tue 16-Sep-08 15:52:02

lulumama - I will get DH to give her a cuddle when he visits and then pass her over to friend, be devious in how we do it.

I just don't want to put pressure on her to feel something she is not, as I don't think her feeling guilty for not jumping for joy will be constructive.

She is saying the right things, just with no conviction, and she is happy for the Drs and Nurses to take the lead, feed baby, pass baby to her DP for nappy change etc. She will do it, but feels it better for someone else to right now as she is uncomfortable.

Hmmm I wonder why she might have got blood poisoning then? They did not identify it until about 15 hours after the birth...

lulumama Tue 16-Sep-08 15:53:46

childbed fever?

she must be worn out and afraid and not wanting ot get close to the baby, just in case. don;'t force it, you are right, gentle encouragement is needed and unequivocal support

tigger15 Tue 16-Sep-08 15:57:04

I found the diabetic nurse worse than useless. She told me that I should test every 2 hours throughout the night. I pointed out that ds was feeding every 2-3 hours so my precious sleep was limited and I was not disturbing it for anything else.

They told me to reduce insulin by 50% beforehand but it required more than that.

My consultant said I could run really high sugars (I did) and so long as I had no ketones it was ok. So I did and checked the old fashioned way. If I'd tried controlling any other way it would have been the end of bf and a few more comas.

LeonieD Tue 16-Sep-08 16:02:22

Message withdrawn

dilbertina Tue 16-Sep-08 16:02:26

If the Docs & nurses are controlling her blood sugars and she is at 2 they are doing a crap job! She may well be on a sliding scale drip for insulin as been very unwell. I found it awful during labour, and frankly the midwives didn't have a clue what they were doing...my DH took over eventually with it, he was also clueless but at least did what I told him!

I think she could REALLY do with seeing a friendly diabetes nurse. They should come to her at home/ hospital whatever, my usual d nurse virtually moved in with a new mum who was struggling getting her levels under control!

PavlovtheCat Tue 16-Sep-08 16:07:57

I will call her in a bit and tell her to call her diabetic nurse...

leonie - oh I shall go look that up...along with childbed fever!

They apparantly tapped into babies spine for some fluid to check in relation to this infection...

I am going tomorrow afternoon with chocolates, magazines as she will be in another week, and a hat for her baby, and lots of hugs and praise for her and new baby...

dilbertina Tue 16-Sep-08 16:10:50

Whilst no doubt chocolate will be appreciated, if you're low it doesn't necessarily get the blood sugar up that quick...I found those small cartons of long-life fruit juice a godsend. Tesco do a variety pack of 9.....

MmeLindt Tue 16-Sep-08 16:10:52

Possibly not relevant, but here in Germany they do not let you go over 24 hours from breaking of the waters. In fact, I have never heard of having the waters broken to kickstart labout, that seems to be more common in UK than here.

My midwife told me that the important thing once the waters have broken is to keep the vaginal examinations to an absolute minimum as this can cause infections.

What a shame that she had such a hard time, it seems to have been very badly managed. I hope that she improves quickly.

dilbertina Tue 16-Sep-08 16:12:32

Maybe with her permission you could offer to call diabetes nurse for her?

TheProvincialLady Tue 16-Sep-08 16:25:04

I don't have diabetes but I do have experience of being very ill with a womb infection after DS was born. It affected my bonding with him initially because I was so, so ill and traumatised by what happened. I had also had some very poor BF advice and was struggling on that score too. In the end I found that getting advice from a qualified BF counsellor helped with the bonding because part of me was rejecting DS because I felt he was rejecting me (due to not latching on etc). The whole process of trying to get him to feed involved lots of skin to skin and time together, plus wearing him in a sling as much as possible, co sleeping later on, and it helped us to bond - we are very close nowsmile Even if that stuff is not done with BF in mind it helps to have the baby as close as possible to the mother, which may involve other people doig all the practical things for the baby if mum is too ill or tired.

Sorry for the ramble, what I am trying to say is that the feeling of distance from her baby is completely understandable (to me) and that it does not mean there will be problems in the future or that BF will not happen. I hope she gets better soon.

bojangles Tue 16-Sep-08 16:48:17

Hi, I am also a Type 1 diabetic and I am currently pregnant with DC3. I really feel for your poor friend - her experience sounds horrible. I had a horrid time with my first baby as I was induced early because of the diabetes and I also developed pre eclampsia. I was induced with pessaries at 36 weeks and thankfully they did kick start my labour but it was horribly medical and resulted in me having a massive PPH, blood transfusion and several days on the High Dependancy Unit. The staff were quite useless with my diabetes and I kept going hypo as the sliding scale wasn't working right. I was fluid resitricted because of the PE and was told to treat hypos with dry toast - this is after 3 days of labour and nothing to drink! I made them bllep my consultant who authorised them to take me off the scale. My DD suffered with very low blood sugars and jaundice and I gave in to the pressure to feed forumla top ups because we couldn't get feeding to work. I felt hugely traumatised by her birth and still feel gulity as though I somehow let her down - mad I know! I had a good debrief with the midwife when I was home and that helped. It did take me time to bond but it was much easier once we were at home and allowed to get on with it ourselves. The hardest bit for me was the feeding as I felt that it should be the least I should have done for her.

Despite my first birth I had DS 2 years later and was booked for an induction at 37 weeks - pre eclamsia again. I was 'lucky'! because DS was in distress so they skipped the pessaries and opted straight for a c section. This was a far more positive experience for me. However, DS was suffering with his blood sugars and had to spend the night on special care where he was given formula top ups but once he was back to me I managed to turn it round and I fed him exclusively until he was 14 months old.. I virtually stopped taking my insulin during the first few weeks - to me the risk of me being hypo with a baby was far greater than the risk to long term health of running slightly higher. All the time I was feeding I needed very little insulin and could get away with eating cakes and loads of carbs.

Sorry for the essay but thought it might help. I mirror the advice of the others in that your friend needs specialist diabetes advice from the experts.

Hope your friend is feeling better soon.
x

tigger15 Tue 16-Sep-08 17:26:55

If she's still in hospital they should be able to send her someone diabetic quite quickly. Ask to page her consultant?

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