If waters break when baby's head not at all engaged and contractions do not start by themselves, can I request a CS or do I have to be induced?

[legallyblond]

The title says it all really.

There is a history of this happening in my family (happened to my mum, her sister and their mother (my grandmother) with their first children).

My mother was induced after 24 hours of her waters breaking (waters broke at 36 weeks) with no signs of any contractions. Becasue the baby's head (my head actually - I am the eldest!) was not engaged at all, labour was VERY slow and painful and took 4 days. Eventually I was delivered by forceps and with a epiostomy (sp?) and I had to be taken to the special care unit for a couple of days. My aunt (mum's sister) had the same thing. Waters broke (at 38 weeks), baby's head not engaged and she was induced. After 48 hours, she had a very last minute/urgent emcs as baby wa so distressed. With my grandmother (although this was the 50s!), same thing happened (waters broke at 38 weeks, head not engaged) and eventually she was given a general anesthetic and birth was by high forceps.

So... IF this happens to me (the baby's is head still free at almost 36 weeks...) can I say that I don't want to be induced and request a CS if contractions don't start within the time limit for induction (either 24 or 48 hours I think)? I just feel that an induced birth when the baby's head is not even engaged is a complete waste of time - it is almost bound to result in a complicated birth and an emcs may be needed at the end of it anyway. Would the hospital be receptive do you think to the idea, if this happens, of a cs before trying induction?

Hopefully it won't happen at all and I can have the waterbirth I want!

This happened to me with my first at 35 weeks, head was completely free and clear at an antenatal appointment in the morning and waters broke that evening. After 24 hrs and no contractions I was put on a syntocinin drip. And guess what the labour was great. Mobile epidural + gas and air( I was able to sit on rocking chair / birthing ball, walk to the toilet myself etc.). Went from 2cm - 10cm in 4.5 hrs. Pushed baby out by myself in 25 mins.

My advice to you is not to think your childbirth experience will follow your family member's (mine certainly hasn't). Methods of induction may not be the same as 20/30 yrs ago in any case. Its easier said than done but try not to get anxious about something that hasn't even happened and has never happened to you. And tell your family and friends not to tell you childbirth horror stories. There are plenty of positive induction stories on here under a variety of circumstances.

Discuss family history with your consultant at your next appointment, ask for your concerns/request to be written in to your notes. If your waters do go before labour, it may be easier for you to challenge the usual induction route if it's something you have talked about with the dr before. You will probably find the Consultant more receptive to your concerns, than a MW, IME, as the consultants are better versed about the risks of having a particular outcome, and act to avoid it, whereas the MW tend to be keener to avoid intervention, and play down risks (both are valid view-points, but they do tend to com at the same problem from opposite sides, I've found!).

Owlingate - thanks for that. Perhaps induction needn't be as bad as I fear... my pregnancy so far has totally mirrored that of my mother and aunt though, which is why I fear the birth might too. I like the sound of you being mobile though - that is the main thing I was worried about with an induction. I just wondered how lying on my back attached to drips without the head engaged could possibly end up in a successful labour!

oldmum - I have just been referred back to MW led care. I was referred to cons becasue I was consistently small for dates - again, exactly like my mother and aunt! - but, after 2 growth scans, all is fine so I only really have the option of discussing with the MW now. My next appointment (in a couple of days) is my 36 week appointment, so I don't have much time really to raise the issue properly...

Everything will probably go fine for you, but you could always bring up the subject with the MW and see how she responds - if she is concerned, or sees you are very worried about it, she may ask if you want to talk to the consultant.

BTW the usual 'time limit' is 48 hrs if full term and no infection. Ask MW for instructions on what to do if your waters do break and no contractions to get things moving yourself.

FWIW its now happened 3 times (but the third was 3/5 engaged at least!) and the third time the contractions did start within 12 hrs.

I've heard the worst possible inductions are when you are overdue but no waters broken, cervix unfavourable etc. When I was 'induced' with DC1 they called it 'augmentation' of labour. The midwife told me I was already halfway there!

My mum's water broke 4 weeks before my brother was born. She was cared for by both her midwife and a doctor and delivered my very lovely brother after a long labour (17hrs) at home with out any induction or medical assistance. I

You are quite within your rights to ask the midwife to make you a consultants opinion. In my (limited) experience consultants are more receptive to your concerns and are better at looking at the bigger picture. Added to which a midwife can't make a decision about a c-section, it has to come from a consultant.

Thanks guys. I will raise it with my MW at my 36 week appointment. Like I said, still hoping I won't be in this situation!

I will ask her about "getting things moving" myself if my waters break as well!

I can be quite persuasive, so I think that, if my waters did break and nothing was happening, i would feel confident enough to insist that i speak with a consultant before they stuck me on the induction drip. I do think that the arguments for a CS in this situtaion (i.e. baby's had not engaged at all) are valid.

hazchem - trouble is, I don't think the hospital would let me go 4 weeks after my waters had broken. I know I could refuse to have an induction or any intervention, but if the Drs tell me that there is a significant risk of infection (that is why I believe they induce after 48 hours of waters breaking), I am not sure I feel remotely confident in my own medical knowledge (I am a lawyer!) to go so totally against their advice...

I gave birth on Sunday. On Sat night I had a small show and then my waters started trickling out. As I am GBS positive I knew I needed to get the antibiotics administered. When I went to hospital in the afternoon I had no contractions and they said the baby's head wasn't engaged. 2 hours after the antibitoics were administered I ended up having a 1 hour 10 minute labour with 7 minutes of pushing. You just don't know what's going to happen. I recommend discussing your concerns with them and using your birth plan as the focus of those discussions so you can explore the options available to you.

Thanks cityangel - that is a very positive story!