Routine IVABS because membranes ruptured?

[puddleduck2001]

Hi hope someones around, I am labouring patiently at home atm, booked for a homebirth, totally normal pregnancy and full term. My waters broke last night, contractions followed an hour later, and the hospital are on at me to be admitted for IVABS if I haven't delivered by 8pm tonight...don't want to go, will probably decline, but has anyone else had this? is it normal practice? All I took in about PROM was the guidelines 'allowing' us up to 96 hrs to give birth. I'm buggered if they're taking my HB off me for this, wouldnt have told them about the waters breaking if I had known...

I would decline. My waters broke at 22 weeks with ds2 (luckily sealed later on in preg after months of bedrest) and they gave me oral anti biotics. They can't make you have anything you don't want. As long as baby is ok, then I'd stay at home, you can go in for checks and still have a hb. Hope it goes well. I also had my waters break at 36 weeks with dd but still no ivabs needed, I went into labour the next day but the most they wanted was to induce.

Puddle - how many weeks are you?
do they think you have an infection??

Hi,

If I remember correctly, the national guidelines say 96 hours but your local hospital protocol probably says 24 hours or something. Who cares, it's your birth and their protocols are their problem (within reason). Isn't it ridiculous that they are allowed to differ from the national guidelines, which are based on proper research?

Best of luck with your home birth and with the birth in general

9nut

Nice guidelines on induction
this

So what are they actually suggesting? Induction or just IVABs? As far as I know the NICE guidelines don't actually mention whether or not to give IVABs, they're just talking about induction after 96 hours. Could you have the IV ABs and then go home for your homebirth? Could you have oral ABs instead? What about temp monitoring and then re-assessing if you show signs of infection?

err, there's no need for IVABS unless there is increase in yourt temp and pulse racing. We are continually told not to waste GPs time for ABs as they are only effective IF there's an infection to treat!!!

If you are not succumbing to infection there's no need for profilactic treatment.

Make sure that your temp and pulse are checked regular, DH can do this if mw are not there yet. And do not allow any unecessary VE which could introduce infection, shower rather than bath.

I think they're talking rubbish and trying to get you to come in, just another tactic.

Happy labouring!

Just out of interest doulaklaw, where did you do your medical or midwifery training? As a doula do you normally tell women that the medical advice they've received is wrong and what qualifies you to do so?

PLEASE consider the IVABS - my friends waters broke last week, she was sent home - I don't want to upset you but the upshot was not good and it turned out she was a group B strep carrier - if you haven't been tested for this, do consider going to hospital. Sorry to bust in on your thread!

puddleduck - I hope that the fact you're not on here means that all has started off on its own accord! Good luck & all the best. Didn't mean to worry you earlier but it hit a nerve...

Thanks all. They just phoned again to give me the hard sell to go in for, well anything they like really.... to check it was waters that broke, for a baseline ctg, and to start IVABS. I am 40w+2, am fine except for pains obviously, temp is 36.6 and me and DH are both senior nurses lol. Have politely declined everything at the mo but said I would like someone to see me as I will likely want to use the G and A/ pool soon.
If they're so worried about me why has no one popped in to see if I'm alive??
And the cheekiest thing - she said well IF i can find someone to come out to you, is there any point or are you going to insist on staying at home regardless, will you come in if MW asks you to? I said of course I will transfer if I AGREE there's a concern, eg heartrate dropping or something, but not just on a whim. ooooh its going to be a long day...

if you are booked for a homebirth, why on earth is a midwife not coming out to see you there !?!?!

you say you need to use g&a soon...are things underway?

Puddleduck I am that they are treating you in that patronising way. Especially as you are a senior nurse and probably understand the IVABS situation better than most.

You sound like you have thought everything through - excellent response to the cheeky MW!

Focus on what you need to do and try not to stress about what anyone else is saying. Maybe your DH could communicate with the hospital on your behalf?

Anyway, as I said, best of luck - will be thinking of you.

9nut

have not heard of prophylactic antibiotics being given when there is rupture of membranes, if there is no sign of infection....NICE guidelines do state 96 hours can elapse before induction should commence.....

MW finally called in about 5ish, the one who came out was ok and understood I was declining the ctg/IVABS etc at present but was willing to review the situation as needed. She would have bitten my hand off if I'd agreed to admission though.
Things have tailed off loads and she feels is still latent stage, only contracting about 50s every 15mins now and more manageable compared to last night so its going to be a long weekend I think. Obs were all spot on, temp 36.9, bp 120/80, fh good and good variability. She did seem to 'get' what my attitude is once I said I would agree to transfer if there was an actual problem but I didn't feel there is, not yet anyway! We have negotiated I will call in to be monitored tomorrow if not labouring properly by then, I will monitor temperature, and she agreed I can use my pool at my discretion when I asked...so overall am happy enough but I was really fed up they make it so difficult. I was really feeling like 'why the did you bother to deliver my HB kit if you are so keen to avoid me actually GETTING a HB?' Maybe its so their figures show I was a planned HB and it makes them look good... Going to try to get some rest if the baby allows, will update when I can. Great to hear lots of you agree with me tho!!

Hi Puddleduck, glad you're OK and you've not been pressured into going into hospital! Just wanted to add that there's a school of thought that your membranes are more likely to rupture prior to labour starting if the baby is in an OP position, so it might be looking at some optimal fetal positioning tips if this is the case for you. Let us know hoe things go!

keep doing what you are doing puddleduck ! you sound really strong and confident, and you know you can birth this baby..this is just a little pause, so you can rest and get your energy for the long haul ! eat a little something, drink , chill and baby will be coming !!

how exciting

In our hospital policy was to give IVABs 24 hours after SRM, then again every 12 hours after that. I don't know what they did about homebirts.

Thanks, baby is LOL, apparently with anterior placenta thats probably the best I could hope for as OA is pretty much ruled out. I don't know about strong and confident but I'm not easily bullied, was just glad they couldn't find anything wrong as an excuse to drag me in lol

i had an OP baby,VBAC, no problem ! just avoid lying on your back !! keep going !!

Rolymomum,

You're right, as a Doula I shouldn't tell women that medical advice they've been given is wrong. As a MNetter I am not paid to offer suggestions and my opinion. I am not posting as a Doula, merely as a person passionate about childbirth, having had two of my own and having done a lot of relevant reading.

And it appears from Puddleduck's posts that she is being pressured to go into the hospital when she has booked a HB and I am not the only one to suggest that she stick to her plans unless there are signs of infection, which any one of us can check at home, as a well-informed adult.

She has 96 hours from ROM not 24, that was clearly wrong. NICE guidelines

I'm sorry if I've tread on toes, that would not be my intention.

I'm thinking of you Puddleduck,

Breathe! Do horsey lips, laugh, envisage your cervix opening....

Can't wait to hear your Birth announcement!

The draft NICE guidelines on intrapartum care, though, do state that a woman should be offered prophylactic intravenous antibiotics 24 hours after SRM (my copy's saved on my hard drive, but you can get it from the NICE website). They do also say that she should also be given the option of no intravenous antibiotics with monitoring of temperature and vaginal loss. The 96 hours is for induction and a separate issue.

Ah Lemonaid...

I've been confused! Apologies. I do however believe that with care, and if a woman is adamant, she should be allowed to wait it out. It is her choice after all! But I do always think that it is important to monitor the situation very carefully.

None of us would ever put our baby at risk and would certainly ask for the appropriate care should it be needed. However, none of the women I've come across online who've had PROM have ever mentioned the IVAB issue before, there has only ever been an issue over induction.

I live and learn! I love it!

Presumably if these guidelines are only DRAFT then that's why not all hosps are implementing them yet

what are any of your views on testing re group B strep? In the "other" section I have a thread calling on people to petition for testing to be offered to all pregnant women.