Risk of infection after waters breaking - how real is it?

[Pennypops]

Please can someone help me? I am 39+6 today but my waters started to go in the early hours of Monday morning and continued yesterday. I had a home birth booked and a midwife came out to have a look but labour still hasn't started despite me doing all the things recommended to get things going. On the midwifes advice I went to the hospital today and I was given antibiotics and told to return in 24 hours to be induced which will take the overall time from waters going to induction to about 60 hours.

However, what nobody has been able to explain including the registrar I saw today was what the risks of infection actually are if I just let nature take its course. Apparently my cervix is still completly closed and facing backwards which to me indicates that any induction is going to be extremely unpleasant.

Does anyone know how high this risk of infection is? I would never put my lo at risk but so far waters are clear, heart rate is good, my bp is fine - am I being an idiot if I refuse to be induced?

Sorry for long post but desperately need info before its too late!

Some info here NICE

Risk is very slight
Did they tell you to take your temp?
What are the ABs for?

The NICE guidelines seem to suggest you can go for 4 days after your waters go - with my first my waters went Fri morning and I was booked for induction Monday

Yep - they said to tale my temp which I am happy to do. AB's are a precaution apparently - there is currently nothing to indicate anything is wrong.

Thanks for info also!

I was a doula at a birth recently and the ladys waters broke at 3pm on the Tuesday and she had her baby by csection on the Weds at 12 midnight. Csection done mainly because of babys position and mum was very tired but she had to have a general instead of a spinal blok because she developed a high temp. and an infection. The local midwives told me that the time span for going in was to be lowered from 24 hours to 18.

Thanks for advice - I guess I'm just worried about intervention spiral. I'll be taken in, hooked up to drips and monitors for 10 hours and then wheeled off to theatre for failure to progress.

Oh WHY doesn't my baby want to come out???? frustrated

Hi Pennypops

I dont think anyone really can give you definate figures on how high the risk is, as each person is different and as far as I am aware, there have not been any definitive studies done on long SRM at term.

Risk of infection is pretty low really if your cervix is closed, as the water coming out the cx washes out any bugs, but I would really avoid anything like baths (until you're in labour) and sex, as it can introduce bugs through the cx, increasing the chance of infection.

Keep a check on your temperature, and if you feel feverish or temp reaches 38C, you should phone your m/w and the hospital and prepare to go in.

As for the induction, some hospitals will give you a prostin pessary 6 hours prior to the synto drip which can increase its efficacy, but your cx doesnt sound like its too keen to get started by itself

Most guidelines are for IOL by about 96 hours, and you should be offered IV antibiotics in labour. Were you given oral or IV antibiotics today? And what were they?

Have you tried the old faithfuls like nipple stim, pineapples, curries, stairs etc?

Good Luck and hope things kick off for you soon.

Pennypops - risk of infection is low in low risk pregnancy however it is policy in most units to give intravenous antibiotics in albour if the waters have been gone for over 18 hours. This is mainly to prevent GroupB Strep (GBS) infection of baby. 30% of women harbour GBS in their vagina and it causes no harm, except if baby becomes exposed during prolonged membrane rupture.

It sounds as though you have been given oral antibiotics which are not actually necessary.

You do not have to be induced and you could certainly wait longer than 60 hours. You certainly would be advised to have IV antibiotics in labour which can be given through a cannula in your hand. You don't actually need to have a running drip.

I have indeed been given oral antibiotics. And yes, all the usual advice has been followed re more fun methods of kickstarting labour!

DH is on the phone ordering a Jalfrezi as we speak.....

In our unit women go home and come in after 60 hours approx of SRM. We do not give oral antibiotics and there is no evidence to say that they are necessary.

What have you been given?

For preterm rupture of membranes we do give erythromycin because that has been shown to delay the onset of labour - a different thing altogether.

The label says Amoxiclav but the actual box says Augmentin?

When you say your waters have gone, how exactly? I 'leaked' amniotic fluid for about a week before I went into labour, but it wasn't so much that they were concerned about there being enough left iyswim.

Like you, there was some mention of infection but fortunately my midwife was willing to hang on for us. When my waters broke again more abundantly and still nothing much was happening she said if we were still in the same position in 12 hours she would want me to go in for a blood test.

Fortunately ds got going (finally!) shortly after that.

I am amazed that you have been given these - there is absolutely no need. Have you had a swab taken recently that has shown an ongoing infection?

If not, I would query why you have been given them TBH.

Agree with Mears - very strange management indeed, as with no current infection they are pointless and you are being completely overtreated

Might be worth a call to the L/W and speaking to another reg for a second opinion.

No swab has been taken so if there is any sort of infection I don't know about it.

As for volume - there's been a lot!

Thanks for advice to all anyway - I guess I'll just see what happens over the next few hours and then just have to go with the flow.

At least we should have the lo with us soon!!

Hi Pennypops (and I hope you DO penny pop soon!) Just sending my best wishes really, everything mears says seems to make perfect sense (As always) I HAVE been in your position exactly and I was induced first with 2 prostgladin pessaries and then on the drip, you know what? It was fine! Super fast delivery and didn't ruin the experience at all. My only advice would be to just go with the flow and enjoy the birth even if you're in hospital and on a monitor...good luck, can't wait to read your birth story

(PS get bouncing on a ball and rub some clary sage oil on your belly)

Hi Lizzer - thank you so much for your lovely message. It's really nice to hear something so positive. I am up and just sorting out stuff ready to go in to hospital and will be taking my birth ball and sage oil with me!. Getting excited now

You're lucky though, as the hospital did let you come home!

My waters broke with DS1 when I was 36+4 weeks, and I was kept in. Consultant said he would leave things until I was 38 weeks, but if nothing had happened by then, he would induce me. Apparently this is the last part of the development of the lungs, which would be sorted by 38 weeks.

I was desperate to go home, but wasn't allowed to! DS1 came of his own accord a week later.

good luck pennypops hope everything goes well for you all.