Disclaimer

I am a childbirth educator, lecturer, doula, and natural mother of eight children. This is not a medical reference; I do not proclaim to give medical advice. Anything stated here is from personal experience, research, study, and opinion. Each woman has the responsibility to do her own research, consult with her own medical team, and make her own decisions about pregnancy and birth.

Sunday, March 20, 2011

"My water broke!"...Guess what...it's NOT an Emergency!

Bismillah al-Rahman al-Rahim

Art by:  Amy Swagman
http://themandalajourney.com/

Important amendment to this article:  I inadvertantly left off some very good points which were made in the comments section by a reader.  Please take the time to read the entire article AND comments to get a more complete view of this topic.

I recently had two separate occasions to work with women that had amniotic leaks prior to the onset of labor.  Both wanted natural birth without medical induction, augmentation, or cesarean surgery.  But both were worried if they didn't rush to the hospital that their babies would be in jeapordy.

Fortunately, I was able to provide them information that gave them the confidence to allow nature to take its course.  I pray that sharing this here will help others in the same circumstance. 

Please contact me if you would like to share a topic idea.  Now on to the article..."My water broke!"...Guess what...it's NOT an Emergency!

Unfortunately we are so conditioned by the media's portrayal of birth as an emergency that we often put ourselves in compromising situations, when all that is called for is patience and common sense monitoring.  Doctors may add to this drama by rushing to intervene. 


I'll begin by categorizing my eight labors in relation to the "water breaking." My personal case study serves to demonstrate that water breaking isn't always indicative of immediate birth.


Water Broke in Active Labor


With babies one, two, three, seven, and eight my water broke late in labor.  With the exception of my first, these babies were born very quickly once my water broke.  The first baby took about 45 minutes, but the rest were in my arms within fifteen minutes or less.  With the exception of the last, I was at my planned birth location when this happened.  With the last I was at home in my bathroom, although we planned to birth her in another room, we decided the bathroom turned out great for ease of clean up, subhanAllah. 


Water Broke During Early Labor


With baby four my water broke during the light contractions of early first stage. We rushed to the hospital expecting our baby to arrive quickly, only to find ourselves passing the next several hours confined to our drab labor room.  Had I known it would be six hours before his birth, I surely would have stayed home longer! 


Water Broke Before the Onset of Labor..Doctor "Helped"


With babies five my water broke before the onset of labor. 


With baby five I followed the conditioning of media and my physician and rushed into the hospital.  After approximately twenty hours with barely noticable contractions and insufficient "progress," I finally gave in to the doctor's insistence to "help me."

I reluctantly agreed to a Pitocin drip (intravenous medication which causes the uterus to contract abnormally hard and fast).  Within seconds I was in extreme pain and regretting the decision.  Fortunatley, my baby was born within fifteen minutes of the drip, but let me tell you, that was fifteen minutes too long! 


Alhamdulelah, I was able to tolerate the artifical labor long enough to birth my baby without any other medical interventions.  But many women receive this drug very early on and are quickly spent of all energy and tolerance and thus begins the domino effect of further medications for pain and many times ending with esarean surgery.

Water Broke Before the Onset of Labor..I Patiently Waited



Case One...Thirty-One Hours

Getting back to my two recent cases.  The first one was full term and noticed leaking.  She called me ready to head to the hopsital.  After a brief inquiry I determined that she had no other noticible signs of labor. 


I reminded her that I am not a doctor and cannot provide medical advice.  I encouraged her to do her own research and make her own decision, but based on my experience and research, I would wait it out, so long as the following conditions existed:

With baby six my water broke with no other noticible signs of labor.  I took my time.  I didn't head to the clinic for birth until labor was well established and I knew it was "time."  I delivered without any intervention within half an hour of arriving.
  1. No signs of infection (fever, foul smelling discharge, etc.)
  2. Clear amniotic fluid (no signs of meconium staining)
  3. Regular fetal movement felt by mother
  4. Mother feeling well
  5. Genital area kept clean
  6. Nothing entered into the birth canal (no intercourse, no tampons, no exams)
  7. Mother stays well hydrated (the body continually produces amniotic fluid and water intake is important)
She got a bit nervous as the time passed and I provided her the following website:  When Your Water Breaks Before Labor Begins.  It was enough to ease her mind.


After about twenty-nine hours her labor was well established and she was ready to go.  Alhamdulelah, she had her baby without interventions thirty-one hours after her water had broken. 

I am pretty sure that if she had rushed in, she would have had Pitosin to induce her labor, at the very least, and possibly ended up with an unnecessary cesarean.


Case Two...Five Weeks


The mother was 35 weeks.  She called me with a concern that her fluid was leaking.  I gave her the same response as the prior case and also suggested she consult her doctor since she was not full term.

When she visited the doctor, she was advised to have a Chortisone (steroid) shot and schedule a Cesarean.   I did some research on the steroid and found that it is given to help boost the baby's lung development but that it is of no use after the thirty-fourth week.  It is also a very painful injection.

The mother opted to avoid the shot and the doctor for a while.  She did not schedule the surgery and just waited it out.  I encouraged her to get a second opinion and stressed the importance of drinking a lot, watching for infection, and taking note of fetal movements.  She felt confident with her baby's fetal activity and opted not to get a second opinon.

Several weeks passed and her due date came and went.  Her doctor was again suggesting a cesarean as she was now "over due."  I reminded her that the due date is nothing more than an educated guess and not an exact science.  I suggested she get a second opinon to be sure that baby was thriving.  Again she avoided the doctor and just waited it out.

A few days later she went into spontaneous labor.  After three hours she had her healthy, full term baby, vaginally, with a different doctor, masha'allah.  She was thrilled with her birth experience and grateful that she hadn't over reacted to the leaking.

Conclusion

If the mother were extremely preterm, the doctor would most likely monitor her for infection and wait it out, in hopes the pregnancy would continue long enough for the baby to be more developed before birth.  However, if the mother is full term (or close enough to it) doctors tend to rush to get the baby out.  This makes no sense to me at all.  If we can monitor and wait for natural labor in the case of an early baby...why rush the full term baby just because it's developed enough to thrive? 

The water breaking is only one of many signs of labor.  Some women have a leak or breaking of water several hours, days, or even weeks before the onset of labor.  The body continuously produces amniotic fluid.  In a healthy, well nourished, hydrated mother there is little risk of a problem associated with leaking amniotic fluid besides infection.  This risk is only compounded by a doctor's fingers inserted in the vagina to do an unnecessary exam.

Patience, hands-off (or out), and common sense monitoring is the theme I'd follow, regardless of gestational age.  But in all cases, it's your body, your birth, and your baby.  No one else lives with the consequences of rushing (which could include induction or cesarean and all the risks associated with major abdominal surgery) or waiting (possible infection).  Both avenues have risks.  But realize, birth is a risk and there's no way around that. 

My Final Advice
  1. Pray Istikarah, ask for guidance, and trust Allah
  2. Get educated, do your own research
  3. Consult your doctor
  4. Get a second (or third or fourth, etc.) opinion if you have doubts
  5. Ask questions to make an informed decision
  6. Remeber the final goal is healthy mother/healthy baby, regardless of how/when it's born
May Allah provide the best guidance to every expectant mother and protect each from any harm....Ameen!

4 comments:

  1. my water broke... well this IS an emergency... at least till your doctor excludes cord prolapse... which (by the time it affects the fetal movements) would be too late... another thing i would like to stress upon... of course u can wait for the spontaneous labor to issue for as long as u want... BUT... u should not "watch for signs of infection" u should start antibiotics to AVOID infection (Big difference)... as chorio-amnionitis (which is the infection of the fetal membranes) is a serious complication that risks the life of the baby (and sometimes of the mother too)...

    Finally... a doctor that urges for unnecessary interference is -of course- not welcomed... but also leaving the management in the hands of the expectant mother according to her research is definitely not my idea of the perfect management either... so... to my mind the ideal management would be:
    1- Consult ur doctor ASA the water breaks to exclude cord prolapse which risks the baby's life
    2- Receive antibiotics to avoid infection
    3- Wait for spontaneous labour to issue... if your doctor tells u there r no other problems that contra-indicate this watchful expectancy...
    4- If the baby is less than 34 weeks u SHOULD receive two shots of steroid 12/hrs apart... it helps the fetal lungs to mature...
    5- if the waiting gets too long and ur water keeps leaking... u should have an U/S to assess the amount of water not to be too little and if this is the case the uterine contractions might coz fetal distress...

    Thanks for ur time...

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  2. Salam Alaikum,

    JZK for your comments and great advice.

    You are absolutely right! I apologize for not mentioning prolapsed cord (the cord coming out before the baby) as a true emergency that can happen once the water breaks, especially if the baby's head is not yet engaged.

    As for antibiotics, I totally agree. They are an easy measure to ward off infection. The doctor in case two did recommend them and I concurred, but I can't recall if the mother took them or not.

    In the case mentioned, the doctor advised unecessary injection (past 34 weeks there's no point in the steroid) plus unecessary cesarean surgery. Considering these two facts, it becomes difficult to trust this particular care provider. However, I totally agree with the advice of the steroid had the gestation been earlier.

    I think the best advice to gleam from this is to read and educate yourself as much as you can and shop around for a doctor who supports the type of birth you desire. This should be done very early in the pregnancy, if not before. This way if a complication does occur you can rest at ease in the trust you have built with your care provider.

    Not all doctors are good, not all doctors are bad. Thankfully, there really are some gems out there, but it takes good consumerism and due diligence on the patient's part to find the right one for her.

    I feel very blessed to have such caring readers which add much value through the dialouge presented. Thanks again for your time and input.

    Dua that Allah provide you only the best of this advice and protects you from any harm.

    Best regards,

    -Aisha, Natural Mom

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  3. My mom's water broke, and she didn't do anything about it. That was 35 yeaers ago. When she went to the hospital the day after, they told her the boy has died due to suffocation (If I remember correctly).
    My mom was still a kid back then, and she didn't have the knowledge and education to know the seriousness of the situation.

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  4. Asalam alaikum, Ahmed,

    I am so sorry to hear of her tragic experience. It sounds like a prolapsed cord issue? But again, I'm not a doctor, so I can't say for sure. May Allah have mercy on her and may she be greeted at the gates of Jennah by her son.

    With anything in birth there is risk. Doing nothing can be risky, rushing into procedures can be risky (as each procedure comes with increased risk...up to and including death of mother and/or baby).

    We will never eliminate the risks of birth (whether all natural or by medical intervention). In fact, we will never eliminate the risks of living!

    It all comes down to Allah's will. May each of us be protected by HIM and comforted in the knowledge that all things are of HIS plan and come to us for a reason and for our best interest.

    Once again, I pray each one is provided the best from this dialogue and protected from any harm in it.

    Thank you so much for sharing your story. May Allah bless you and your family.

    Best regards,

    -Aisha, Natural Mom

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