# Ok, what is the real deal with infection after your water breaks?



## mormontreehugger (Feb 25, 2009)

I keep hearing different things. I am of the opinion that if you don't already have an infection and you're careful not to introduce one to your vagine or even use some kind of anti bacterial wash or something, then infection doesn't just appear out of nowhere.
Here's what I've heard:
My OB: It travels up the vagina. (that's it, he didn't say where it came from.)
A midwife I interviewed: Mostly would travel over from the anus. (and if you wipe front to back... does that make a difference? or does infectious stuff just float around in your underwear?)
Friend at church: Oh it mostly comes from inside... like if the baby poops or something (????? then why would infection not happen BEFORE the water breaks?)

Anyway, I would really like to know the answer to this. If one or all of the above is correct, I'll accept it and move on. I just don't understand the idea of spontaneous infection....


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## Robinna (Aug 11, 2003)

Your OB is right - it travels up the vagina. With fingers or a speculum. But if you don't put either of those things (or anything else) IN, then IMO your waters, continuously flowing downward, are pretty much going to disallow any upward travels.

Have there been any studies about this? I don't think so. Someone please correct me if I'm wrong! However my understanding is that this is one of those obstetrical beliefs that is quite old and unchallenged and is due for investigation.

Your MWs comment surprises me, and your rlf's comment astonishes me. Which is not to say they're for sure wrong, I certainly don't know everything, but i have never heard either of these ideas about infection before and I've done a LOT of talking about this with a really huge number of people, and I've never heard either of those before.


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## Limabean1975 (Jan 4, 2008)

According to my MW, the reason for the whole GBS issue is GBS can travel from the rectum into the vagina - GBS does NOT originate in the vagina, so if you're GBS positive on a vaginal swab, it had to come from somewhere.

The question then is does it travel up there on it's own, or do fingers, speculum, or penis *push* it up there?


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## Jane (May 15, 2002)

Infection spreads from the vagina to the amniotic fluid around the baby. The vagina has a lot of natural, normal bacteria in it. Even GBS bacteria can be a normal part of a woman's flora. The amniotic fluid is sterile until the water breaks.
The body produces lots more mucus and fluid in pregnancy to help keep things less microbial by flushing continously outward. The water in the baby's sac keeps replenishing and and flowing outward - this also helps prevent infection by washing out the vagina.
The amniotic fluid can become infected even without any speculum or vaginal exams, but those are a serious risk factor for infection, because they take flora from the vulva (lips) and external vaginal are and move it up into the cervix area. It's just a hop skip and jump into the uterus from there. That's why providers use sterile gloves after the water breaks, to do everything possible to prevent infection.

Having baby poop (meconium) in the water is a risk factor for infection. Although the poop is sterile and not a source of infection itself, it provides a nice medium for bacteria to grow by diluting some of the natural antibacterials and giving the bacterial something to eat.

Some women have nice colonies of GBS living in their vaginas, rectums and even in their bladders. Perhaps it once came from the anus, but it can live quite happily elsewhere for months or years. Does it matter where it once came from?
As far as GBS, if the mother has it, it's likely to get to the baby in the process of birth, even without exams - just passing through the vagina is enough to pick it up in the nose and mouth. There's usually some stool passed in birthing.


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## mormontreehugger (Feb 25, 2009)

What if the mother is not GBS positive? Would the risk go down then?

I guess what I really want to know is, what's the ideal situation and what precautions could someone take whose water breaks but doesn't go into labor right away? My mom was given 12 hours every time she gave birth to start labor on her own, and they induced her every single time (she has 8 children). I think that's awful, but I also want to know what she could have done (and what other mothers could do) to avoid that scenario. I read of a situation in my Bradley childbirth book where the woman went about 4-5 days without going into labor and everything was fine. She took her temp constantly to check for infection and was just really careful. Was she just really really lucky? Or could that be more common to avoid induction?


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## Jane (May 15, 2002)

The risk of GBS infection would go down, of course. Although, any of the normal intestinal bacteria could cause infection. GBS bacteria happens to be really good at getting into the respiratory passages of newborn babies and causing serious, serious pneumonia.
It's very similar to a bladder infection. The bladder is normally sterile. The flow of pee out and away keeps bacteria washed away. But sometimes, bacteria get in, the body doesn't eliminate them fast enough, and they multiply and cause an infection. It's much less likely to get an infection of the amniotic fluid than the bladder because usually the baby is born before the bacteria can enter and get a foothold.

I forgot the add the ways to detect infection - odor or change in color of the leaking fluid, temperature rise in the mother, fast heartbeat in the baby, contractions become uncoordinated.

Obviously, I'm a big proponent of midwife attended birth. One of the benefits to a trusted attendant is that she can answer any questions and you should be able to trust her to keep an eye on you and the baby, so you can do the real work that actually gets the baby out. I don't mean that to be condescending or to discourage you to find out everything you can. Just that labor is hard work and you deserve the chance to focus on it as needed.


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## Amila (Apr 4, 2006)

My midwife said some of her Amish patients go for days and weeks without any problems. The whole 24- hour thing is to CYA.


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## mormontreehugger (Feb 25, 2009)

Thanks so much for the responses so far.

Apricot--you don't sound condescending at all. I'm glad to feel more informed on things without having to rely on just the little bits of information that have become big huge scary things that people like to pass on without discussing the options calmly.
I do feel better about things and I will definitely be choosing a midwife that I would feel comfortable with who I could trust with that sort of thing. I wouldn't feel all that comfortable with the first one I interviewed just because she sounded like water breaking was an automatic hospital transfer and I just can't believe that (I could understand definitely if there was a previously existing condition like GBS).

I would really like to study up more on how the Amish do things also--they seem to be a lot closer to natural than most of us. I'm gonna go out on a limb here and assume that their lifestyles are probably a lot healthier as well...


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## Devaskyla (Oct 5, 2003)

I went 88 hours after my water broke with ds2 before labour started. I got cut for the 24 hour rule with ds1. There was no way I was going to let that happen again.

With ds2, I took vitamin c a few times, monitored my temp & kept everything out until I had h check me when pushing hadn't gotten anywhere after many hours. My water also broke prior to labour with ds3. I did the vitamin c/temp, nothing in the vagina thing again (except for a very fast self check to make sure the cord hadn't prolapsed). Labour started a lot faster, though.


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## chandasz (Apr 13, 2005)

Let me look in my binders but I know I have a study in there showing that the risk of infection (without fanny fiddling) is negligible even at 96 hours....


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## TzippityDoulah (Jun 29, 2005)

Quote:


Originally Posted by *mormontreehugger* 
I would really like to study up more on how the Amish do things also--they seem to be a lot closer to natural than most of us. I'm gonna go out on a limb here and assume that their lifestyles are probably a lot healthier as well...

for some that is true... but really, not all. My husband works with a lot of Amish families and many birth in hospitals and some find the fact that I homebirth is so weird. ( fo course some are much more traditional and natural, but it's no longer safe to assume about the majority)

Amish people are a very different culture for sure, but aside from not having electricity, you would likely be surprised by how modern many of them are!

my husband has one amish client who has an iphone and emails from the road all day. He has a mennonite driver - lol I don't even have the slightest idea how to use an iphone!!


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## heatherweh (Nov 29, 2007)

Quote:


Originally Posted by *Devaskyla* 
(except for a very fast self check to make sure the cord hadn't prolapsed).

That's what actually worries me, I know its rare, but I do wish that I could just be sure there was no prolapse and then be able to labor without worry.

The infection concern is as OP said, more of a risk from being examined frequently really (or sex or anything else going upward). Baths or birthing tubs are still supposed to be perfectly safe after membranes rupture.

I just read a book called "Homebirth in the Hospital" and one woman (a doctor and so probably demanding of respect for her wishes) went in to her OB after her water broke because she was also Group B strep positive. She told them her plan was to labor at home and that was exactly what she was going to do, so barring them being able to force her to check in to the hospital they gave her oral antibiotics (I think did a quick check to make sure no prolapse) and sent her home to labor in peace! I was just amazed that they listened to her and let her do things in a somewhat unconventional manner.


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## chandasz (Apr 13, 2005)

Something to consider... prolapse is really really unlikely (I will never say impossible to anything) if baby is engaged.

Something you can ask your caregiver toward the end of your pregnancy. Many women experience "lightening" when baby's head engages in the pelvis. This blocks and prevents the possibility of prolapse.

Find out what you need to to feel safe and remember that birth is as safe as life can be. We've just made it into a scary thing through this culture of fear we live in.


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