Premature rupture of membranes

Premature rupture of membranes (PROM) refers to the bag of waters breaking prior to the onset of labor. Usually labor starts soon after, most often within the first 24 hours- though not always. In my class I provide a copy of a study that shows no higher risk of infection/complication in 12 hours or 72 hours of managed labor after PROM.

I came across this very thorough look of studies related to PROM.  LOTS of information to read through, but worth it to educate yourself in how you would handle this situation should it happen to you.

Premature Rupture of Membranes at Term

Belly Tales

Answers to common objections to delayed cord clamping

Most Bradley students include in their birth plan that they desire delayed cord clamping. Sometimes they are met with objections from their birth team. Here is an article, siting recent research, that pediatrician Mark Sloan, MD wrote refuting common objections.

Unclamped cord over the course of 15 minutes

Please click on the title to read the full article.

Common Objections to Delayed Cord Clamping – What’s The Evidence Say?

November 13th, 2012 by Sharon Muza

Goto commentsLeave a comment

by Mark Sloan M.D.

Today’s guest post is written by Dr. Mark Sloan, pediatrician and author of Birth Day: A Pediatrician Explores the Science, the History and the Wonder of Childbirth.  Dr. Sloan shares information and current research on delayed cord clamping after birth, in a helpful Q&A style format that consumers and professionals can use to discuss this important topic.

_____________________

photo credit pattiramos.com

Many maternity care providers continue to clamp the umbilical cord immediately after an uncomplicated vaginal birth, even though the significant neonatal benefits of delayed cord clamping (usually defined as 2 to 3 minutes after birth) are now well known.

In some cases this continued practice is due to a misunderstanding of placental physiology in the first few minutes after birth. In others, human nature plays a role: We are often reluctant to change the way we were taught to do things, even in the face of clear evidence that contradicts that teaching.

Though there is no strong scientific support for immediate cord clamping (ICC), entrenched medical habits can be glacially slow in changing. Here are some often-heard objections to delayed cord clamping (DCC), and how an advocate for delayed clamping might respond to them:

Little-to-no evidence for the use of a saline lock during an un-medicated labor

Read the full article for more information to help you make an informed decision about having a hep-lock. The article sites other research. I encourage you to read the article in it's entirety, but here is a part (for you cliff note readers)

Evidence for the Saline Lock during Labor

http://evidencebasedbirth.com/the-saline-lock-during-labor/

Benefits of having a saline lock:

• If you change your mind and decide you want an epidural, most anesthesiologists want you to have a fluid bolus prior to the epidural and you will become “more high risk” with an epidural and need the IV
• There is an overall 2.9% risk for post-partum hemorrhage (the risk is much less if you have a vaginal delivery and no risk factors), in which case an IV will need to be inserted for fluids, Pitocin (which can also be given in a muscle injection), and (very rarely) blood products
• If you do get really thirsty or tired and can’t hold anything down, you can be given IV fluids for a bit of a boost
• If you do decide you want a saline lock, Dr. Shannon recommends, “Get it placed earlier in labor when you are more comfortable, as you may desire or need IV medications later on (such as for nausea, pain, or hemorrhage) when placing an IV may be more difficult (of course, Pitocin can be given by muscle injection if necessary for post-partum hemorrhage).

Risks of having a saline lock:

• It hurts to have the IV placed, and some women find it uncomfortable and distracting during their labor
• It may cause bruising or small amount of bleeding at the IV site
• The vein can become inflamed (phlebitis) which can cause redness and pain (risk = 7-10%) (Rickard et al. 2010)
• If the IV is used for medication or fluids, these may leak out of the vein and into the tissues, also known as extravasation (risk = 30-33%) (Rickard et al., 2010)
• Infection at the IV site resulting in a severe bloodstream infection (risk = 0.1%) (Maki et al. 2006)
• Having a saline lock might make it easier for your doctor or nurse to initiate unnecessary interventions, like IV fluids or Pitocin for augmentation
• The saline lock could be viewed as a symbol that the woman is “sick” and a “patient” instead of a healthy woman giving birth, and this symbol may have consequences for the woman’s mindset for giving birth– and may also adversely affect caregivers’ attitudes towards the laboring woman  (Newton et al., 1988)

In the end, I think it comes down to this. There is little-to-no evidence for the use of a saline lock during an un-medicated labor. However, there are risks and benefits to having the saline lock. The ultimate decision for whether or not to have a saline lock should come from you. If you want one and feel safer or more comfortable by having a saline lock just in case it is needed for medications or IV fluids, then that is your right to make that choice. If you have reviewed the risks and benefits and feel that you do not want a saline lock, then that is your right to make that choice. You are a consumer, and you have educated yourself on the risks and benefits, and you do have a say in this matter!