When to start Pitocin after water breaks

Chenny555 · June 2011

I'm planning a natural birth and my doctor has always seemed to be on board with this. Today I asked her some fairly basic questions like when she wants me to head to the hospital if/when my water breaks. I asked how long after my water breaking would they allow me to labor and she said they'd start Pit pretty quick - after like an hour. This seems really fast. My sister's water broke very early, contractions were not even regular and her dr. waited 12 hours to start Pit. Anybody have any insight? I'm a little scared at how rigid my dr. seemed today, up to this point she has been flexible and seemingly on board with my plans to birth with as few interventions as possible. I will be talking to her about this more, but this late in the game, I'm nervous.

LindseyJW · June 2011

for 50% of women, labor naturally begins within 24 hours of the membranes releasing. that means half of women don't start labor naturally within 24 hours. OBs want labor to begin because the risk of infection increases within 24hrs of membranes releasing.

in my HypnoBirthing class, I ask families to describe the properties of the vagina that are similar to a vacuum cleaner. usually, no one can come up with any and that's because the vagina is not a vacuum. if you don't introduce any bacteria, there won't be any bacteria. the vagina does not go around sucking things up.

so if you are one of the 5-10% of women for whom membranes release before the natural onset of labor, don't consent to a vaginal exam and you should be fine.

it would seem to be a red flag to me if your OB wants to start pitocin within an hour of your membranes releasing, for no reason other than your membranes releasing. often, they are under the stronghold of insurance and hospital policy or rush to turn over patients. don't be lost in the shuffle!

if your fluid is clear and sweet smelling, there is no reason to go to the hospital. they will only put you on a clock. the good thing here, is that you now know this and can avoid the clock!

Temp76535187505890 · June 2011

Wha?? An hour? That's ridiculous. My water broke with both of my children and contractions didn't start for an hour and a half. I'd hate to think I would have been put on pitocin needlessly in those cases.

How long care givers go varies. My midwives asked me to come in after 12 hours if my contractions didn't start. Some practitioners don't do anything for at least 24 hours and sometimes even longer. Personally, I'd want a minimum of 12 hours (preferably more) before any interventions were even discussed unless there was some medical need.

Chenny555 · June 2011

Thanks. I've done my research and have taken a Bradley class and am hoping to labor at home as long as possible. My doc is a family practice doc and I'm sure her policies are those of the hospital. In the past she has been very supportive of my decisions regarding my health and not pushy at all. I will definitely be talking with her about these things and making my own decisions. Just really sucks that it is happening now. I thought things were fine, but apparently I should have been asking more questions earlier.

Sharon21 · June 2011

My water broke at the onset of labor with both of my DDs. With DD#1 I was 1cm for fifteen hours before my midwife suggested pitocin, which I agreed to. With DD#2 20 hours after my water broke I was only 4cm and my contractions were spacing out. When my Midwife checked me she discovered that I had a "forebag" (had never heard of it, apparently when my water broke the amnio sac formed a little bubble) so she popped that and my contractions picked back up and I was able to avoid pitocin.

With both of my labors I had prolonged rupture so I was given antibotics. That might be something to bring up with your doctor. Maybe if you tell her that you would be okay having antibotics if you were ruptured for a long time she might not be so pushy with the pitocin. Just remember it is your body and you don't have to have pitocin if you don't want to.

NurseLaLa · June 2011

LindseyJW:
for 50% of women, labor naturally begins within 24 hours of the membranes releasing. that means half of women don't start labor naturally within 24 hours. OBs want labor to begin because the risk of infection increases within 24hrs of membranes releasing.
in my HypnoBirthing class, I ask families to describe the properties of the vagina that are similar to a vacuum cleaner. usually, no one can come up with any and that's because the vagina is not a vacuum. if you don't introduce any bacteria, there won't be any bacteria. the vagina does not go around sucking things up.
so if you are one of the 5-10% of women for whom membranes release before the natural onset of labor, don't consent to a vaginal exam and you should be fine.
it would seem to be a red flag to me if your OB wants to start pitocin within an hour of your membranes releasing, for no reason other than your membranes releasing. often, they are under the stronghold of insurance and hospital policy or rush to turn over patients. don't be lost in the shuffle!
if your fluid is clear and sweet smelling, there is no reason to go to the hospital. they will only put you on a clock. the good thing here, is that you now know this and can avoid the clock!

Love this response. The risk of infection is loooooowwww! In western medicine, we're taught to be afraid of all potential risks, regardless of how low they are, if it is pertaining to pregnancy, labor, and delivery.

maddiemoon43 · June 2011

My MWs have said that as long as the fluid is clear, if it were to break in the middle of the night, I can relax and try and catch more sleep while I can, and page them in the morning. I am also GBS-, so this seemed to make them even more relaxed about me waiting at home.

jsabouh · June 2011

I asked my MW what would happen if I went 12+ after my water breaking. (with LOs 1&2 the dr would start pit at 12 hours) She threw her hands up and said, "then we just keep our hands out of there, and there shouldn't really be a risk for infection." She said the real risk is from the docs/nurses/whomever checking your progress over and over again and by doing so introduce bacteria from outside into the birth canal.

I also have a OB for back up and I asked him the same question, in case I was to have to deliver in the hospital, and he said that as long as mine and baby's vitals look good, he wouldn't start suggesting pit until at least 12 hours after.

BTW... they can't "make" you get pit after one hour or really anytime unless you or the baby are really in danger, you might piss him/her off for not consenting tho... but they are not the one having the baby.

cottonlily84 · June 2011

That would freak me out too. Not just that scary very short time of an hour but that she actually had a hard and fast answer. Instead of saying she will play it by ear or see how you progress on your own, etc. Just remember (I'm trying to do the same myself!) that when you ask questions you often get the "policy" answer. You can dig a little deeper in the conversation and ultimately refuse anything.

ridesbuttons · June 2011

Pitocin was not something suggested to me either. My water breaking was the first sign of labour with my first child. Contractions started on their own within a couple of hours. It never came up.

Chenny555 · June 2011

That would freak me out too. Not just that scary very short time of an hour but that she actually had a hard and fast answer. Instead of saying she will play it by ear or see how you progress on your own, etc. Just remember (I'm trying to do the same myself!) that when you ask questions you often get the "policy" answer. You can dig a little deeper in the conversation and ultimately refuse anything.

This. I was more freaked out by the rigid nature of her answers vs. a "wait and see" approach. She has always been a "wait and see" type of doctor who has let me make my own decisions about my health. The fact that she said this and then started with the "risk of infection" and "having baby in 24 hrs" stuff was unexpected. The sudden shift from treating me like a totally healthy person to suddenly, a person who may have a risky delivery was hard to stomach too. I've been low-risk and healthy before and during pregnancy. I'm not agreeing to interventions "just in case". I will be talking with her more at our appt next week and ultimately, I may be refusing procedures. Thank you all for your great advice!

katcarls · June 2011

One hour is crazy and I have never heard that before. I would check with another doctor and the hospital to see what their policy is. You should discuss it with your doctor again too in case there was a miscommunication. If not, you might want to find another provider. Most importantly, remember that you control when you go to the hospital.

My midwife wanted me to come in if my water broke and contractions didn't start within 12-18 hours. If contractions did start in that time, then it was fine to continue laboring at home until I was ready to go to the hospital.

Daisharain · June 2011

Things like this just anger me- what is up with Doctors pushing pitocin when labor isn't going as fast as THEY would like.

20 years ago women would be given 40 hours of labor before doctors would talk about C-sections and other interventions.

I labor as much as I can at home- I have long labors- My first I labored 32 hours all together. I spent about 14 or so at the hospital. Nobody mentioned pitocin but this was 13 years ago.

My second was a 28 hour labor- I had contractions every 3 min for the last 6 hours of it ugh. I stayed home for 18 hours that time, and when I got to the hospital I was at 5cm. It took another 10 hours to get to 10, and nobody mentioned pitocin that time either ( about 6 years ago)

I am nervous as hell that they will push it on me- I already told my SO that if they mention it I will tell them to take the IV's out I am going home until its time to push LOL

DoulaSamma · June 2011

That would make me run to a new provider right away. There is no medical backing for that at all. And just because a provider is on board with a natural birth does not mean they are supportive of a low intervention active birth. If you don't want to look for a new provider or can't because of insurance there are a few things you can do.

The first is to start taking vitamin C to help create a nice strong amniotic sac, this can prevent pre-labor rupture of membranes.

If your water breaks and it is clear don't go in. There is no reason to be at the hospital with no contractions or not steady ones anyway. Stay home, nap, walk, use a pump for some contractions, go for a walk and just let nature do its work.

x0stephanie · June 2011

If you are GBS negative, I'd just stay at home until your contractions began and started getting closer together. If your positive they'll want you to start antibiotics right away though.

If it had been like 12 hours with no progress, I'd probably call/go in though. Definitely not after 1 hour.

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