No, I don’t need answer fast, I’m not with child, but my sister-in-law is in the hospital today working on introducing my new nephew to the world, and I’m a bit confused about the information I’m getting in the updates.
Her water broke yesterday afternoon, so she was told to report to the hospital. She was only one centimeter dilated, and contractions were a few minutes apart, so they had her walking around for a while, and at some point in the evening they started her on pitocin. This made the baby’s heart rate drop, so they stopped it. This morning, they’re trying it again for some reason, and I’ve been told that they will only wait 24 hours from the rupture of membranes before initiating a C-section, so she’s only got a few hours left to manage the vaginal delivery she wanted. No pressure!
It seems to me that they’re rushing to a C-section without giving labor a chance to progress, but I’m not a doctor or nurse and I’ve never been pregnant. Is the 24-hour window standard practice? I understand there’s a risk of infection once the membranes rupture, and I don’t know if she tested positive for Group B Strep or not, but her contractions didn’t start until after the water broke, so isn’t the 24-hour expectation a little unrealistic?
So… what factors go into the decision to start pitocin in the first place? Why would they be trying it again if it dropped the baby’s heart rate last night? And why will they only wait 24 hours before moving on to a section?
It is fairly standard. Once the water breaks, the baby is at greater risk of developing an infection.
I know from experience that pitocin on an unready cervix sucks, and of course the harder pitocin-induced contractions are rougher on the baby. This combination (unready cervix, harsh contractions) does lead to an increased risk of “needing” a c-section.
But the reasoning is, unfortunately not out of line.
Whether 24 hours is too conservative (i.e. whether it’d be safe to wait a bit longer), I don’t know. I’d bet they didn’t do anything to ripen the cervix (there are substances they can apply topically to “loosen things up”… but the incompetent lying bitch doc I was stuck with refused to use them on me).
Anyway - I came fairly close to having a GET BABY OUT NOW c-section as a result of the chain of events - my son was having some decelerations and scalp sampling showed his oxygen levels were dropping. They got him out using forceps, unfortunately - having subsequently had a C-section with my daughter, those are a LOT less damaging than a forceps vaginal delivery.
Oh - and as far as why try the pitocin again, I can’t say but can speculate. Maybe a slower ramping-up would be less stressful. Maybe they did the cervix-ripening stuff overnight. Maybe the baby has had a chance to shift position some and there’ll be less cord compression.
I can only tell you about my experience, which sounds a bit similar… My water didn’t break in a big gush, but on Saturday morning through afternoon there was a slow but steady drip of amniotic fluid, and painless contractions. I called and they said, come on right in… Went to the hospital 6 p.m., I wasn’t very dilated so they started Pitocin, hooked baby up to a monitor, and labor pains started in earnest. Sunday morning 8 a.m. they just said I wasn’t progressing fast enough, so they took me in for a C-section. (No complications, though the baby had the driest, scaliest skin you ever saw!) The nurses should be able to answer your sister-in-law’s questions. Good luck to her!
Yes, what you’re hearing is routine in hospital births in the US. Whether or not it should be is best fodder for Great Debates.
There is definitely a risk to prolonging labor for more than 24 hours after the water breaks. A friend of mine had complications (i.e., uterine infection and large blood loss) because she didn’t delivery until about 36 hours from when the water broke. This was about 30 years ago.
And given that a hospital is about the worst place possible to acquire an infection, I do not think the current policy is wrong.