Bath After Broken Water

lisamc1RN, LPN · May 11, 2004

The risks of infection are minimal. I chose to labor in the water with my 4th child, after my membranes broke. Certainly, the risks are far less than internals every hour! I would definitely support a woman who chose to labor in the tub. I hope to be a part of a hospital that allows that option for women. I wonder what the justification is for those hospitals that don't allow it? What is their scientific evidence to support such a policy, when the benefits to women can be so tremendous?

Lisa M.

Nursing Student

imenid37 · May 11, 2004

I fail to see how laying in a bed (or sitting on a chair, or labor ball) in a pool of amniontic fluid can POSSIBLE be "safer" than being in a tub?????
ITA. The tub is great. It is sanitized between pt's. I wish each room had its' own tub, but we only have one. Pt's w/ ROM use the tub frequently and this doesn't seem to cause problems. We don't usually have pretermers in the tub because they're usually on continuous EFM, so the dr. won't order it. I can't say personally, the situation has ever come up for me w/ HIV, HBV or HCV + pt. requesting the tub, so I do not know. It is cleaned w/ bleach, so it would probably be ok, but I bet our docs would not order it for that pt. just because they are quite conservative. GBS + use tub w/o any special precautions unles theere is a fever or something else going on causing them to be excluded anyway.

L&D_RN_OH · May 11, 2004

No water births. Jacuzzi's used for patients with intact membranes, and for post-partum moms.
When you do water births, how long is the patient "submerged" prior to birth? I can see that it would probably not be an issue if the patient enters the water shortly before delivering (no time for the bacteria to migrate and infect the baby), but I'd definitely be afraid of infection with patients whose membranes are ruptured who soak in a tub, and then don't deliver for a prolonged period of time.

How is it safer for PP moms to bathe with an open cervix than intrpartum pts?

The pt is "submerged" as long as they want to be. The benefit of the Jacuzzi is for contraction pain. If you don't get into the tub until ready to push, you kind of miss the benefit of using the jets. Some pts get in at 4, some 6, some 8. Some get in and out, and in and out. :chuckle Our tubs are santized between pts, so the risk of any bacteria there is nil.

Pretermers are not allowed to use the jacuzzi, nor are Hep B or HIV pos pts, or pts with mec stained fluid. GBS + pts can, as they are treated with abx throughout labor anyway.

Jolie, BSN · May 11, 2004

How is it safer for PP moms to bathe with an open cervix than intrpartum pts?
The pt is "submerged" as long as they want to be. The benefit of the Jacuzzi is for contraction pain. If you don't get into the tub until ready to push, you kind of miss the benefit of using the jets. Some pts get in at 4, some 6, some 8. Some get in and out, and in and out. :chuckle Our tubs are santized between pts, so the risk of any bacteria there is nil.
Pretermers are not allowed to use the jacuzzi, nor are Hep B or HIV pos pts, or pts with mec stained fluid. GBS + pts can, as they are treated with abx throughout labor anyway.

It probably isn't any "safer" for PP moms, but there is no longer any risk of the baby becoming infected, which is what the OBs and CNMs are really worried about.

Housekeeping "disinfects" the tubs between patients, but I really can't help but wonder what is lurking in the jets. I read an article a while back about the stagnant water which gets trapped in the jets of home Jacuzzi tubs. It makes me wonder how effectively the hospital tubs are cleaned. Do the housekeepers actually run the jets with cleaning solution in the tub? How long must the solution sit in the tubs to actually kill bacteria and viruses?

Don't get me wrong. I think water therapy is an excellent method of relaxation and pain relief in labor, and have had many patients benefit from it. Just being the "germophobe" that I am, I would rather labor in my own tub at home, with my own germs, than take the chance on contracting (no pun intended) something during labor.

The moms that have requested water deliveries have delivered over a very large basin of warm water into which the doc or midwife eases the baby. The bathrooms in the patient suites were not designed to accomodate deliveries.

mitchsmom · May 11, 2004

I'd be open-minded if research demonstrates its safety. Unfortunately, with the lawsuit-happy public these days, it would take only one case of "tub aquired" infection to ruin an OB's practice and put the tubs in mothballs.

That's just the thing, I think that the evidence shows that it is safe, but as someone said, sometimes things are done out of habit instead of evidence. I haven't looked this stuff up in quite a while, so someone can correct me if I'm wrong.

PS... I looked up one list of studies that found no increased rate of infection:

http://www.gentlebirth.org/archives/waterbirthAbs.html

They are all on PubMed, I looked them up.

mother/babyRN, RN · May 11, 2004

We have no problems and have had no problems and we make it clear that it is the moms choice....We actually have had one doc who still wanted to do enemas until we convinced him ( or attempted to convince him-Iguess we outlasted him) that one way we assess correct pushing is when we see feces....He was grossed out but did finally acquiese.....If they take baths at home, they can take baths at the hospital...

nekhismom · May 12, 2004

I agree with Deb, as usual. I WISH we had whirlpool tubs where I work. I'd like one for my next one, whenever I decide to have one.

Gompers, BSN, RN · May 12, 2004

Housekeeping "disinfects" the tubs between patients, but I really can't help but wonder what is lurking in the jets. I read an article a while back about the stagnant water which gets trapped in the jets of home Jacuzzi tubs. It makes me wonder how effectively the hospital tubs are cleaned. Do the housekeepers actually run the jets with cleaning solution in the tub? How long must the solution sit in the tubs to actually kill bacteria and viruses?

This is what always worries me about jacuzzi tubs - be it at the hospital, in a hotel, at home, wherever. How do you clean out the jets? It kind of scares me, but I still think I'd love to use a tub. (No kids for a few years, though.) I posted in another thread that I'm afraid of epidurals, and since I find soaking in my own tub extremely relaxing I'd like to have the jacuzzi option when I have kids. Of course, being a NICU nurse, I'm not planning on an actual waterbirth OR doing a homebirth.

crankyasanoldma · May 12, 2004

I guess I was confused by the op- I was thinking "there's no way we'd let our ruptured patients in a tub", but then realized some of ours are ruptured for weeks or months even.

I guess the discussion here is covering term laboring moms, in which case a tub birth is a fine idea for those who want it.

Someone said they would prefer their own tub and thier own germs- I just wanted to point out that those germs are totally new to the infant. Just be clean!

L&D_RN_OH · May 12, 2004

It probably isn't any "safer" for PP moms, but there is no longer any risk of the baby becoming infected, which is what the OBs and CNMs are really worried about.
--Maybe that's the difference, at my facility. The OBs and CNMS aren't worried about babies becoming infected from Mom's bath water. Must be the studies that are out. The biggest concern they have is being able to reach the baby as it delivers.
Do the housekeepers actually run the jets with cleaning solution in the tub? How long must the solution sit in the tubs to actually kill bacteria and viruses?
--Yes, they are cleaned with bleach and run the jets for 30 minutes.
The moms that have requested water deliveries have delivered over a very large basin of warm water into which the doc or midwife eases the baby.

Now, that's just weird. I had a water birth, by the way. In a huge jacuzzi, that my 2 yr old also got into. :eek: And I would do it again, at home.

So the idea of squatting over a basin of water sounds quite strange.

Dayray, RN · May 13, 2004

I have also read up on this subject and the consensus of all the real studies is that it's okay. You can still find allot of old stuff that assumes there is a risk but really the risk is minimal to a patient with broken membranes. For one there is a constant flow out, for another we aren't talking about public pools with a bunch of different people in them, just a personal bath. We let patient jacuzzi as long as they want have even had a few unplanned water births and haven't had any problem. I personally have never had a patient end up with corio that had been Jacuzzi.

The benefits are great, sometimes a jacuzzi can take the edge off for hours. Its great for those patient that don't want pain medicine. Wonderful for labor checks, I let them alternate between Jacuzzi and walking. Really good for an induction that is contracting too much to put in another cytotec or prostin but not favorable enough to start pit, it tends to space out the contx caused by irritation but wont take away real labor contx. Sometimes When I have a patient contracting but not dilating I stick them in the Jacuzzi and then check them 45 min later and find 2 cm change.

Ont he the other hand I haven't read any studies about post partum moms bathing or swimming. I still tell them not to do it for at least 6 weeks because I haven't seen any research saying it's okay. I suppose some of the same research would apply except that there isn't a head down there blocking off the up flow.