Hi!! Ok so a client called me last night saying her water broke (slightly). Went to hospital and was admitted around 2am. She was checked - very posterior and a fingertip dilated.
So they let her sleep and this morning at 9am I call her and they started her on pitocin. It's 11am now and she says she is feeling *slight* contractions.
I'm wondering how long will they try pitocin and stuff (her water has been broken since 11pm last night) until they "give up" and go for a c-section?
Aug 30, '02
Often there is a magical number of "24 hours"......they are on the "clock" for roughly 24 hours after their water has broken. We tend to start the clock for 24 hours after the FIRST VAGINAL EXAM after water is broken. So, you see, if a patient comes to me, water broken but NOT CONTRACTING, I tend to NOT CHECK HER AT ALL TIL SHE CONTRACTS REGULARLY, unless there is a good reason, e.g. fetal heart tones are concerning or mom is feeling pressure and/or showing signs of active labor. This allows more time for her to labor before csection is considered.
We monitor their temperatures every 2 hours. If they become febrile, or the baby shows signs of intolerance (heart rate changes or decelerations), obviously, this makes it necessary to re-evaluate the situation. There is NO SET TIME, really. It's just everywhere I have worked, 24 hours since the sac has broken seems to be a general rule of thumb by OB's. Deferring from numerous vaginal checks really helps in keeping infection chances down tho.....hope this helps.
Aug 30, '02
We don't really have a set time for a C-Section in this scenario. Usually we will start IV antibiotics after a certain length of time (12-24hrs depending on the providor). We also keep vaginal exams to a minimum. If the patient is making progress we will usually just let her go. Sometimes it takes longer than 24 hours, if the mom and baby are both doing well we tend to be conservative. We have a staff composed of certified nurse midwives (conservative approach) and newer OBs who believe in decreasing the primary C-Section rate.
We had a patient about a year ago whose membranes ruptured and she came in. Her OB was off and the on call wanted to start Pitocin. She refused until her OB was back. We just put her on antibiotics and waited. She finally was started on Pitocin after almost 48 hours and delivered vaginally without complications.
Aug 30, '02
Heck, for me it was almost 72 hours. By the time I agreed to have an epidural (was trying to go natural) I was completely zonked out during the birth - woke up enough to hear Emma cry and make sure she came out okay, was out right after. I'm not an OB nurse, but I thought that was way too long.
Aug 30, '02
For us, there really isnt a clock either. What really matters is the big picture of how the baby is tolerating labor, the progression of labor (Friedman Curve), how long the mother has been ruptured, vital signs, etc.
Aug 31, '02
it not really a clock issue especially as far as pitocin is concerned. It is more related to the lenght of time that the patient ruptured. our docs generally start antibiotics 12 hours after rupture and will labor patient up to 36 hours if baby tolerates labor well and no elevated maternal temps which we chech every 2 hours.
i personally don't like it when the doc lets a patient rest after water breaks. notice they only do this at night so doc can sleep. i prefer to give patient a little time to contract if nothing happens start pit slowly and proceed with labor.
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