Standing up for my birthing rights: refusing induction when my water broke early (PROM)

My labour and delivery story
Standing up for my birthing rights: refusing induction when my water broke early (PROM)
What I did when my waters broke early

It has taken me a very long time to publish this story even if I have wanted to right from the beginning. I will admit that it took me a long time to process my son’s birth and although in the end everything turned out perfectly fine for both me and my baby, I – together with a third of other Australian women – was left traumatised by the maternal care I received during my birth, in particular from the constant pressure and bullying I received for me to give birth the way the doctors wanted me to. On the other hand I also felt incredibly empowered by my ability to stand up for my rights despite aggressive opposition and I could not be more proud of myself for sticking up for my convictions and not giving in to the many scare tactics used by the medical staff to try and get me to birth in line with their policy. This is the reason I want to share my story , because one too many women are made to feel like they are being a bad mother if they don’t follow along with medical advise, only to come out of their birth experience feeling violated and disempowered . I think it’s incredibly important that mothers stop being pressured into outsourcing their birth and parenting choices to authorities in the name of “safety”. What is safe for one person can be dangerous for another.

In short, my waters broke early at just under 36 weeks. This is called PROM which stands for Premature Rupture of Membranes. Under these circumstances normal protocol at my hospital dictates that I had to be induced with artificial oxytocin (a hormone) in order to avoid the potential of infection. I refused induction and went on to give birth naturally to a very healthy baby 9 days later at 37+1 weeks. 37 weeks is considered term (baby has finished developing).

Personally I had some very important reasons as to why I wanted to avoid induction, namely I strongly believe natural spontaneous births are the best and safest options for both mother and baby when possible and more importantly that I can not tolerate medication. Save Panadol and some antibiotics there has not been one medicine in the past 7 years that I have taken that has not given me a violent reaction. I have even reacted quite severely to natural remedies and supplements. I was actually unable to take any supplements during my pregnancy because I reacted quite strongly to them. Induction was only something I would have considered if I actually developed an infection as side effects to induction can be life threatening. (More on this in another post) . I was also at very high risk of C section due to the babies position and was very concerned with the long term effects of intervention like post natal depression and loss of milk supply . Truth be told I was never convinced that the risk of contracting an infection was as high as the doctors made it seem. To me it seemed obvious that I was being treated by doctors that were more concerned with following protocol than actually doing what is in the best interest of the patient (and her baby).

I asked various doctors what the risk of infection was and they all found a way to avoid the question. I also asked many of the doctors to tell me why my waters broke early and they all told me they didn’t know. (There was a real reason for it and I will address this in another article) So since the doctors were unable to answer my questions I did my own research and came to my own conclusions with the help of some lovely midwives and nurses who were encouraging me to stand true to my convictions. Here are some of the things I learned that helped me stay true to my decision despite some pretty aggressive opposition from medical staff:

• There are no other risks to the baby once your waters break as the water keeps replenishing itself

• If your waters break prior to 36 weeks normal protocol is to prescribe steroids in order to try keep the baby inside the womb as long as possible. This made me doubt the likelihood of infection was high.

• A recent study published by a hospital in Brisbane collected data from cases of women with pre-ruptured membranes stated that 25% of women went on to give birth prematurely within a few hours, 25% of women were induced due to various medical complications and 50% carried to 37 weeks or longer before giving birth (term).

• Although the infection is severe and life threatening recent studies show that the chance of the mother contracting an infection is about 6-7% and with proper screening and treatment (which I adhered to) the chance drops to 1.2%

• The chance of the newborn contracting an infection is 1-2%.

• Hospital protocol of inducing labour 24 hours after water break is based on old research done in the 50’s and 60’s when there was less access to antibiotics and medical practices were less stringent. All current research dismisses the 24 hour rule.

• Many researches have concluded that infection due to PROM is over diagnosed.

• Recent studies indicate that there is zero risk of infection up to 96 hours after water breaks.

• Many countries allow for much longer waiting times before offering induction.

• I personally knew women that waited for long periods of time after their waters broke including my own mother who’s water broke 2 weeks before she delivered me

“Induction of labor with intravenous oxytocin, induction of labor with vaginal prostaglandin E2 gel, and expectant management (no intervention) are all reasonable options for women and their babies if membranes rupture before the start of labor at term, since they result in similar rates of neonatal infection and cesarean section. Both are evidence based approaches.”

I completely understand that I did not have a straight forward labour and delivery and that my case was more complicated than it should have been, because of that I can not fault the doctors for following protocol as best they could but In my case my labour had already started on its own with measurable contractions about 12 hours after my waters broke.  Based on my research I argued that I should have been allowed to labour naturally without the need for induction if I so chose, however I was pressured into choosing induction since my labour was taking longer than 24 hours. I found this a little unfair since many first time mums can be in early labour for days before they move on to active labour and I felt as if I wasn’t being given the option to allow my body to labour naturally. I acknowledged this risk of infection and agreed to take antibiotics orally in order to prevent infection. (Yes I did react to them but thankfully my body is ok with antibiotics so the reaction was manageable) I also agreed that I would accept induction at the first sign of actual infection which included a raise in temperature and/or a change in colour in the water I was losing. I also agreed to monitoring of the baby’s heart rate. I never developed any of these complications and the baby was always “happy” at each monitoring session.

I laboured at home for the next week with irregular contractions of varying intensity. Once my contractions became regular and about 3 minutes apart, I returned to the hospital. When I arrived I was already 10cm dilated and ready to push. I was incredibly happy that I was able to carry to term even though it was still a fair bit earlier than expected and am convinced that the baby was much happier entering the world once he was fully developed.  It was a somewhat more complicated delivery with a long pushing time as the baby was not in an ideal position but in the end the baby came induction free and  100 % pain relief free.

I have told my story to a few people that could not understand why I was so against medical advise and why I would assume such a big health risk for me and the baby. Others have told me they would be much too uncomfortably labouring on and off for 9 days and could not labour for so long. I completely understand this response and I want to stress that my decision was right for me. I am not against induction or pain relief in birth. I am glad that these options exist for women that can tolerate them or that choose them. My decision did carry some risk, but I was much more comfortable assuming a 1-2 % of infection as opposed to a 70% or above risk of severe side effects and c section as well as long term implications of medical intervention. (70% risk was given to me by the doctors themselves).

Although I think it’s sad that hospital protocol is based on outdated research and strongly favours the best outcome for the doctors, I felt empowered by my ability to stand up for my rights and I want to encourage women to educate themselves on birth so that they can also stand up for the birth they want and feel confident in doing so. It is true that very few births go to plan (mine certainly didn’t ) especially first time births , and so it’s important to stay open to the possibility of things going very differently than what we imagined. However this does not mean there is no room left to fight for your birthing rights. There is always more choice than women are made to believe. Birth education is key.

Since my article mentions quite a few studies and statistics I thought it would be best to include some references to go along with this blog post. Unfortunately, most of my research was done in the few days prior to birth which at the moment of writing this article was 15 months ago. I have tried but cannot find a lot of the articles that I was reading at the time. A lot of the information also came from hospital staff and friends and family that shared their experience with me which I cannot reference. I will include a link to an article that helped me most. The majority of my statistics come from this article so if you want to check it out for yourself you can:

Some background : Due to my strong opposition towards medical intervention I educated myself quite extensively on birth and birth options.  I chose to go through a midwife run birth centre (no doctors) . At 34 weeks my midwife fell ill so myself and all her patients were forced to go through the hospital system. There were no home birth midwives available in my area so I had no choice but to deliver at the hospital (there was only one public hospital in my area). Since my waters broke prematurely I would have been unable to birth at the birth centre or at home and would have been transferred to the hospital regardless. I tried my hardest to avoid the hospitals and the doctors as I strongly favour midwife led care but was unable to in the end. I genuinely did not think the doctors believed my concerns about side effects to medication until they saw how badly I reacted to a muscle relaxant I was given without my knowledge post delivery where I almost lost consciousness and lost the ability to walk and talk for 5 hours. Both me and my baby were given strong antibiotics post birth without consent. Thankfully a lovely nurse managed to reduce the time we were on them and so am hoping that not too much damage was done. Beyond the reaction I had to the antibiotics and the muscle relaxant I had no other complications post birth at all with a very quick healing time and ample milk supply.




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