Even though at least 80% of women will be having contraction within 24 hours, many providers and hospitals have policies that say a baby needs to be born 18 or sometimes 24 hours after the bag of waters ruptures, and antibiotics may be given preventatively. It is explained that the risk of infection goes up the longer the protection of the amniotic sac is gone. This has been shown to be true in a hospital setting, but out-of-hospital midwives often are much more lenient in those time frames. Are they just reckless, or is something else going on here?
After the sac ruptures, amniotic fluid is constantly replaced. Mother should stay well-hydrated and keep track of her temperature so she notices the first signs of a fever, which is often the first sign of infection. But studies show that these women will not get any infection more often than a woman who doesn't have her water break until the end of labor if she stays away from ONE thing.
What is that one thing?
Fortunately, it's something no pregnant or laboring woman enjoys.
Let's think about what's happening once the water bag breaks. Fluid is continuously leaking out a little at a time. This is washing all microorganisms OUT of the vagina. Pretty smart, our bodies.
What does a vaginal exam (or tampons, or sex, or anything else inserted) do? It pushes the bacteria UP. Giving them a free ride closer to your uterus and baby.
So studies have now shown that the risk of infection does not actually go up after 24 hours as long as there are no vaginal exams. Yet another example of how we've created a problem from something that was not a problem because we wanted to have a number (of dilation) to put on our charts.
What's more, a Cochrane Review has determined that antibiotics should NOT be used routinely when waters break close to term. They should be saved for when there is actually an infection present. Because antibiotics have side effects. Who knew?
So the takeaway is that when your water breaks and there's not a very good reason, Just Say No to things in your vagina!