Your Water Breaks First - A Date to PROM (Premature Rupture of Membranes) - Good Bacteria Versus Prophylactic Antibiotics

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Your body plays host to a mind boggling amount of single-celled organisms, they make up what is called your natural biome. This biome is essential for the healthy functioning of your body and its immune system. The natural flora of organisms that inhabit your birth canal and vaginal tract, as well as those naturally found in breastmilk are essential for your baby as well.

During the course of a normal physiological birth, as your baby moves down the birth canal he/she is inoculated with a dose of your normal microbiological flora that jumpstarts among other things your baby’s healthy digestion and their immunity system. Skin to skin contact and breastmilk also have vital roles that help ensure nature’s inoculation process.

This is yet another worthy topic that I promise to devote the time to giving it a full post, in the future. In this particular post, I just want to make a couple of points and suggestions.

The vast majority of antibiotics are NOT organism specific, they instead destroy the healthy along with the infectious bacteria. The benefit of destroying a microorganism that is capable of creating a fatal infection far outweighs the resultant destruction of your normal flora has always been the viewpoint of the medical world.

Antisepsis, germ theory, and antibiotics mark the greatest achievements in medicine thus far, they have saved countless millions of mothers’ lives.  However, this cure has brought about a rampant overuse of antibiotics over the years, with them often being prescribed prophylactically  “just in case”.

Such is the case after a positive screening result for GBS, where a laboring mother receives antibiotics prophylactically every four hours or so, until the baby is born. This is all well and good if they are genuinely called for and necessary.

However, here’s the thing. If term PROM presents, you will be advised to get your first round of antibiotics in promptly, which turns this into a bit of a Catch-22.

Do you decide to wait for labor, knowing that it may take up to 24 hours or longer for contractions to begin, in the light that this will mean 6-8 courses of prophylactic antibiotics?

Do you decide instead to get your antibiotics with a side of immediate induction, hoping that this will mean that you receive fewer doses of antibiotics overall?

How do you decide to treat a mystery fever?

Induction with a prostaglandin gel often causes a maternal fever, and induction via Pitocin often turns into the need for epidural analgesics which also cause maternal fever. These and other non-infectious forms of fever are often misdiagnosed as possible infections, or worse as “mystery fevers”.

Which in turn causes health care providers to move towards a risk management approach to your care. The provider says—as I don’t know exactly where this fever is coming from and I am reluctant to prescribe an anti-inflammatory such as Tylenol for fear it may mask an infection—   so let’s start antibiotics “just in case” and start considering that a Cesarean Section is what is safest for your baby at this point.

Ask for a more complete workup in the face of a mystery fever, get as much of the following information as is feasibly possible.

The new guidelines surrounding diagnosis of a suspected intrapartum inflammation infection or both (Triple I) requires not only a fever (greater than 102.5° OR between 100.4° and 102.5° for longer than 30minutes) without a clear source of origin plus any of the following: fetal tachycardia (greater than 160 beats a minute for 10 minutes or longer OR maternal white blood count greater than 15,000 per mm³ OR definite purulent fluid from cervical opening.

As discussed previously, neither mothers or babies benefit from unnecessary prophylactic antibiotics or from unnecessary Cesarean Sections.

Cesarean sections and infection protocols typically mean longer hospital stays and routine antibiotics for both moms and babies and a maternal diagnosis of infection has serious implications for the management of newborns.

Even in well-appearing infants, this diagnosis will subject newborns to much testing, longer hospital stays, sepsis workups, NICU stays, and treatment with antibiotics.