"Hi Henci,
I have a question about restricted movement. I know about the 6 Care Practices, Cochrane Reviews on Maternal positions and mobility, The Rights of Childbearing Women, the importance of movement, etc. Here's my question: Is there any evidence proving that it's safe or unsafe for women to be out of bed moving when the membranes are ruptured? I'm sick of dealing with care providers whose protocol is that women have to be in bed if their membranes have ruptured for fear of baby coming down and prolapsing a cord.
Thanks for any assistance that you can give.
Margaret Martin, RN, LCCE, CD(DONA)"

(Martin had problems posting to the forum and asked that I post for her.)

I am not aware of any research on the risk of cord prolapse with ruptured membranes when women are upright, and anyone who is, please feel free to chime in. Common sense, though, says that if the head is engaged in the pelvis, there would be no risk of the cord slipping down ahead of the baby's head because the head would be sitting in the bowl of the woman's pelvis like an egg in an egg cup. Common sense also says that when the head is not engaged, upright postures would be safer than recumbent ones because when upright, gravity would bring the head downward. I am not a clinician, but what makes sense to me is to have the woman stand up and for someone to  listen to the heart tones through a couple of contractions to make sure the cord isn't being pinched between the baby's head and the woman's pelvis (occult prolapse), and if the baby sounds good, to let the woman alone.

-- Henci