Your Water Breaks First - A Date to PROM (Premature Rupture of Membranes) - Introduction

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Most likely your health care provider has already told you to call the office at once if think your water has broken especially if it all seems to gush out at once, and/or this happens well in advance of your estimated due date.

You’ve probably heard rumors about the 24 hour clock, the risk of infection to both mother and baby, and other potential birth complications, your doctors using scary language, the emphasis on immediate induction or else…time limits, rules, and ultimatums.

Just as likely you’ve also been hearing midwives, doulas, childbirth educators and physiological birth advocates say the 24 hour clock is based on faulty out-dated evidence, that there are better ways than induction to reduce the risk of infection and that the very same evidence that is used to advocate immediate induction works just as well to advocate expectant management (waiting for labor to begin on its own).

What does seem to be true is this:

There are two valid evidence based options for most women:

  1. Induction (active management) at term PROM (Premature Rupture of Membranes) or
  2. Waiting for labor to begin on its own accord (expectant management) after term PROM.
  3. This evidence, especially on the active management side, is fraught with problems and ACOG (American College of Obstetricians and Gynecologists) can’t make up its mind.
  4. I have done my best to present both sides.

I probably should apologize for the length but —this was indeed the depth of research I felt necessary as it has given me an extensive base of knowledge—something that I like to have to hand when I am teaching, when I am assisting a client as a Birth Doula, and when I am helping women work up a birth preferences plan. How lovely for you that I have done all the trudging through the books and the internet.

PPROM (pre-term premature rupture of membranes) ≤37 weeks is a genuine medical emergency, you need to be calling your caregiver on the way to the hospital, and from there determine your best decisions for moving forward.

If reassuring criteria is met then this scenario will generally involve a period of expectant management as delaying birth (giving more time for the development of lung function, etc.) far outweighs the lesser risk of potential infection and is safer for baby. Both of you will be continually monitored and most likely you will be required to remain in bed. Forgive me, if I hope that after you finish reading this post you find this protocol as ironic as I do.

Term PROM ≥37 weeks, however, requires a more complicated discussion, as several valid options for proceeding are available to mothers. 

According to Cynthia Gabriel, in “Natural Hospital Birth”, beginning labor with term PROM is one of the most common situations that result in medical intervention and unnecessary Cesarean Sections. I agree with her, and in this case an ounce of prevention is worth a pound of cure.

Once your waters break you will most likely feel at the mercy of your hospital’s and caregiver’s protocol. Unless you have properly educated yourself beforehand there is a strong chance that you will begin basing your decisions on fear rather than knowledge, your decisions being heavily influenced by the fear mongering language preferred by most doctors especially when they want a patient to agree to a medical intervention protocol such as immediate induction.

To best assure yourself and so that you give yourself the best chance of receiving optimal maternity care I believe you need to know the full picture, as having the right knowledge, will enable you to make informed decisions about how you would like to proceed after entering the elite term PROM club.

Knowledge equals Power