Your Water Breaks First - A Date to PROM (Premature Rupture of Membranes) - What are Your Options with Term PROM (or perhaps what should be your options!)

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There are two valid evidence based birth options for most women:

  1. Induction (active management) at term PROM or
  2. Waiting for labor to begin on its own (expectant management) after term PROM.

Induction with Pitocin (intravenous artificial oxytocin) as well as induction with a prostaglandin gel, AND expectant management all result in similar rates of neonatal infection and Cesarean Section.

The data from the term PROM studies show a neonatal infection rate that ranged from 2-3%. Neonatal is classified as ≤28 days. There was no difference in newborn infection rates between any of the study groups.

The best I could find for today’s rate was (on numerous online websites) that intrapartum (during labor) fever affected moms and babies in 1-2% of all deliveries and of those chorioamnionitis accounted for 2-4% of these incidences.  These numbers are from 2017 and are for all births whether or not PROM was present, and what they meant by chorioamnionitis is not specified.

There exists a serious amount of lag time in medicine. It can take upwards of 20 years for research findings to be translated into routine clinical procedures. NON-evidence based care happens all the time in birthing situations, unfortunately, I find myself having to write about this frequently but I believe it is important to know now rather than after the fact so that you can better assure for yourself optimal maternity care.

As they say on Evidence Based Birth: Practice that is not based on the best evidence is not best practice.

The dance you will be sharing with PROM (hee hee) is a mash up of non-evidence based care, active precautionary management, time management etc. I will leave the malpractice CYA tactics to another time.

The largest concern surrounding term PROM is that during prolonged PROM (≥24 hours in the absence of contractions) women and their babies face a higher risk of infection. So I guess the logical place to “start” is with the 24 hour clock rule.