Your Water Breaks First - A Date to PROM (Premature Rupture of Membranes) - Childbirth, Hygiene, and Antibiotics

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A little bit of history surrounding childbirth, hygiene, and antibiotics. Now I have promised myself an “infection term paper” in the future, but for now I am just going to make a few points in this post that are relevant to our date with PROM.

Hard to believe a time when this was not so, but the fact that surgery needs to be sterile, is a standard that is barely 100 years old.

Medical knowledge has radically shifted in the last 150 years but people including doctors are still reluctant to wash their hands. According to a study in 2012, doctors who fail to wash their hands kills roughly 100,000 Americans a year and sickens 1.7 million more.

Even after the introduction and the acceptance of antisepsis, women would have to wait for medicine rather than doctors to kill off maternal related infectious illnesses.

Penicillin, the first antibiotic, was “accidentally” discovered in the 1930’s, developed for use by the military during WWII, and was made widely available to the public by the end of the war. The discovery of penicillin was one of the most important advances in the history of medical science, introducing a whole world of wonder drugs that are now becoming a victim of their own success—in other words these microorganisms are somewhat successfully fighting back.

During the Post World War II Era (1940’s-1950’s) a hospital infection rate of ~10% and a clean wound rate of ~5% was common. In the United States deaths from infectious diseases dropped dramatically— the annual mortality rate fell from 797 deaths per 100,000 persons in 1900 to 75|100,000 in 1952. But even in the 50’s germs were already becoming penicillin resistant.

In the 50’s and 60’s, antibiotics were new, their use varied from hospital to hospital from doctor to doctor. There also were no standards for sterilization and antisepsis. The only antibiotics available were penicillin and its early derivatives and they were not alway effective.

During this period treatment with antibiotics was not the routine prophylactic measure that it is today. Today you would typically get prescribed a round of antibiotics just as a precautionary measure-as seen in the standard protocol of administering antibiotics during labor after a Group B Strep positive result.

During the 50|60’s many women did not receive treatment with antibiotics until their symptoms were quite severe. GBS was not known, not understood, and not treated for during this time frame.

With today’s access and often proactive approach to antibiotics the 24 hour clock is no longer based on evidence.