Your Water Breaks First - A Date to PROM (Premature Rupture of Membranes) - Waiting For Labor Considerations

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Along this path you will most likely hear your provider say something along the lines of “I can not allow you to…” or “ it is not my practice to allow women to…”

In light of all these studies, reports, reviews, and secondary analyses, medical healthcare providers who immediately offer induction seem woefully unaware of the contrary evidence.

You do not lose your right to informed consent or informed refusal in the light of this birth circumstance, the legal authority in the birthing room, office, etc. is you as the pregnant woman seeking medical guidance.

You have the legal right to make all decisions about your body and your baby, just like any American citizen, pregnant or not. This is your constitutional right and this right has been affirmed by the Ethics Committee of ACOG and it was re-affirmed in 2013.

So speak up—if you don’t want a procedure after proper counseling then politely refuse it.

If you plan on waiting for contractions to begin naturally then you should begin a practice of avoiding and refusing all vaginal exams until you are well established in labor and keep them at the absolute minimum even then.

Expectant Management of term PROM (waiting) is a birth preference that you need to discuss thoroughly with your care provider, well before birth. Approaching the discussion in a calm reasonable and accommodating manner.

According to Cynthia Gabriel you are unlikely to convince a healthcare provider who has developed a different style of handling term PROM management that you are right and they are mistaken.  Instead you will be better served by explaining how important a physiological vaginal birth is to you, that you deeply desire something different, that you believe it is better for your health and your baby’s as well, and make a heartfelt request for their support. 

I like Cynthia Gabriel’s “Natural Hospital Birth” phrasing:

“Certainly, my most important objective is a healthy baby. Your support for our birthing preferences would give me peace of mind. If I develop a fever or the baby isn’t doing well, I will gladly reconsider. But, if I do not get a fever and the baby is doing fine, I would really appreciate your support in allowing up to 24 hours before we talk about induction. As I am planning a vaginal birth, with minimal medical interventions, I’d also like to avoid all digital vaginal exams until I get close to the end of my labor always assuming that I do not have a fever and my baby is doing well.”

Henci Goer also makes an excellent case, using a combination of neonatal infection rates and the median time to active labor, she uses the numbers culled from the data.

“It therefore seems reasonable to wait about 18 hours before inducing labor. Half the group of women will have achieved active labor by this time, and, if induced at ≥18 hours, the remaining half are likely to have started active labor by the 24-hour cut point.”

If you can get your provider to sign off on these preferences with an air of mutual understanding then it will add an extra layer of assurance that you are being listened to and your wishes are being respected.

If you do make it your “plan” to wait, then make it a plan that entails you waiting without worrying about the “what if’s” so as to avoid turning your uterus into a “watched pot” by keeping a strong commitment that is geared towards giving your body the time it needs to adjust to labor.

If your mind is watching your body along with everyone else, then this added scrutiny has the unfortunate consequence of slowing down labor and especially true in a hospital setting.

It pays instead to get your mind involved elsewhere, maybe a good movie or a binge watch, a work project, baking, taking a walk, any activity that provides distraction.  Rest and near constant hydration as well, please.