If your water breaks, but labor doesn’t start immediately, it’s called “premature rupture of membranes” or PROM (pronounced “pee-rom”). Many doctors will want to start labor artificially. But labor induction immediately after PROM is a practice you’ll want to ask your care provider about as you plan your birth. Why? Because it’s a common – but outdated – hospital practice modern medicine still needs to rethink.
Educating yourself about the will help you plan your birth choices. Knowing those choices helps you create your hospital bag checklist and birth plan.
There are two ways of approaching PROM: induction or wait-and-see (expectant management). Some health care providers are comfortable with relaxed time frames, and some are not.
This question can be asked at the first prenatal visit with your doctor or midwife, before you write your birth plan, so you know what to expect from them. If you aren’t comfortable with the answer, you can always get a second opinion or change care providers.
Once your water breaks (membranes rupture), the fear is about infection. Infection for mama or baby is no joke. Everyone wants to prevent infection. Current studies show that when aseptic techniques (sterile techniques) are used, the risk of infection is not as threatening as it’s been in the past.
The question is, how long is safe to wait? It’s an unanswered question, still up for debate.
THE 24-HOUR INFECTION CLOCK
The “24 hour infection clock” is the time frame many practitioners and hospitals use to decide when to induce after PROM.
In the 1960s, a study said the infection clock begins ticking as soon the membranes break. But that study is now considered questionable. New research shows waiting even 72 hours has the same risk/benefits ratio as inducing labor immediately.
Most women go into labor within that time. Statistics show that 80-85% of women with ruptured membranes begin normal labor within 24 hours (Varney, 1987, p. 320).
Today, many women choose to wait so they can bring baby into the world according to their birth preferences. Some wait at home, some are in the hospital.
Still, if a woman hasn’t begun true labor within 24 hours, many practitioners will induce her labor, often by using medication like oxytocin/Pitocin or a prostaglandin gel.
Induction is sometimes a life-saving intervention for high-risk babies and high-risk mothers. In this case, the risks outweigh the benefit of waiting.
But, inductions for low risk women can fail. That failure leads to cesarean sections which have a host of risks, add considerable discomfort after the birth, and can have consequences for future births.
Many times, induction is an unnecessary intervention. Every unnecessary intervention can lead to another intervention, with each one carrying its own risks,. As we discussed in another post, one of the most common interventions is frequent vaginal exams, which are a leading cause of infection.
LOW RISK BABIES NEED THOSE EXTRA DAYS IN UTERO
Please note! We are talking about artificially inducing labor before your baby has signaled to your body that she is ready to be born. Please don’t think that if you spontaneously go into labor before 38 weeks your baby will have these issues.
For low-risk babies who are not full term (less than 38 weeks), induction can unnecessarily interfere with their last bits of development. Induction deprives baby of a day or two more of development, and two days really matter in the life of an unborn baby.
Inducing labor before baby signals it’s ready to be born can result in your baby not being fully capable of managing the demands of the outside world. Even two days less in utero can contribute to developmental issues that can have lifetime effects .
Another day or two in utero also gives baby a chance to get into a good position. Baby’s position can help reduce the need for epidurals and C-sections.
When your baby is ready to be born, your body knows—hormones shift so labor can begin. Those hormones also contribute to cervical softening in preparation for labor. Softening contributes to the cervix opening well and allowing baby to come through the vaginal canal.
Your birth preferences can guide which way your care provider approaches PROM. Hopefully, you’ve collaborated with them to develop your birth plan and already agree on which approach to take.
Whether you plan to give birth at home, in birthing center, or the hospital, pack your latest copy of your birth plan into your hospital bag so your birth team knows if your choice on PROM management is induction, or aseptic techniques with a wait-and-see approach.
To learn more about birth practices, download our free Birth Plan eBook now. After three years of research, collaboration with more than 100 childbirth experts and resource centers from Healthy Child Healthy World to the American Association of Neonatal Nurses, the Best Ever Baby Birth Plan Guide is available for a free download.
This new resource for pregnant families is a compilation of top tips and advice from more than 20 nationally-recognized experts in the field including renowned pediatrician, Dr. Alan Greene and GraceFull Birthing founder, midwife Elizabeth Bachner. These trusted experts offer thoughtful guidance for whatever type of birthing experience parents want, in whichever setting they choose.
Published: September 30, 2017 | By SP Turgon, Certified Labor Doula | Reviewed by: The Best Ever Baby Expert Team | Last reviewed: September, 2017