What if your water breaks before labor begins?

Premature (or prelabor) rupture of membranes (PROM), happens when a person’s water breaks before the start of labor. Term PROM is when the water breaks before labor at 37+ weeks of pregnancy. Preterm PROM, or PPROM, happens when your water breaks before 37 weeks.  This post is about Term PROM.

Roughly 8-10% or 1 in 10 people will have their water break before the onset of labor.  When this happens, people are often told they must be induced.  The timeframe for induction can range from immediately to 12-24 hours after the water has broken.  This range is based on information from the 1950-1960s.  Maternal care and birth practices has changed greatly since these studies were done.  Today, the current research supports the “12-24-hour clock” for giving birth is no longer necessary as it was 50+ years ago.  

Current evidence suggests that people who have Term PROM should be given information about the pros and cons of an induction and waiting (“expectant management”) so they can make a choice specific to them and their situation.  As long as both mother and baby are doing well and meet certain criteria below,  waiting for up to 2-3 days for labor to begin on its own may be a safe and evidenced-based option.  
The criteria for expectant management include:

  • Term, uncomplicated, singleton pregnancy
  • Clear amniotic fluid
  • No infections, including GBS
  • No fever
  • Normal fetal heart rate
  • No vaginal exam at baseline; keep vaginal exams to a minimum as to reduce chances of infection

Check with your healthcare provider to decide what is the best option for you.  You can read more about Term PROM at https://evidencebasedbirth.com/evidence-inducing-labor-water-breaks-term/

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