• Does Premature Rupture of Membranes mean I have to be induced?

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    There are a few reoccurring themes i see with birth as a doula and a childbirth educator. I support women no matter what choices they make regarding their pregnancy and birth journey- but there is advice I wish every client could understand in the moment.

    For some reason a  least 60% of my clients experience their water breaking before they go into labor. Crazy- because statistically most resources say that only 10-15% of women will experience their water breaking before they go into labor. This is one of my least favorite birth scenarios of all time- and here is why.

    If your water breaks before you start having contractions, typically within 12-24 hours your body will get the signal and will start contracting on its own. So what’s the issue? If your water breaks and you call to tell your provider, more than likely they are going to tell you to come in. First, they want to check to see if it really was the amniotic sac that ruptured and then second, they will want to admit you and start the induction process.

    Historically, this comes from the 24 hour clock that was imposed on women since the 1950s. Doctors felt that if the bag of water had been ruptured for more than 24 hours there was more likelihood of baby becoming infected through being exposed to bacteria and germs in the vaginal canal and in the environment. It was true that during this time there was a higher rate of stillbirth and infection related to PROM (premature rupture of membranes) greater than 24 hours.  Therefore, there was good reason to impose this 24 hour clock. The problem today, is that there is little to no evidence that continues to supports the 24 hour clock.

    With the use of antibiotics and the ability to monitor mom’s temperature, we are able to keep a very close eye and make sure mom and/or baby is not infected. If moms with PROM are not induced, around 45% will go into labor within 12 hours, between 77% and 95% will go into labor within 24 hours. (Shalev et al., 1995).  So if this is true, then why is the medical community rushing to induce women who have experienced PROM?

    We know that a first time mom is 50% more likely to have a Cesarean birth if she is induced and the cascade of interventions that occurs with induction often leads families into birth environments they don’t want to be in. Induction is great when is necessary, but you should ask yourself- is this a medically necessary situation for induction?

    So what should you do if your water breaks?

    Feel free to let your provider know, but then make sure you let them know that you are not going to be admitted, but will wait at home, monitor your temperature and arrive at your birth place when active labor has begun. Don’t stress about trying to get labor going, take the time to rest, eat a healthy meal, and settle in awaiting your newest little ones arrival. By advocating for yourself and using evidence to make your birth choices, you can have the birth you desire.

    If you wish to learn more about birth, in order to have an amazing birth, take Birth Boot Camp!


    Disclaimer: I am not a medical doctor and am not offering medical advice. If you feel you need medical assistance please contact your provider immediatley.

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