You are beyond 37 weeks gestation and you feel a little trickle or a big gush- this may be your membranes (or waters, as commonly called) breaking.  How exciting!  This means that labour is imminent!  Or does it?

Five to ten percent of women may experience their waters breaking without labour starting immediately.   Once you alert your midwife or homebirth team of your waters breaking, you may be up against the clock.  Depending on where you live, you may be pressured to go in for induction and antibiotics anywhere from 18 – 24 hours after your waters break.  The main reason for these suggestions is mostly to lessen the perceived risk of infection to both you and the baby.  Other risks include cord prolapse, which can occur if the baby is not engaged.

As recently as 2008, NICE guidelines stated that women should be offered expectant management up to 96 hours after waters breaking before inducing labour, since up to 94% of women will spontaneously go into labour by 95 hours.  Sadly, this time limit was reduced to 24 hours without concrete evidence to show that this change was beneficial or safer for the mother and baby.  You may find, however, that depending on how busy the labour and delivery suite are, that you are sent home and told to come back the next day when they ‘may’ have a bed available for you. This in itself demonstrates that the new guidelines are not based on sound data.

You can reduce the risk of infection to yourself and your baby by declining any vaginal examinations, sweeps and swabs for GBS which may be offered; at this point in time, you want to keep things OUT of your vagina, not insert potential sources of contamination.  This also means that intercourse is not a good idea, and baths should be avoided as well.  You may want to try natural approaches to induction, such as reflexology treatments, acupuncture or talking to a homeopath who may suggest a remedy to get labour started.  The other well-known tips may help as well, such as going for walks or eating spicy food.  The best option is to rest, have a nice chat with your baby, and have cuddles, smooches and special time with your partner to get the oxytocin flowing.

 

If you decide to go for expectant management, you can monitor yourself for signs of infection by taking your temperature every 4 hours and by being aware of any foul smelling  fluid or discharge.  You may also decide to go in for CTG monitoring to listen to how the baby is doing to reassure yourself- this does not mean that you have to stay in hospital, although you may be pressured to stay in. You can decline any antibiotics and offers of induction for as long as you are happy to do so.  Indeed, a study published in 2002 demonstrated that women allowed to remain at home for the period of expectant management were at no greater risk from adverse outcomes than those who remained in hospital.

 

 

Recommended reading:

Midwife Thinking – Pre-labour Rupture of Membranes : impatience and risk.

Gentle Birth – Midwife Archives: PROM

NICE (page 14)

 

Written by Cathy, who experienced a PROM at 37+3, declined induction and antibiotics and birthed her daughter naturally at 37+6