Baby Hints & Tips

Midwife Tips: Pre Labour/Premature Rupture of Membranes (PROM)

Expert tips by Caroline May (Midwife)

The moment your waters break is usually a signal for women that they will get to meet their baby soon. For most women, if they are left to labour uninhibited, their waters will break spontaneously between 37 and 42 weeks and at around full dilation. This is the perfect time for them to break, but for some women waters breaking happens either pre labour or pre term and this is not ideal. Sometimes it is a gush, but other times it can be a tiny trickle.

In pre labour (or premature) rupture of the membranes (PROM) the waters break between 37 and 42 weeks but there are no contractions so labour does not commence. This can be very frustrating for prospective parents. If you think your waters have broken it is important that you contact your Midwife or hospital so that they can confirm this and exclude any complications. Most hospitals will recommend induction of labour within 24 hours of this happening to reduce the risk of infection in either you or the baby. Some hospitals will recommend immediate induction. Most will recommend either immediate or delayed induction based on your individual set of circumstances and the work load of the unit at the time. If you are not keen to be induced it is useful to know that a significant proportion of women will go into labour spontaneously during this first 24 hours and nearly all women will have birthed within 72 hours, but the longer the time lag between the waters breaking and the baby being born the higher the risk of infection. Of course induction is not without risk so it is worth weighing up the risks of induction versus the risks of waiting. You may also be offered intravenous antibiotics and your baby will monitored closely once it is born for any signs of infection.

For some women things don’t go quite according to plan and the waters will break both pre labour and pre term. This is known as pre term pre labour (or premature) rupture of membranes (PPROM) and is the biggest identifiable cause of pre term births. If you suspect your waters have gone prior to 37 weeks gestation it is vital that you contact your care provider, as apart from pre term birth and the complications that go along with a premature baby, you are also at risk of infections such as chorioamnionitis. If you are less than 34 weeks pregnant you will likely be offered corticosteroids which are usually given as 2 injections 24 hours apart. The aim of these injections is to help mature the baby’s lungs in case of pre term birth. If you do not go into established labour it is likely that conservative measures will be taken to prolong the pregnancy and you will also be offered a number of tests which may include vaginal swabs, ultrasound and blood tests. The aim of these tests is to determine if in fact your waters have broken and if so is there an identifiable cause or an infection. Apart from infection another serious risk of pre term pre labour rupture of membranes is that the cord may prolapse through the cervix and into the vagina as the baby is more likely to not be engaged in the pelvis or in a position such as breech. Whilst not common this is potentially life threatening to the baby and so if you suspect your waters have gone pre term it is vital that you seek an expert opinion as soon as it is practical to do so.

If you are between 34 and 37 weeks when your waters break you are unfortunately in the grey area where corticosteroids are not recommended and there is no conclusive evidence as to whether it is safer to birth or continue with the pregnancy. Your circumstances will need to be considered on an individual basis.

My tips for when you think your waters have broken:

Don’t panic, it is not a medical emergency despite what you see in movies! It is important not to ignore it though. Put on a sanitary towel to see if more drains and observe the colour. Keep any that have become wet to take to the hospital with you or show your midwife. Sometimes this can be the only conclusive evidence. Monitor the baby’s movement. Call your care provider and finally, prepare to meet your baby.

Some useful links:

Clinical Guidelines for treatment of PROM (King Edward Memorial Hospital, WA) – Includes clinical information regarding confirmation of diagnosis, expectant management (waiting) and active management (induction)and antibiotic use, etc.

Clinical Guidelines for treatment of PPROM (The Royal Women’s Hospital, VIC) – Includes clinical information regarding diagnosis, initial treatment, antibiotic use, surveillance for infection, etc.

PPROM Facebook Support Group – A good place to connect with other mums who have or are experiencing PPROM, including some who’s membranes ruptured very early in their pregnancy.

Caroline May qualified as a Midwife in 1999 and has worked in both community and hospital settings around Australia and in the UK. Currently residing in Perth with her partner and two young children, Caroline is particularly interested in home and waterbirth and is passionate about enabling women to make an informed decision and play an active role in their care. You can find all her articles here.

 

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  1. Samantha says:

    I have experienced 2 PROM, my first at 34 weeks and my second at 36 weeks. Both babies were delivered safely within 24 hours of my waters breaking and spent 3 weeks, (Bub 1) and 8 days (Bub 2) in the SCN. I would love to have a third child but both my husband and I are terrified of going down the premature birth and special care road again. Is there anything I can do to minimise the risk of PROM occurring again?

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