PROM – It’s Not About the Dress

mariapokluda Maria Pokluda, natural birth

PROM (1)It seems that on TV every pregnant character has a scene where out of the blue her water breaks followed by intense contractions, a wild rush to the hospital and a baby quickly born.  However, while a big gush of amniotic fluid makes for good television, labor starting in this fashion is the exception and not the rule and often when a pregnant woman’s water does break, contractions are not so quick to follow.  Left to its own devices, the bag of waters most often will rupture during transition – that crazy intense time at the end of labor and not at the beginning of the process.

Here are the cliff notes for PROM as it pertains to full-term labors:

  • PROM is defined as the water breaking 1 hour prior to the start of contractions
  •  PROM is thought to occur in 8-10% of all pregnancies
  •  75% of women will spontaneously start labor within 24 hours after PROM
  •  95% of of women with PROM will deliver within 28 hours*

While PROM may be a normal variation of labor, the small (but normal) percentage of women that experience their water breaking prior to the onset of labor do face special challenges, especially if they are hoping for a low intervention birth.  As noted, statistics show that labor will likely start one way or the other within 24 hours, but that means some women will start having regular contractions fairly quickly and others will start at hour 23…and it cannot be predicted which women are which until contractions actually start.

The question of what to do if your water breaks is a conversation expectant parents should preferably have with their care provider before finding themselves leaking amniotic fluid.  The answer will depend on the care provider, the couples desires, the type of birth they are planning and even the ever present concern about rush hour traffic.

If the decision is made to hang out at home, mom should eat/drink and try to get some rest.  If it is night time, she should seriously consider going to bed to rest up for the labor that is soon to come one way or the other!  She can pay attention to her baby’s movements, be aware if she starts to run a fever and follow her intuition…and of course stay in touch with her doula.  If it is chosen to go into the hospital, they may ask to have limited vaginal exams to reduce the risk of infection and discuss with the care provider the option of using pitocin or other methods to start labor vs the risks of waiting for labor to start on it’s on.  At home or at the hospital a women usually still has the option to wait to see if her contractions will start and can also consider using low tech ways of encouraging labor such as nipple stimulation with a breast pump or walking.

*Abstract of this particular study:http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005302.pub2/abstract

Maria Pokluda has been a doula serving expecting families in Dallas and Ft. Worth since 2007 and has helped hundreds of IMG_7310families have happy birth days.  Maria was voted “Best Doula” by DFW Child the past three years and has a special passion for helping couples achieve VBACs.  You can find information about Maria’s services or read her blog at greatexpectationsbirth.com