PROM (Premature Rupture of Membranes) is a fancy way of saying when your water breaks before contractions start. It usually happens in about 10% of all births. Two thirds of that happens after 37 weeks gestation. If it happens prior to 37 weeks, it’s called P-PROM (preterm premature rupture of membranes).
Keep in mind that this is a variation of normal but it’s not usually the norm.
If contractions haven’t start, when do they usually start?
- 79% will go into labor within 12 hours
- 95% within 24 hours
If it’s the birthing person’s first time giving birth then it will typically take longer for contractions to start.
How do you know if it’s PROM? Well.. you feel the water and you definitely know you didn’t just pee. If you’re still not sure, put on dry and clean underwear with a pad or panty liner. Lay down for 30 minutes or so. If you stand up and water comes out then it’s likely that it’s amniotic fluid. Or you can go to the hospital and they will take a sample of the fluid and then test it to see if it’s amniotic fluid.
Usually when your water breaks on its own it will either feel like a slow trickle, leak or small gush of water coming down. For my first labor, the midwife broke my water (Artificial Rupture of Membranes aka AROM) and for my second labor, I had PROM!
What could be the factors for PROM?
- Vaginal checks at the end of pregnancy
- Membrane Strips/Sweeps
- Too much amniotic fluid
- Birthing person has a low BMI
- Birthing person smokes
- Vaginal, Cervical or Amniotic Fluid infections
- Baby may be posterior
Credit: Evidence Based Birth
Why do we care if PROM happens?
As a doula, I’ve been hearing from my clients that if their labor starts spontaneously and water haven’t broke then, their provider wants them to wait to go to the hospital when contractions are 5-1-1 or 4-1-1.
But if their water breaks, they want them to go to the hospital right away even if contractions haven’t started yet. It might be their protocol at that hospital or providers may make the recommendation based on the client’s risk factors, how many weeks pregnant they are, if it’s their first time giving birth or not, their Group B Strep status and other factors.
This matters because if you envision laboring at home until your labor is more established before heading to the hospital to try to decrease the chances of unnecessary intervention being done and/or to make a shorter hospital stay. Then PROM may impact your plans.
The concerns that medical providers have around PROM is that it starts “the clock” on when the baby should be out by because concerns of possible infection to birther and/or baby. Remember that the amniotic fluid is in the amniotic sac which acts as a cushion and protective barrier for the baby from the outside world. They want to make sure that there are no complications related to the umbilical cord. So induction may be strongly encouraged by medical provider to have a baby within 24-72 hours (most often 24 hours) of when the water just broke and if labor haven’t started already.
Discuss options with your care provider
It’s best that this possible scenario was discussed with your care provider ahead of time but you can decide if you want to go right away or wait until contractions start. Or even something like “If my contractions haven’t started by _:__AM/PM time then I will go to the hospital. That’s after discussing scenarios in which it’s safe to wait. (We’ll cover this in the upcoming blog post!).
I’ve had a client whose water broke just before bedtime and her contractions haven’t started. She decided to get some sleep (very smart so that your body has a chance to charge before labor begins). If her contractions hadn’t started by the time she woke up the next morning then she was going to go to the hospital. Spoiler: Her contractions started a few hours later.
Keep an eye out for the next blog post that will talk about what can be done to prevent PROM prenatally.