Premature Rupture of Membranes (PROM)… You mean the dance?
What is PROM anyway? Isn't that something you went to in high school? Well, yes, but it is also something a small number of people experience in pregnancy.
PROM means, premature rupture of membranes. Simply put, it means your water has broken before contractions have begun. Although it is a range of normal, only about 10% of birthers experience it.
Does it mean you are in labor? Yes and no. Yes, it means that your baby is on the way, but it also means that it could still be a few days before labor begins.
It's great to inform your care team that your water has broken, but it doesn't mean that you need to rush to the hospital. Sometimes it just means you need to do a little extra monitoring as you wait for labor to start.
It's good to have a conversation with your provider asking what they recommend with PROM, but if you do have additional risk factors, expectant management (waiting for labor to begin) could be a safe option for you.
One study (Hannah Term PROM Study) finds that expectant management finds no difference in cesarean rates, vacuum/ forceps delivery, newborn infection, stillborn, and APGAR tests when compared to induction groups.
Induction can reduce chorioamnonitis to 4% versus 8.6%, postpartum fever, lower NICU rates and infant antibiotics, reduces time before active labor, and higher satisfaction rates. It increases uterine tachysystole (uterine overstimulation).
What do the professionals recommend?
ACNM (American College of Nurse Midwives): Can wait for labor to start if full term pregnancy, clear fluid, no GBS, no infections, no fever, good fetal heart tone, no cervical exams
ACOG (American Congress of Obstetrics and Gynecology): changes recommendation often without change in research, induction is recommended, but expectant management (waiting) is ok for 12-24 hours unless GBS positive
If you are Group B Strep (GBS) positive it is recommended to treat with antibiotics and start induction right away.
So how do you know what to do in if you experience PROM? We suggest that you use your BRAIN…
What does that mean for you? It means, ask these 5 questions to open up a conversation between you and your provider! If you ask these questions we typically see providers soften, and offer more information, shared and informed decision making, and it keeps you in the drivers seat.
So what BRAIN stand for?
B- Benefits
R- Risks
A-Available Alternatives
I- Intuition
N- Now/ Nothing
How that might look…
What are the benefits for inducing? / What are the benefits for waiting to start on it’s own?
What are the risks when inducing? / What are the risks for waiting for labor to start?
What are my available alternatives?
What does my intuition tell me?
What happens if I don’t do this now? / What happens if I do nothing?
Whether or not to wait for labor to start on its own, or get induced is a personal decision between you and your provider. We wanted to share this information with you, so you can make informed decisions and open up the communication lined between you and your provider. PROM is common, but it does not always mean a medical induction.