Let's talk about Term PROM

ToasterCat · January 2015

Term premature rupture of membranes or "PROM" is when you are >37 weeks (or 39 now) and your sac ruptures before labor begins.

The procedure in my region is to go to the hospital immediately after waters breaking and be induced within 6 hours if labor does not begin on it's own. This happened to me and I believe the very short window I was allowed "watchful management" (waiting to see if labor begins on it's own) led to a much more complicated birth than was necessary.

I have since made it my mission to learn more about term PROM so that I can make more educated decisions for myself and my birthing experience this time around. I stumbled across a well cited article about this issue over at EvidenceBasedBirth.com and found it to be a very helpful resource.

How many of you STM+ moms ruptured before labor started? Did you feel well educated about what should happen after it occurred? Did you end up being induced, and were you happy/unhappy about it?

This is something I really wish I had known more about before I gave birth last time. I hope this resource will be empowering to someone.

https://evidencebasedbirth.com/evidence-inducing-labor-water-breaks-term/

Whitfry · January 2015

I'm not super familiar with this, so I'm following this thread for the sake of education, yo!

Amber&Reva · January 2015

So I PPROMed last pregnancy (Preterm Premature Rupture of Membranes) because I was not 24w the only decision was to make sure I was healthy. I was induced within 5hours of my PPROM the only reason it took that long is because I was in the ER for hours before they finally sent me to L&D some good resources I found were:

https://aapprom.org/

and

https://emedicine.medscape.com/article/261137-overview#aw2aab6b7

jack12trip · January 2015

Same, FTM just following for education. Thanks for posting!

Boycrazymommy · January 2015

My membranes spontaneously ruptured at 38 weeks 3 days with DS1. I hadn't done a lot of specific research on the subject, but I was aiming for a med-free delivery, so I had discussed the specifics of this with my OB in advance. Her guideline was that I could labor at home for up to 12 hours before proceeding to the hospital after a rupture. The point was moot with me, however, because I was in the throes of active labor within an hour. My contractions went from 0 to 10 in a big hurry (in my back, he was posterior) and started at 4 and a half minutes apart. I didn't require any pitocin and delivered my son well within the hospital infection "deadline" of 24 hours post-rupture. I consider myself very lucky to have had such a textbook progression on labor.

janda426 · January 2015

I was JUST thinking about this and am going to ask my doctor what their procedure is. Because I know I don't wanna be that chick to rush to the hospital just cause my water broke and Id much rather wait to see if contractions start on their own. I know the hospital wouldn't want me just hanging around for like 24 hours, they're a business and would want contractions started ASAP.

Unknown · January 2015

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Unknown · January 2015

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janda426 · January 2015

@ToasterCat‌ if it happens this time do you think you would just hang around and wait? Idk what I'd do if my doctor tells me they want me to come in right away. I think it's silly unless I'm having contractions on my own...

Unknown · January 2015

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Stephy129 · January 2015

Thanks for posting the information. My water never broke on its own the first time so I had not even thought about this.

FrecklesInside · January 2015

My waters breaking was the first step in a series of unfortunate events and circumstances that led to me losing all control in my birthing. I DID lie, even though I was GBS positive, and that is one complication you need to consider. The GBS positive factor made me uncomfortable waiting more than about four hours before heading in. I was supposed to go in immediately but knew I'd be put on a clock and so I monitored at home as long as I felt comfortable without worrying about the need for the IV for the possibility of infection due to GBS. Had I not been GBS positive I would have monitored carefully at home until labor began instead of going into the hospital and being put on the 24 hour clock.

If membranes rupture again this time, as long as I'm not GBS positive, that is still the plan. If I am GBS positive, I've at least switched to a practice that doesn't see membrane rupture as an immediate concern that puts you on a labor clock. I'm refusing all cervical exams prior to labor unless absolutely necessary.

Most women don't rupture prematurely, but I agree being educated on it is essential. Many hospitals put you on the clock and essentially force induction and it is totally unnecessary. Your body will likely go into labor on its own (it can take a couple of days even!) and as long as LO is still moving around, there is no meconium in the waters, and no elevated or erratic heart rates, there isn't a cause for concern, IMO, based on the research I've done.

The fear mongering is very upsetting. We love our babies and want to do what is right for them and for ourselves, but oftentimes we are misled into believing our bodies cannot handle a situation when they can. Oftentimes ONE medical intervention can lead to a ridiculous series of medical interventions that would have been and should have been completely unavoidable.

I'm thankful to have found a new practice and hospital that doesn't, even being GBS positive, enforce the 24 hour rule, which is an absurd standard. I have some regrets about how I handled things my last birth, but I was educated then too. When you get into the hospital and you have people telling you you are on a clock and you need to do what is best for your child, a lot of what you had researched goes out the window. There are many things I wish I had stood my ground on and that I know I'll do better with this time should I have any repeat circumstances. The best thing you can do is educate yourself and be prepared for a variety of situations.

lawsonellis · January 2015

Firstly, I didn't know what gbs was, so I googled it (the more you know!) but secondly it is found in 25% of all pregnant women!!!

So I'm glad you mentioned it @FrecklesInside‌ because I had no idea about any of it.

Unknown · January 2015

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DragonflyDreaming · January 2015

@ToasterCat‌ That article is gold and you rock!

Like @lawsonellis‌, I had no idea what GBS was until reading that article. Good thing I know, now, since it's apparently not even checked for in a lot of other countries. For those that had it ... do they just manage it with antibiotics? Or is there something else they need to do?

I'll go a step further ... until I got pregnant (and even into the pregnancy a bit), I was under the impression that every woman's water broke before going into labor. (Thanks to movies, I guess?).

Which brings my next question! If your water doesn't pop, prior to labor, how long did you ladies wait to have it broken? I've read that doctors do it for you in some instances and am curious about this side of the issue? (Since a some books I've read don't seem to like the doctor popping part)

crunchymamaof2 · January 2015

@DragonflyDreaming‌ my waters broke naturally, shortly before pushing, when I had my second. AROM (artificial rupture of membranes) was never mentioned, and I would have likely refused as IME contractions without the cushion of your waters suck. Badly. Some doctors will break your waters to speed up labor, but then you're on the clock. And risk a cord prolapse if they're broken too early.

Amy and Jay · January 2015

My water broke at 41wks and 2 days w/ dd #2 and I went in within an hour b/c I was GBS+. I wasn't contracting at all though and would have preferred to stay home longer if I could have. They did give me pitocin but honestly the birth went fairly smoothly (30min. of pushing).

Unknown · January 2015

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JennyP0222 · January 2015

DragonflyDreaming said:

@ToasterCat‌ That article is gold and you rock! Like @lawsonellis‌, I had no idea what GBS was until reading that article. Good thing I know, now, since it's apparently not even checked for in a lot of other countries. For those that had it ... do they just manage it with antibiotics? Or is there something else they need to do? I'll go a step further ... until I got pregnant (and even into the pregnancy a bit), I was under the impression that every woman's water broke before going into labor. (Thanks to movies, I guess?). Which brings my next question! If your water doesn't pop, prior to labor, how long did you ladies wait to have it broken? I've read that doctors do it for you in some instances and am curious about this side of the issue? (Since a some books I've read don't seem to like the doctor popping part)

The doctor on call kept asking me to break mine but I was SO paranoid about the "24 hour clock" I kept refusing. When I finally got to 9 cm, he asked me again and said I would most likely progress to 10 cm in a matter of minutes if I just let him do it. I decided at that point I was close enough and my risk of not giving birth within 24 hours was minimal so I let him break it. And, turns out he was right in my case. 1) I progressed to 10 cm immediately and 2) They discovered I had meconium in my water. They then had the neonatal team geared up and ready to grab him as soon as he was out to suction and check him. In my case it was actually to my benefit that I had him break it at all because we would not have seen the meconium beforehand had we not.

Anljcollins · January 2015

My water broke as I was walking out of a restaurant. I was basically looking at my hospital when it happened. I live 15 miles away so there was no point in going home. I was not having contractions yet but they put me on pitocin as soon as I got in the bed.

Unknown · January 2015

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KD32412 · January 2015

My water broke at 32 (+2) weeks with my first. We called the doctor and my FIL and went straight to the ER. I was immediately given my first steroid shot (to help with lung development) and they checked to make sure it was actually amniotic fluid leaking - as opposed to pee? I dunno. After getting set up in an actual birthing room, many a neonatal specialist and other doctors dropped by. The plan was to keep baby in for, at the LONGEST, a week. They were worried about infection setting in, but also wanted me to make it to 33 weeks. I was very closely monitored and was experiencing only very mild contractions. I had no pelvic exams (fear of causing infection or inducing labor), was on strict bed rest, and my temperature was monitored (fever was a sign of infection setting in). During this time I pretty much googled PROM and all things premature baby related. It made me a little crazy, but I put my trust in the specialists. I started having strong contractions after 5 days and dilated FAST! It was amazing to see all the doctors and nurses getting ready for the delivery. Everyone was there, about 12 people total, just waiting for the little one. Was so relieved to hear her first cry, I got one quick look at her, then she was incubated and went straight to the NICU. We were very lucky. She only had a month stay, and only had a handful of apnea episodes. She just had her 2nd birthday and is perfectly healthy, just a small speech delay, but her pediatrician is amazed at her progress.

-Technology is pretty amazing. According to the NICU nurses, 24 week babies have a good survival rate.

Unknown · January 2015

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KD32412 · January 2015

ToasterCat said:

KD32412 said:

My water broke at 32 (+2) weeks with my first. We called the doctor and my FIL and went straight to the ER. I was immediately given my first steroid shot (to help with lung development) and they checked to make sure it was actually amniotic fluid leaking - as opposed to pee? I dunno. After getting set up in an actual birthing room, many a neonatal specialist and other doctors dropped by. The plan was to keep baby in for, at the LONGEST, a week. They were worried about infection setting in, but also wanted me to make it to 33 weeks. I was very closely monitored and was experiencing only very mild contractions. I had no pelvic exams (fear of causing infection or inducing labor), was on strict bed rest, and my temperature was monitored (fever was a sign of infection setting in). During this time I pretty much googled PROM and all things premature baby related. It made me a little crazy, but I put my trust in the specialists. I started having strong contractions after 5 days and dilated FAST! It was amazing to see all the doctors and nurses getting ready for the delivery. Everyone was there, about 12 people total, just waiting for the little one. Was so relieved to hear her first cry, I got one quick look at her, then she was incubated and went straight to the NICU. We were very lucky. She only had a month stay, and only had a handful of apnea episodes. She just had her 2nd birthday and is perfectly healthy, just a small speech delay, but her pediatrician is amazed at her progress.

-Technology is pretty amazing. According to the NICU nurses, 24 week babies have a good survival rate.

I'm so glad that everything turned out ok for you and your baby! Just a clarification though, there is a difference between termPROM and PPROM, which is what happens when your waters rupture before 37 weeks.

Oh poops! I just saw "PROM" and went off. Sorry about that... Please feel free to ignore my long ass post!

Unknown · January 2015

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kcbizme · January 2015

Also a FTM reading for education. Thank you for this post! I am adding this to my list of questions for my doctor.

Mrs. jk3a · January 2015

This happened to me with my first. Water broke in the middle of the night at 37w4d but I never felt any contractions. I went straight to the hospital. I was at 4cm and they gave me an epidural with stopped my contractions (the monitor said I was having them even though I couldn't feel them) so then they started pitocin.

Thank you for educating me! I will do things differently this time of it happens again!

thursday · January 2015

This is a great thread. My water broke with DD at exactly 37 weeks. I was not having any contractions and showed up to the hospital a couple hours later. I was induced within the hour of being there. Although it was great never feeling any contractions because I received my epidural shortly after I was induced. After reading different birthing stories if it happens like this again I will try to stay at home and start labor naturally.

JenniCollins · January 2015

My bag of waters broke right before I was going to run to target for some last minute baby items. I called the doctor to ask whe I should go in and they told me to head over to get checked out. It was about two hours later by the time I got there and I still had no contractions. The hospital policy is to give you 12 hours to get things started on your own. At 7 we opted for pitocin since it didn't look like my body was in a rush to do anything, this was 9 hours later. Got my epidural about two hours later and took a wonderful nap until 2. Started pushing at 2:30 and she was out in about 20 minutes. The hospital wasnt pushy and I had a good experience. The best part was the hour of skin to skin contact with her before they did any tests.

Beamer14 · January 2015

So question then...if the usual protocol is to have baby within a few hours *of* rupture..does that mean the chick who just intro'd herself saying she had pprom but baby was still in there and she may be able to fly home is possibly not being truthful? Or am I missing something that is completely going over my head?

Edited for auto correct fail

Unknown · January 2015

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conleyk7 · January 2015

ToasterCat said:

Beamer14 said:

So question then...if the usual protocol is to have baby within a few hours *of* rupture..does that mean the chick who just intro'd herself saying she had pprom but baby was still in there and she may be able to fly home is possibly not being truthful? Or am I missing something that is completely going over my head?

Edited for auto correct fail

Did you read the article I posted at all? The procedure of some hospitals is to wait a while then induce, induce right away, or even wait for the body to go into labor on it's own with monitoring. I think the likelihood of her being able to get on a plane with ruptured membranes is small, but there is no immediate need to give birth if there is no sign of distress or infection.

Definitely not being dishonest. Women with pprom can be managed on bedrest for days to weeks if there is no sign of a medical indication to induce labor (infection, fetal distress, etc) and no sign of active labor. @ToasterCat‌ is right, there is a very small chance of getting on a plane but it remains possible for me due to the absence of the above. This could, of course, change with one fever, one episode of a painful belly, or spontaneous labor unable to be stopped with meds. I'm cautiously hopeful.

Beamer14 · January 2015

Ok, which is why I said I had a question, and if I was misreading it and something was going over my head. And no, I can't get the link to work on my app, so I hadn't read it.

Beamer14 · January 2015

Since I couldn't read the article, I was going off of the comments, all of which were induced within a few hours. Only reason I asked

conleyk7 · January 2015

Beamer14 said:
Since I couldn't read the article, I was going off of the comments, all of which were induced within a few hours. Only reason I asked

No worries! One thing that's confusing and I'm learning too is that with pprom many OBs have the goal of getting you to 34 weeks if safe/possible, after which the risk of being inside of infection outweighs the benefit of delivery at that point. That's why most ladies with prom deliver more quickly instead of waiting days or weeks

FrecklesInside · January 2015

A lot going on today and some folks have been discussing water breaking. Bumping this for a revisit.

Unknown · January 2015

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kcbizme · January 2015

EmpireRecords24 said:

Bumpity bump bump bump. We've had TWO ladies today who have had their water break (broken their waters? Sounds too biblical...) so good to read up on PPROM and PROM.
Link from one of the ladies on FB. https://www.tommys.org/prem/pprom

Who was the second?

kcbizme · January 2015

EmpireRecords24 said:

kcbizme said:

EmpireRecords24 said:

Bumpity bump bump bump. We've had TWO ladies today who have had their water break (broken their waters? Sounds too biblical...) so good to read up on PPROM and PROM.
Link from one of the ladies on FB. https://www.tommys.org/prem/pprom

Who was the second?

Nannabee21 -- Last update was that she was headed to the hospital.

Apparently I missed that one? Yikes!

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