PROM: Premature/Prelabor Rupture of Membranes
What Is PROM
Prelabor rupture of membranes or PROM means that your water breaks before labor begins at term pregnancy which is 37 weeks or later. PROM is a common variation of normal pregnancy and occurs in approximately ten percent of term pregnancies.
When PROM occurs most people will go into labor on their own within the first twenty four hours. Some will take longer and this can still be normal depending on individual circumstances.
This page addresses term PROM only. PROM that occurs before 37 weeks is managed differently.
ALWAYS CALL YOUR MIDWIFE IF YOU THINK YOUR WATER BREAKS!
What Happens After Your Water Breaks
Once the amniotic sac ruptures the protective barrier between the uterus and the outside environment is reduced. Because of this the risk of infection slowly increases as time passes.
Evidence shows that:
Most people will begin labor spontaneously within twenty four hours
The overall risk of infection remains low initially but increases gradually over time
Avoiding unnecessary vaginal exams reduces infection risk
Decisions about how long to wait are individualized and based on maternal health, fetal wellbeing, Group B Strep status and client preference.
Your Right to Request Medical Induction
At any time after PROM you have the right to request:
Transfer to obstetric care
Medical induction of labor
Hospital based management
This decision does not require an emergency or complication. It is always your choice. Your midwife will support your request and assist with transfer coordination as needed.
Midwifery Management of PROM
If you and baby appear healthy and you wish to wait for labor to begin on its own, midwifery care may include expectant management with close monitoring.
If you are Group B Strep positive your midwife may recommend starting IV antibiotics right away and continue with a dose every 8 hours until baby is born.
Your midwife may recommend natural supportive measures to encourage labor:
Beginning around 12 hours after rupture if Group B Strep positive
Beginning around 24 hours after rupture if Group B Strep negative
These recommendations are optional and based on balancing infection risk with physiologic labor onset. You may decline or accept any recommendation.
You may also choose antibiotics at any point regardless of initial plan.
Hygiene and Infection Prevention After PROM
To reduce the risk of infection after your water breaks:
No vaginal exams unless clinically necessary
Nothing in the vagina including tampons intercourse douching or vaginal suppositories
No baths hot tubs or swimming
Showering is acceptable
Wipe front to back after using the restroom
Self Monitoring at Home
After PROM you will be asked to monitor and report:
Your temperature every 4 waking hours
The color of the amniotic fluid
Fetal movements
Any signs or symptoms of infection
Contact your midwife immediately if you notice decreased fetal movement, change in fluid color, fever, foul smelling fluid or feel unwell.
Assessments and Location of Care
You may come into the birth center at any time for maternal and fetal assessments even if you are not in active labor. Your midwife will want to do regular vitals on you and your baby. If your water breaks during the middle of the night you are encouraged to go back to sleep after calling your midwife and meet in the morning.
Even if you are planning a home birth all assessments while you are not in active labor will still be completed at the birth center.
Once active labor begins, your midwife will meet you at the birth center or at your home.
When Transfer Is Recommended
Your midwife may recommend consultation or transfer to obstetric care if:
Signs of infection develop
Fetal monitoring is non reassuring
Labor does not begin within an agreed upon timeframe
You request induction or hospital based care
These recommendations are made to support safety and informed decision making and do not remove your autonomy.
PROM at term is not an emergency by itself. It is a situation that requires thoughtful monitoring clear communication and shared decision making.
Our role as midwives is to provide evidence informed guidance, clinical judgment and support while honoring your right to choose the path that feels safest and most aligned for you and your baby.
https://evidencebasedbirth.com/wp-content/uploads/2023/08/PROM-Handout.pdf
