Pre-Labor (or Prolonged) Rupture of Membranes

Any rupture of the membranes (water bag) constitutes the general distinction of labor. While you may or may not be contracting, the simple fact that your membranes are ruptured dictates a change in daily hygiene routine and supplementation.

The bag of water provides more than a cushion for baby It also serves as a barrier from bacteria and infection.

Prelabor (meaning no uterine contractions present) rupture of membranes occurs in about 6-19% of all term pregnancies. Epidemiological data shows that about 86% of all women with prelabor rupture of membranes go into spontaneous (not induced) labor within 24 hours of their water breaking. Only 6% of the remaining go longer than 96 hours without any sign of labor starting.

Some membranes rupture high up in the uterus. This is called a hind leak. Typically, water will come out slowly, perhaps gush once and trickle here and there. Hind leaks may be caused from baby's foot breaking the bag, or a positional change.

As there are two layers of the membranes (the amnion and the chorion), sometimes leaking may be caused from the outer layer of the bag (the chorion) breaking. In both cases with a hind leak and a leak from the chorion breaking, there is a good chance of the bag resealing itself with cessation of any sort of leak.

A full leak is a break in the lower part of the uterus, particularly over the cervix. This sort of leak rarely re-seals. While it may be difficult to know what type of rupture has occurred, the following guidelines should be followed any time there is suspicion or confirmation of a rupture.

Currently, the medical literature shows that expectant management (waiting until labor starts with the following guidelines) is an effective and safe course of action, provided NO VAGINAL EXAMS ARE DONE. Of course, you do have the right to choose to be induced in the hospital at any point during this prelabor period.

However, by being in your own home, you already are much more protected from bacterial infection than if you were in a hospital (the overall infection rate is four times higher in a hospital, hence the need for more rigorous antibiotic regimes). The bacteria present in your home are bacteria that your body is familiar with and acclimated to.

Absolutely, positively, NOTHING in the vagina. No fingers, tampons, penis, oral-genital contact, etc.

Drink plenty of water to help replenish amniotic fluid ? at least 64oz of water a day

Wear something loose-fitting with no panties when you can

If you are leaking and need something for sitting, use clean towels fresh out of a hot dryer

Take your temperature every 4 hours while you are awake (record on a sheet of paper).

Take 250mg Vitamin C every 3-4 hours while you are awake

Eat foods that are unconstipating and easy to digest

Be meticulous about toileting (wipe front to back, clean toilet tissue, etc.)

After showers, use a clean towel fresh out of a hot dryer or oven to dry your vulva

Do fetal movement counts twice a day after eating (looking for 10 movements in an hour)

Notice any change (color, odor) to the fluid and report results to your midwife immediately

After a full 24 hours since rupture, the addition of Oregon Grape Root and Echinacea tinctures to your daily supplementation regimen is recommended. Take a dropperful of each tincture four times a day.

REST, REST, REST, REST!

Pam, an Oregon Midwife.