Incidence: 8% to 12% of all pregnancies will experience spontaneous, prelabor rupture of membranes prior to the onset of uterine activity. This is common and often a normal, physiologic event of late pregnancy, right before labor begins on its own. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492588/
Causes: Small leaks can be part of the normal cervical softening and thinning that occurs in the days leading up to labor. The enzymatic action that causes the collagen in the cervix to degrade can also result in small tears and leaks of the amniotic sac. http://emedicine.medscape.com/article/261137-overview
Making a plan with your care provider
Ideally, creating a management plan with your health care provider begins prenatally. Find out what your doctor's or midwife's philosophy and protocols are for inducing a woman's labor if her water breaks before labor starts. Be sure to describe your desires and reasons for wanting a normal, physiologic labor. Find out if your health care provider is willing to support your goals. Even if your care provider normally prefers immediate induction, talking to your care provider about why you want to wait for labor to start on its own can help you and your care provider find a satisfying middle ground.
If you are negative for the GBS bacteria, at term, and healthy, you have some flexibility in waiting for your labor to begin on its own, if that's your wish.
Despite a lack of evidence, there is a widespread impression among providers that when duration of rupture of membranes exceeds 24 hours, there is increased danger to mother and baby. Birth within 24 hours is a common management goal when the membranes are ruptured. This may lead to use of oxytocin and associated practices such as internal monitors and more frequent vaginal examinations, which are in themselves independent risk factors for infection. http://www.medscape.com/viewarticle/494127
Questions for your HCP so you can make a clear, confident decision:
"If we induce my labor now, is there a clear medical benefit? Does it outweigh the risks of induction, including failed induction, higher need for cesarean and higher need for pain medication?
"What is the likelihood of my induction succeeding?"
"How does an immediate (before 24 hours) induction improve my or my baby's health?"
"What happens if I wait for 24 hours?" Can you tell me about the relative and absolute risks of waiting for labor to begin on its own? How likely are those risks?
"What factors increase my likelihood of infection?" "Are my personal odds of having a poor obstetrical outcome higher or lower than the average?"
"Are we treating a known problem or are we treating a potential for a problem?" "Is there a chance we are over-treating by inducing now?"
"Are there other things I could do?"
Reasons to Induce Labor Before 24 hours after a rupture of membranes
Your health and/or the health of your baby will likely improve.
Reasons to wait for labor to begin on it's own.
Your Bishop Score is unfavorable and the induction is likely to fail.
Most women (85%) will be in active labor within 24 hours of a prelabor rupture of membranes. A long early phase wasn't nearly as predictive of infection as a long active phase. http://www.medscape.com/medline/abstract/9396886
Waiting for the active phase of labor to begin on its own gives the woman and her partner time to rest and nourish themselves before the hard work of active labor. http://www.medscape.com/medline/abstract/9396886
The small rupture may help the cervix continue softening and thinning over the course of the next 24 hours, making the active part of labor more efficient with less need for pitocin augmentation.
A midwife's view on waiting for labor to begin vs immediate induction: http://midwifethinking.com/2010/09/10/pre-labour-rupture-of-membranes-impatience-and-risk/
Elective induction for first-time laboring women increases the chances of a cesarean birth by 2x. http://www.ajog.org/article/S0002-9378(02)48051-9/abstract
When to Use Medical Interventions:
| YES |
Choose medical interventions when the benefits of the intervention clearly outweigh the risks. |
| NO |
Any intervention used for convenience can result in HIGHER complication rates for mother and baby. |
| MAYBE |
When there is a gray area (benefits and risks may be similar or unclear), consider:
- Is mother okay now? Is baby okay now? Consider waiting a little longer before acting.
- Is this a routine procedure that you offer everyone or is there something unique about my situation? If routine, consider waiting a little longer.
- Who benefits from the intervention now? Mother, baby, care provider? If only the care provider benefits, consider waiting a little longer.
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