Your labor begins with your water breaking, it happens without warning, and often in the absence of any real uterine activity. It maybe a sudden rush or a slow trickle, you may not even be sure that this is what actually happened.

It most likely surprises you, maybe its a little scary, some women experience term PROM as a loss of control, so give yourself a moment before you start sounding the alarm. Take some deep breaths allow that surge of emotion and adrenaline to pass, this is undoubtedly not the start to labor that you wished for yourself and your baby.

But the fact is that the breaking of your waters means that you ARE in labor, even though you may not feel regular contractions as of yet. It is a far better strategy to just go with the actual circumstance of your particular labor instead of fighting it and wasting time wishing for different circumstances.

Ideally this moment happens in private at home, but since it can happen anytime, anywhere, it may very well be more of a “clean-up in aisle 4 kind of moment”. 

If you are still several weeks away (≤37 weeks) from your estimated due date then you would be very well advised to seek the security of your hospital at this point. If such is the case, gather up your birth team, call your health care provider and head towards the hospital.

Otherwise— there is no need for panic—being out in public makes for more of an embarrassment  than anything else (good for the birth story), if you are out calmly make your way home with the minimum of fuss.

Wash your hands and then clean your bottom half with antibacterial soap, you may even wish to take a shower. DO NOT insert anything inside of your vagina.  If you are using a pad to catch the draining fluids—change it frequently.  Examine ALL of them before disposing as well as your original undergarments.

Everyone that comes in contact with you (including yourself) from this point forward has washed hands as well as uses hand sanitizer, at the very minimum. Establish a good antiseptic protocol from the beginning.

At this point, if you haven’t already, you should let both your birth partner and your birth Doula know of these new circumstances, both will be key in making the best informed choices for moving forward.

You have assessment work to do and decisions to make.

Drink a large glass of purified water, continue to drink a lot of purified water, your body will continue to make amniotic fluid, there is no such thing as a “dry” birth—BUT you will need a lot fluid intake.

After achieving as much calm cleanliness as you can— you then need to determine the following: Time of Rupture, Amount of, Color of, and Odor of your Amniotic Fluid.

Remember this by using the acronym: TACO. Color and Odor are of most concern. Whether you accurately divulge the number for T to medical staff —well—that is totally up to you.

What you determine during your self assessment will help you to determine if you meet reassuring criteria standards, give you vital answers about your choices, and help in the decision making process.

Next up assess your TACO findings using the following criteria:

Reassuring Signs:

1. You are at term (≥37 weeks) and are experiencing an uncomplicated singleton pregnancy.
2. Your amniotic fluid is clear. It may have a slight pinkish tinge and/or a bit of brownish dried blood. You may have had a gush or a trickle but it is clear. It either smells slightly sweet or has no odor at all.
3. You have no fever. Make sure you have an accurate thermometer.  You have checked your temperature several times.
4. To your knowledge you have no type of infection and you have tested negative for Group B Strep (GBS).
5. You can feel reassuring fetal movement.

1. The following will also need to be assessed and these criteria are essential but usually not determined at home:

1. At Hospital/Dr. Office: normal fetal heart rate. Normal maternal heart rate. (You will feel your heart/pulse if it continues to race after the initial adrenaline rush fades.)
2. At Hospital/Dr. Office: no sign of umbilical cord compromise or prolapse. (It pays to have gathered accurate information about your baby’s position at your last exam. The knowledge that your baby is head down and engaged in your pelvis disallows for prolapse and is reassuring.)
3. At Hospital/Dr. Office: no vaginal exam done to determine baseline, and vaginal exams kept to an absolute minimum. Politely decline the procedure unless it is of medical necessity.
4. At Hospital/Dr. Office, or over phone: You have been thoroughly counseled about all the potential benefits and risks of both induction and waiting for labor to begin on its own-so that you can make the best choice for your unique situation. In fact, you have already discussed this possibility with your health care provider and have a mutual understanding about your preferences in this circumstance.

Need for Concern:

1. You are pre-term (≤37weeks) and are experiencing any type of pregnancy. You are ≥37 weeks but are carrying more than one baby.
2. Your amniotic fluid in any amount is green, gray, brown, bright red, and/or black. It has a foul odor.
3. You have a fever of 99.5° or above. Take your temperature at least twice.
4. You have some sort of infection be it a cold, a yeast, etc. You are GBS positive.
5. Your baby’s movements or lack of movement are not very reassuring.

1. The following will also need to be assessed and these criteria are essential but usually not determined at home:

1. Non-reassuring fetal heart rate. Non-reassuring maternal heart rate.
2. Possibility for Prolapsed Umbilical Cord. Your baby is still high, not engaged, or is not head down.
3. Multiple recent vaginal exams.
4. Call your caregiver about any of the first 5 assessments and they will rightly advise you to make your way promptly to the hospital. From there determine your options and best choices.

You will face four possible scenarios regarding uterine activity.

1. your contractions will begin almost immediately (this happens for a few women)
2. you will feel contractions within 12 hours (45%)
3. you will feel contractions within 24 hours (77-95%)
4. or you will theoretically still be waiting

When you have finished your home assessment and have your birth team at the ready, call your healthcare provider, make arrangements to come in and get checked so that all of your assessment criteria get answers.

If reassuring criteria is met, the best existing scientific evidence available shows that waiting up to 48-72 hours after your “water breaks” DOES NOT increase the risk of neonatal infection, nor the risk of infant mortality and it DOES NOT make it more likely that you will need a Cesarean Section.

Your healthcare provider very well may tell you differently— they often cite the risk of maternal and fetal infection as the basis for their recommendation of immediate induction. This is NOT evidence-based medicine. There are better ways than immediate induction to decrease the risk of infection after term PROM.

The number one place to pick up an infection is in a healthcare related setting and by agreeing to invasive procedures such as digital vaginal exams, IV administration, etc., this has always been true and remains true today.

The rupture of your membranes opens a door—providing a pathway for transmission of infectious agents through a barrier that was previously closed.

So while the decision to wait does increase the risk of you getting an infection—the majority of that increased risk comes from the continued exposure to the above stated risks.

So while prolonged rupture (greater than 24 hours) increases the risk for neonatal infection—the majority of that increased risk comes from your continued exposure to the above stated risks.

More on that below, getting slightly ahead of myself there, but hence the need for establishing your version of antiseptic protocol immediately upon rupture—AND—the lack of a genuine need to rush to the hospital and/or induction in the absence of any concerning signs.

If instead your assessment has uncovered areas of concern, then it is best to consult with your caregiver about how best to proceed, make your decisions based on their guidance and continuing to request non-invasive options including vaginal birth as your first choice.

It is your preference— your choice should be dictated by what gives you the most peace of mind—your best option for keeping both yourself and your baby healthy— that very well may mean for you, being in the hospital and choosing immediate induction—or equally it may mean that you feel at peace with waiting— or at least you strike a compromise utilizing the guidelines in this post. This all will be covered in more depth later, as well.