1. Drink plenty of fluids. Minimum: 8 glasses spaced throughout the day. Purified water with lemon squeezed in it is good.
2. Allow nothing in vagina. No fingers, no tampons, no oral-genital contact, no bath water, no swimming pool water, no speculum, no penis, nothing whatsoever!
3. Wear something loose-fitting with no panties.
4. If you are leaking and need something for sitting, use clean towels fresh out of a hot dryer.
5. Take your temperature every 4 hours while you are awake. Normal range is 35.5 to 37.3 Degrees Centigrade or 96 to 99 Degrees Fahrenheit. If it goes above the upper ranges, drink some water, retake it and if your temperature remains up call your medical person. It could be a sign of infection.
6. Take 250mg Vitamin C every 3 hours while you are awake. Oranges, grapefruit, kiwi fruit, red peppers are all good sources.
7. No baths. Shower as much as you like.
8. Eat foods that are non-constipating and easy to digest. Especially avoid foods with MSG or nitrates, such as pizza, Chinese food, or deli meats. These foods can make you vomit in the birth process.
9. Be meticulous about toileting. Wipe from front to back, and wash hands carefully after.
l0. If the water is colored green or brown (meconium), or if it has a bad smell (sign of infection), let your medical person know.
If you want to know your baby is doing well, check the baby’s heart rate- have someone put his or her ear against your lower belly or listen through a toilet paper roll. The fetal heart rate should be 140-160 beats a minute. And to monitor the fetal movements in a day, start at 9 a.m. and count each time the baby kicks until 3 p.m. There should be l0 distinct movements (the Cardiff fetal movement test). Contact your medical person if you get less than 10 movements, or if you’re having problems assessing the fetal heart rate.
Question to Gloria: “How long can I go after my waters have broken before birth?”
“There is always more fluid being released to replace the amniotic waters. I once had a client with released membranes and water gushing out for 6 weeks. She gave birth on her due date to a healthy 7 1/2 pound girl. If the temperature of the Mom is normal and she is using the precautions above, there is no reason to treat the mother/baby any differently than if the membranes are intact. The woman usually wants to drink extra fluids and should be encouraged to salt her food liberally.”
Mary’s Expectant Management of SROM
“How do I ‘manage’ SROM [spontaneous rupture of the membranes- waters breaking] prelabour at term at home? If expectant [“wait and see”] management is chosen by the mother, I do NOTHING, no vaginal exams, and await events asking the woman to monitor her Temperature AND PULSE. I am perhaps a little obsessive about maternal pulses, but in my experience a rising pulse rate can often precede a rise in temp. If no signs of labour after 24 hours I would do a full blood count and C reactive protein and repeat this every 2 days. I would advise avoiding penetrative sex, and suggest showering rather than bathing.
“I have a current client whose membranes ruptured spontaneously with a twin pregnancy at 28 weeks; she, with truly amazing strength and fortitude, coped with leaking liquor [water] until labour started spontaneously at 35 weeks.” -Mary Cronk, Independent Midwife, United Kingdom
There’s a truly inspiring video of Teresa’s VBA3C birth. She gave birth after 10 days of released membranes.
By the way, I learned to call it “released membranes” rather than “broken waters” from my friend, Nancy Wainer. Nancy says there’s nothing broken about birth. The vast majority of women who release their membranes spontaneously will give birth within 24 hours, another large percentage will give birth within 48 hours, but there are always a few women who will go for a long time with released membranes (why do they always seem to be my clients?). It seems that the amniotic fluid has some prostaglandins in it that help to soften and ripen the cervix so the births tend to go smoothly once they begin.
Update November 2014: Wojcieszek AM, Stock OM, Flenady V. Antibiotics for prelabour rupture of membranes at or near term. Cochrane Database Syst Rev. 2014 Oct 29;10:CD001807. doi: 10.1002/14651858.CD001807.pub2. (Review) PMID: 25352443
AUTHORS’ CONCLUSIONS: This updated review demonstrates no convincing evidence of benefit for mothers or neonates from the routine use of antibiotics for PROM at or near term. We are unable to adequately assess the risk of short- and long-term harms from the use of antibiotics due to the unavailability of data. Given the unmeasured potential adverse effects of antibiotic use, the potential for the development of resistant organisms, and the low risk of maternal infection in the control group, the routine use of antibiotics for PROM at or near term in the absence of confirmed maternal infection should be avoided.