Membrane release before birth sensations begin, what to do?

Spontaneous release of Membranes (SROM)

Spontaneous release of Membranes (SROM)

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.wateroncarpet

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
Quote used with permission: “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 end of quote

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.

27 thoughts on “Membrane release before birth sensations begin, what to do?

  1. Gloria,

    I’m curious as to why no bathing, when water-birth is a perfectly valid option. Is it just to be “on the safe side”? Also, do the recommendations change when there is known GBS+ status?

    And here’s a freebie for you — how to insert a link so that clicking on it will take you to the webpage. It’s a bit tricky to tell you how to do it, because if I just copy and paste the correct html, then it will convert it to a link when you see it. 🙂

    All html goes inside the less than / greater than signs , so the first thing is ”

    Then you type the phrase that you want to be the actual link you want to be in blue and underlined (typically something like “click here”), and follow that up by closing the html (take out all the spaces).

    Here’s how the tinyurl link above would look embedded:

    There’s a truly inspiring video of Teresa’s VBA3C birth.

    It’s complicated to explain, but once you get used to it, easy to do. I’ll embed my blog by linking my name in the signature — you may be able to see the exact html text by editing my comment, which will make it a lot clearer.


  2. Kathy, thanks so much. It’s actually easy for me to imbed links because it’s automatic on wordpress but I disabled the rich text feature and then forgot to turn it back on –Duh.

    re the showers only. You’re right, water doesn’t go up the vagina unless you purposely hold your labia open so (really) tub baths are not a problem. We discourage tub bathing as an “over zealous” precaution and also so that, if there is a transport to hosp, the mother can truthfully say she hasn’t been sitting in a bath. The woman that I had with 6 weeks of released membranes had a waterbirth. G

  3. I had SROM for five days prior to the birth of my HBAC daughter. The midwife advised the same precautions, but I chose to have a few baths in a tub scrubbed clean with baking soda and vinegar, and kept track of my temperature. I was surprised to learn that we could confirm that it was amnoitic fluid by smearing it on a slide and checking for a ferning pattern!

  4. i had SROM at 34 and 1 – unfortunately i was in the hospital with my daughter so i was admitted and monitored for almost 2 weeks before she came. they wanted to induce me several times for no reason other than i had broken water but i refused. all they did was check my temp, bp and used a doppler (not my first choice) several times a day and had a few U/S to check the fluid levels (also not my first choice). it’s totally possible to be in hospital with SROM, you just have to advocate for yourself and baby.

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  6. Wish I had read/known how long you can wait before having my first babe. She was born about 6 months before this post actually! Midwives transferred me to hospital at 30+ hours of released membranes with no labor…pitocin. Drives me nuts now but what’s done is done. Now I get to help educate others.

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  10. My membrane ruptured on the dot of 39 weeks and I had no contractions for 28 hours. They began then at six minutes apart and were never closer than about three minutes apart right up until my son was born another 38 hours later. It was at home in a pool. I was also GBS positive but refused antibiotics and all was fine. My temp and heart rate (and baby’s too) were totally normal the whole time. I had no VEs (my midwife suggested this). I never planned for the possibility of this happening and then having to wait so long for the contractions but apparently this is exactly what happened at my own birth too! Perhaps these things are hereditary… Either way, I am so glad I stayed home!

    • So glad your experience with GBS+ was a positive one! I had a similar story… water breaking, labor taking forever to start… but the infection to baby was so bad we almost lost him. Scariest 10 minutes of my life post-birth. And then another week in the NICU. If this happens again for us, I’m going to go straight in and get the antibiotics started.

      I don’t want to add fear for anyone, but it’s not something to mess around with. Adding comment in case others are reading through and wondering what to do in the face of GBS+ and waters breaking. I’m hoping scenarios are more like the one above!

      • Hi Leah, your comment brings up some good points. First, if the pregnant woman has been for membrane stripping because of being near or over her due date, this can lead to infection. The woman should be advised about that and it is not easy to have confidence in temperature changes and other signs when this has been done. Secondly, what you are suggesting, “go in and get the antibiotics started”, is no longer the recommended practice. There is a big concern with giving unnecessary antibiotics because of antibiotic resistant strains of bacteria. To see the latest recommendations on antibiotic use in pregnant women who are positive for Group B Strep, see this post.

  11. Thankyou for this message about the six week leak! I felt totally disempowered by the expectation to have IV antibiotics ( and no home labour as a result). I missed out on the vaginal birth I so dearly want as the cascade of interventions built up. I wondered what would happen if I just managed the soaking and went on with life until contractions and dilation. I am so glad you are here in this area working with women and helping Babies before during and after birth!

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  16. Can you comment on GBS+ with PROM? This seems to often lead to induction, even when a client is with a midwife, whether a hospital-based midwife, or a homebirth midwife. This has led to traumatic births or cesarean section for several of my clients. (I am a CBE with Informed Beginnings and also a doula.)

    • Hi Tara, Clinical assessments must be taken into account when determining the wisest route to take with any birth. For example, a non-smoker with an excellent diet should not be given the same recommendation as a pack-a-day smoker with a “small for dates” baby. I agree that it’s a crying shame when all women are lumped into protocols and frightened into induction. Induction is very aggressive and should only be undertaken when absolutely necessary. Many doulas work with their clients to improve their diets prenatally and, then, give tips on how to avoid a GBS positive diagnosis. If the membranes release, the woman needs to be informed that medical caregivers must protect their licenses first.

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