"What Should I Do If My Water Breaks Before Labor?"

First of all, in the words of one of my favorite authors Douglas Adams,

Don't Panic!

Okay, so what next? There are a few things to think about before rushing to the hospital or to call your doctor. While most women experience their water breaking on it's own during active labor, about 20% of women will experience their water breaking before labor really begins. It's best to be informed of your options and the risks and benefits of waiting for labor to begin on it's own, just-in-case you are one of the 20%! Your water breaking DOESN'T necessarily mean that labor has begun. If your doctor wants to admit you to the hospital before labor is established, you are at a higher risk of complications associated with inductions- higher use of epidural anesthesia, fetal distress, and cesarean, among others. Inducing labor should not be taken lightly, especially if you are a first-time mother.

Please know that you do have options in your care even if your water is broken before labor. Research has shown that it is SAFE and not more risky than induction to wait as long as 72 hours between water breaking and contractions, as long as there are no signs of an infection. 95% of women will go into labor within 24 hours of rupture of membranes, so you have plenty of time!

"But my hospital or OB says that I only have 12 hours to go into labor! WHY?"

I can't really speak for them, but this Cochrane review of the available studies indicates that although more babies were admitted to the NICU when labor was allowed to start (expectant management) vs. induction, there were NO higher rates of infection for babies. So some babies were admitted most likely because membranes had been ruptured for longer than "normal". My feeling about this hospital policy is that it has simply become easier for doctors to admit a mother to the hospital and to induce labor rather than wait for contractions to start on their own. It's also probably tempting from a provider standpoint to do something rather than reassure an anxious pregnant woman that she can relax.

Many hospitals insist on induction within 12 hours of your water breaking, but you have the option of waiting for regular contractions.

So what should you do? Take your temperature every 4 hours or so just to make sure that you're not getting an infection. Think positive thoughts. Relax. Take a shower. Connect with your baby and your body.

What should you not do? Don't put anything in the vagina! That means no sex for stimulating labor, although you might try nipple stimulation if you're so inclined. Also, cervical checks should be kept to an absolute minimum, even (especially)  in the hospital. The factor that increases the risk of infection for you and your baby is lots of vaginal exams due to introduction of bacteria into the birth canal, and you are well within your rights to refuse them if you wish.

What is the bottom line?

You can safely exercise the option to WAIT for regular contractions to begin before heading to the hospital.

You have a 95% chance or so of going into labor within 24 hours, but up to 72 hours has been studied and not risky.

Do think positive thoughts, relax, and enjoy these final moments with your baby. You'll never get them back!

Most of all, Don't Panic!!

For an even more detailed discussion of this topic, see Midwife Thinking's Blog here.