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What causes natural PROM  

post #1 of 27
10/31/07 at 11:58am
Thread Starter 
In reading these threads, I notice alot of talk about PROM. Is there somethign that causes it, (Short of a manual exam that went awry)? Stress maybe? I know it's often seen as something to avoid happening, but I guess I'm a little unclear as to why/how it happens. Does it happen a majority of the time due to exams/something inserted?
post #2 of 27
10/31/07 at 12:48pm
When it is explainable (isn't always) it is usually something like polyhydramnios (too much fluid) or an infection (such as bacterial vaginosis).

Most of the time it doesn't have any connection to exams or insertion but an underlying problem.
post #3 of 27
10/31/07 at 12:53pm
Well, there are theories out there...they mostly involve things which assume that rupture of membranes in absense of contrax is a problem of some sort--like underlying infection.

but really, I don't think anyone really knows WHY some women start labor with rupture of membranes rather than with contrax.

Just to be clear--PROM means in medicalese 'premature rupture of membranes' and I find this offensive. It is assuming that when labor starts with ROM, instead of with contrax, the ROM was premature, too early, not in a good timing for mom/baby. And this is just not the case! As a mw, when I have a mom who starts labor at term with her water breaking, I just call it ROM, or SROM (spontaneous rupture), NOT PROM. While it is not the most common way for labor to start, it is certainly not unusual; and I had 2 of 6 labors start with SROM and proceed just fine as most labors do however they start. Only rarely have I seen labor start with SROM and then fail to bring contrax within 24-48hrs (usually far quicker).

P-PROM is 'preterm premature rupture of membranes' which to me sounds a bit repetitive. Preterm rupture of membranes, to me, is the only ROM that might accurately be called 'premature' (say, before 36wks or so).
post #4 of 27
10/31/07 at 1:27pm
good point, MsBlack! I've always used PROM to mean prolonged rupture - but even then, why is it prolonged? Like it's not 'normal' ....

There are a few things that COULD contribute to SROM prior to contractions - but they're not things that WILL cause it.

Sometimes when baby's head isn't well applied to the cervix (when baby is posterior or asynclitic or even some breeches), the increased strength of the braxton hicks contractions can create a nice bulge of water in front of the presenting part and the pressure with increased contractions could cause it to break. (There is also the theory that this bulging forewater has more strain on it than the rest of the bag, not sure if that's the case)

Sometimes an increased colonization of bacteria can decrease the bag's integrity.

Some women who smoke or have very poor nutrition can have membranes that release early.

I think that there is a reason for everything - and nearly all of those reasons we are not privvy to.

SROM is only an issue when fingers travel where they're not supposed to!
post #5 of 27
10/31/07 at 2:20pm
Thread Starter 
Thank you! There are so many little subtelties still to learn!
post #6 of 27
10/31/07 at 2:43pm
Quote:
Originally Posted by pamamidwife View Post
Sometimes when baby's head isn't well applied to the cervix (when baby is posterior or asynclitic or even some breeches), the increased strength of the braxton hicks contractions can create a nice bulge of water in front of the presenting part and the pressure with increased contractions could cause it to break. (There is also the theory that this bulging forewater has more strain on it than the rest of the bag, not sure if that's the case)
That's interesting. Both my labours started with SROM, both of the "slow trickle" variety. #1 contrax started in about an hour, #2 it was 10 hours before labour. #1 was posterior until 2 days before labour; then in late labour my MW broke my hindwaters because she felt he wasn't rotating down all the way due to waters (would this be considered malpositioning or just something that would have happened anyway without interference?). #2 was frank breech.
post #7 of 27
10/31/07 at 2:55pm
Quote:
Originally Posted by MsBlack View Post
Well, there are theories out there...they mostly involve things which assume that rupture of membranes in absense of contrax is a problem of some sort--like underlying infection.

but really, I don't think anyone really knows WHY some women start labor with rupture of membranes rather than with contrax.

Just to be clear--PROM means in medicalese 'premature rupture of membranes' and I find this offensive. It is assuming that when labor starts with ROM, instead of with contrax, the ROM was premature, too early, not in a good timing for mom/baby. And this is just not the case! As a mw, when I have a mom who starts labor at term with her water breaking, I just call it ROM, or SROM (spontaneous rupture), NOT PROM. While it is not the most common way for labor to start, it is certainly not unusual; and I had 2 of 6 labors start with SROM and proceed just fine as most labors do however they start. Only rarely have I seen labor start with SROM and then fail to bring contrax within 24-48hrs (usually far quicker).

P-PROM is 'preterm premature rupture of membranes' which to me sounds a bit repetitive. Preterm rupture of membranes, to me, is the only ROM that might accurately be called 'premature' (say, before 36wks or so).
But your definition doesn't allow for ROM that doesn't proceed with labor. I had PROM - and yes, I consider it PROM - where my membranes ruptured and for several days nothing happened until I induced with black/blue cohosh. While I realize that the induction was debatable as to whether it was a good idea, I fully believe my experience involved premature rupture of membranes. If they were meant to rupture then, labor would have started.

I believe the PROM was caused by a VE earlier in the day, but one or more posters on this board have vehemently disagreed, saying that if it was the VE then the rupture would have happened right then. I don't have a satisfactory explanation for that, just some vague ideas of the VE weakening some part of the membrane until a few hours later I moved in just the right (or wrong) position, and kersplash. Given that labor did not ensue, and that I was only 39 weeks and first-timer, it seems early and premature (though certainly not preterm).
post #8 of 27
10/31/07 at 2:56pm
Interesting... My water broke at 39 weeks, then labor started right away. My son was breech too, but I was more inclined to blame the rupture and early-ish labor (I was born at 42 weeks) on the stomach bug I got the week before. I spent a night throwing up, and the next day had contractions 3 minutes apart, but they went away. I always figured that could have weakened the membranes.
post #9 of 27
10/31/07 at 4:39pm
Quote:
Originally Posted by MsBlack View Post
Just to be clear--PROM means in medicalese 'premature rupture of membranes' and I find this offensive. It is assuming that when labor starts with ROM, instead of with contrax, the ROM was premature, too early, not in a good timing for mom/baby. And this is just not the case!
Why on earth do you find it offensive? Everyone tells me contractions with intacts waters are easier than dry ones, for a start. And even when the baby is past it's EDD, it may still not be ready to be born.

In fact, I'd take labour not starting when waters are broken as a positive sign that is was too early, and the baby's not ready. If the baby was ready, wouldn't labour start? And, if the baby's not ready, doesn't the waters breaking sometimes precipitate labour?

In an ideal world I'd have everyone's waters go as they're pushing.
post #10 of 27
10/31/07 at 5:40pm
I dunno. I had fast & easy labours with broken membranes, both times. I'm a hynomama though - I didn't actively use it during labour but I'm sure the suggestions were there so maybe that's why I didn't find it a big deal? I have no idea what labour with intact membranes would be like for me, but for me leaking throughout labour was a mess issue, not a pain issue.
post #11 of 27
10/31/07 at 5:56pm
Quote:
Originally Posted by Robinna View Post
I dunno. I had fast & easy labours with broken membranes, both times. I'm a hynomama though - I didn't actively use it during labour but I'm sure the suggestions were there so maybe that's why I didn't find it a big deal? I have no idea what labour with intact membranes would be like for me, but for me leaking throughout labour was a mess issue, not a pain issue.
I don't think I've ever heard any theories that early (not necessarily premature) ROM would increase the pain of labor (contractions) for the mama.

It can sometimes cause the baby to drop into a less-than ideal position. In that case I imagine it would be more painful for both baby and mama.

And even when the baby drops in a good position, I would imagine it's more painful for the baby to experience labor with early ROM. But all that's my assmptions, and not based on studies or anything like that.
post #12 of 27
10/31/07 at 9:06pm
My water broke ahead of labor with my second child. I seriously doubt anything was "wrong." I was healthy. I didn't have any infections. I hadn't had a vaginal exam. Actually I "knew" ahead of time it was going to happen. I was wearing a pad "just in case" (first time I'd ever done that), and I was 17 days early! My water broke at 1:30am, labor started at 1:55am, and my son was born at 7:13am. He was perfectly healthy.
post #13 of 27
11/1/07 at 1:00am
I don't know. I ate well, had no infection, no VEs either. She was posterior every now and then, if she was at 4am that night, no idea.

She was born 3 days later.
post #14 of 27
11/1/07 at 1:23am
Ok, I'll add my data point...

I'd say that, even though I was 40+2 when my membrane ruptured, it was premature. My husband somewhat blames us getting busy before going to bed that night. ;-) Yes, we were trying the, er, application of natural male prostaglandin method of induction.

At any rate, a couple hours later, I woke up. I had the impression that what woke me was a "pop" that was more felt than heard. Being 40+2, and having been asleep for two hours, I headed straight to the bathroom, where there was LOT more than just pee. ;-) There was heavy meconium in the fluid, but no smell.

18 hours and a cervadil tab later, no contractions that I could feel. Finally induced with Pitocin.

18 hours after *that* and my body still wasn't playing along. Got an epidural so they could crank up the Pit without consulting with me every single time.

12 hours later finally had a c-section, after "secondary uterine inertia" set in.

No, my body wasn't ready to go into labor, which implies that neither was my baby. Oh, he was fine the whole time, by the way... there was *one* dip in his heart rate right after admission, but from then on he was juuuust fiiiine. It was me they were fussing over. ;-) GBS+, BP a tic above the magic numbers, and then there's the meconium... but after an hour or so, the fluid was running clear and stayed clear the rest of the time. Maybe he was just cleaning up a bit!

Never any sign of infection. Was getting the abx for the GBS, though, so who knows... but like I said, no smell when I started leaking, either, and the waters were clear aside from the meconium. I've never smoked, had perfect weight gain, no particular physical stress leading up to the event, yadda yadda. I have *no* idea why this happened, and boy would I LOVE to find out!

This time, if my water breaks, I'm staying the F home until I'm in active labor, unless my temp starts going up or something smells or feels wrong. (Well, "home" may be a hotel room nearer by the hospital, since it's clear across town and that can be 90 minutes at the wrong time of day.)
post #15 of 27
11/1/07 at 3:48am
Laohaire, on the day that my waters broke with Rowan my cervix had taken repeated blows (sexual assault.) At the same time, it wasn't until I changed position that I felt the waters break, and in that instance her cord prolapsed. The police were involved, and there were medical experts who were prepared to take the witness stand and say that yes, in their opinion the assault caused the ROM.

ETA: I'm one of those people who has theories that labours that start with ROM are more likely to end with a mama with a c-section, based on anecdotal evidence. Our local hospital has recently stopped treating hindwater leaks as high risk, though, so hopefully those figures will change.

Ms Black, 36 weeks is 6 weeks early for some women. How can that not be premature? I'm curious.
post #16 of 27
11/1/07 at 9:47am
Quote:
Originally Posted by flapjack View Post
Laohaire, on the day that my waters broke with Rowan my cervix had taken repeated blows (sexual assault.) At the same time, it wasn't until I changed position that I felt the waters break, and in that instance her cord prolapsed. The police were involved, and there were medical experts who were prepared to take the witness stand and say that yes, in their opinion the assault caused the ROM.


I'm so sorry, what a shocking experience.

I'm so sorry you and baby had to go through that.
post #17 of 27
11/1/07 at 10:18am
Ok--

What I find 'offensive' is to apply the term 'premature rupture' to every case in which waters breaking is the first sign of labor. I would say that only *after* the birth can one see whether that rupture was 'premature' or 'perfectly timed for this pair'. If waters break, and labor follows within some hours or days (variable) without interference or problems (such as infection), then I don't think it can be called 'premature'. It's just the way that mama and baby worked things out, it's NORMAL for them. If labor does not ensue naturally, then I suppose the ROM could be called 'premature', at least if you assume that the baby really wasn't ready.

That said, anyone whose water breaks upon pre-labor VE, or in the hours following VE, is probably someone who did not suffer 'premature rupture', but ARTIFICIAL rupture. I pretty much consider ALL AROM to be premature rupture..unless maybe that AROM happens once baby's head is out (for babies born in the caul) .

I find numerous pregnancy medical terms 'offensive', because they are based on the 'pregnancy as pathology or impending pathology' viewpoint. Such terms do not reflect trust in, respect for, or appropriate and adequate knowledge of the normal, healthy processes of pregnancy and birth and the enormous variation of normal. 'Prematurity' is necessarily and by definition a term that implies pathology ('not-ready'; wrongness, sickness). I feel the same way about what is called 'physiologic anemia of pregnancy'--sure, the term 'physiologic' (normal physiology) is applied, but 'anemia' means insufficient red blood cells. These words play with our heads, they subtly direct our feelings and thoughts and so, our choices and experiences. They also (and sometimes even more importantly) influence caregivers' feelings and actions--fear and fearful watchfulness is instigated by such terms, and this in turn does influence their suggestions, actions, etc. Because women take on more fluid into their blood normally during pregnancy, the blood is more diluted than non-pregnant--the numbers *look* lower even though she still has a normal amount of cells and hemoglobin--this is NOT any form of anemia at all! Why call it 'anemia' if it's normal? It comes from the pathology-oriented viewpoint, and the viewpoint that women's bodies are necessarily problematic, imperfect, 'not-male'.

So, yes, I find offensive the term 'premature rupture of membranes', as applied to any woman who begins labor w/water breaking spontaneously. It is a sexist term at base--assuming that women's bodies are flawed; it is a disrespectful term, not recognizing the wisdom of the body and speaking of man's belief that he/we know how birth should 'best' happen.

And to my knowledge there is no evidence that early ROM makes for more painful labors --for mom OR baby--than later ROM. This is one of the popular myths, I think 'oh no, she had a DRY birth!' as if such a thing were even really possible....even with very low amniotic fluid, well birth is a pretty wet event and the vagina is a pretty wet place! (whenever I hear the term 'dry birth', I always imagine a baby emerging all scraped-up as with serious rug burns... )

Finally--yes, it is true that a 36wk ROM *might* be 6wks premature for a given baby. While realizing that many factors can play a part in this, so, not meaning to overgeneralize, still--IF the baby is truly not ready and IF the mother is able to get 'enough' (food, drink, rest, love/support), waters can and do reseal. Or, waters can leak so slowly/minimally that the leak really doesn't pose a problem to amniotic fluid levels (because mom's body is always making more, anyway, even w/bag intact)--and pregnancy can carry on. What enters into things, that tend to define this experience, are all external factors: for most women, there is the caregiver danger--if your HCP gets panicky and insists that baby MUST come out by any means possible within 24 hrs (or whathaveyou), then you won't have the chance to find out if the leak would have resealed. A UC mama, or one with a more natural-oriented HCP, might just wait it out and provide supportive measures to help resealing happen. If you were assaulted, or were in a car wreck, and that caused ROM, then you may be too emotionally traumatized and/or physically injured for you to continue a healthy pregnancy. And so forth...too often, it is these external factors--and MOST often it is the HCP-factor--that end up defining a woman's birth experience and she doesn't even know it. If you had a ROM at 36wks that resulted in induction and an early baby because your HCP insisted on it...you might *believe* it was a 'premature' rupture and something that needed to be 'helped', when perhaps things could have gone differently...the event of early ROM itself did not define things, the *people* actively interfered to shape events and define them-- with their chosen and prejudiced beliefs, words and actions.

Basically, before I will call this 'premature' rupture of membranes, I'd have to know the whole story...I simply won't use the term for all women who have spontaneous rupture as first sign of labor and do think it is a mistake to do so.

And I do think words/terms matter....very very much!
post #18 of 27
11/1/07 at 10:22am
One last---

It is very likely that labors which begin with ROM will end in csec...IF you planning a hospital birth, or if your homebirth provider has a medicalized approach to pregnancy and birth.

I have not seen this in my hb practice, however! Never have had a csec occur for prolonged rupture.
post #19 of 27
11/1/07 at 11:22am
I had SROM with both of my previous pg's. 1st pg broke with a pop around 6:30 a.m. when I rolled over in bed. I did take herbs to help induce ctx b/c I didn't want to go "over" the midwives time limit and have to have abx due to "prolonged" rupture. DD was born just before 11 p.m. (which was "IV time").

My 2nd pg they broke with a gush...more like a flood...as I was lying in bed. It was around 9:30 p.m. and he was born at 4 a.m. with no augmentation of labor.

I'm thinking odds are I'll labor intact this time, which makes me worry I won't recognize labor. I didn't think labor with waters broken was terrible, but then I have nothing to compare it to.

Christa
post #20 of 27
11/1/07 at 11:29am
Quote:
Originally Posted by wannabe View Post

In fact, I'd take labour not starting when waters are broken as a positive sign that is was too early, and the baby's not ready. If the baby was ready, wouldn't labour start? And, if the baby's not ready, doesn't the waters breaking sometimes precipitate labour?
My waters broke when I was 41w, and I didn't have ctx for nearly 48h. Baby was ready, she was 8lbs 7oz.
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