Often there is no differentiation between ROM and hindwater leaks which easily reseal either. I've had 2 hindwater leaks with 2 babies, the second one a week and a half before birth and 8 days before that labour commenced. I know in the hospy system I'd have had trouble if I'd owned up to that. My membranes only released about 2 hours before my second babe was born after 50+ hours of labour. So I have quite an interest in this stuff
This is what I give women to help them decide for themselves what steps to take in the event of ROM or HWL.
A hindwater leak occurs when only a small amount of fluid is released. There can be many reasons for this occurring rather than a full ROM. You'd be surprised how much liquor can be released in a hindwater leak and thus how easy it can be to confuse it with a full ROM.
Obviously, the risk of infection will be higher when there is a large opening in the amniotic sac directly over the cervix, and the risk of infection will be almost negligible when the fluid is leaking from a high leak in the hindwaters. Bacteria would have to be awfully clever to find their way against a tide of outflowing fluid to find a small opening high in the amniotic sac.
Some ways to tell that the fluid is coming from a high leak in the hindwaters:
Belly still feels full of fluid, and baby's body isn't clearly outlined in the belly
Without touching the cervix, do a vaginal exam with sterile gloves to palpate the lower uterine segment directly inside the vagina. If the baby is easily ballotable, meaning it kind of floats up a bit, then there's still fluid in the belly, and the leak isn't over the cervix.
There are two layers of membranes - the outer sac (the chorion), and the inner sac (the amnion); it is possible for the outer sac to break while the inner sac remains intact; this can still release some fluid that might have accumulated between the layers. This would tend to be a small amount of fluid, and generally there is not a continuing trickle.
It is possible for baby to poke a hole through the membranes at some point. Then, as fluid is released, the sac may double over on itself at that point and, like Glad Wrap, stick to itself, forming a seal over the leak. Again, this would tend to be a small amount of fluid, and generally there is not a continuing trickle.
There is no inherent benefit either way. Some women find drippy labours irritating after ROM, some women's membranes do not rupture until crowning, some never do and the baby is born "in the caul". If you're birthing in a hospital, regardless of how much fluid has left the building, stay home until contractions are strong and close together or you'll be on a timetable and pressured to induce. You will be told that you are at risk of infection.
NICE guidelines from the UK state that women can go up to 96 hours without being induced. The likelihood of infection is significantly reduced if you put nothing in your vagina (this includes VEs which are a major way germs are spread) and stay home in your own friendly germ environment as long as possible.
5.5 Induction of Labour in the presence of Prelabour Rupture of the Membranes (page 2
5.5.1 ....Epidemiological data on time interval from term PROM to spontaneous labour demonstrates that most women go into spontaneous labour within 24 hours of rupturing their membranes.
86% of women will labour within 12-23 hours
91% will labour within 24-47 hours
94% will labour within 48-95 hours
6% of women will not be in spontaneous labour witthin 96 hours of PROM.
USA Midwife Archives page on Prelabour Rupture Of Membranes:
NICE/RCOG guidelines on induction of labour (short form)
NICE/ RCOG evidence- based full clinical guideline on induction of labour
Premature Rupture of Membranes (PROM) By Elizabeth Bruce, on the Compleat Mother site. Discusses both prelabour and preterm rupture of membranes.
Preterm Prelabour Rupture of Membranes, from the Dartmouth Hitchcock Medical Center - Straightforward factsheet.
PROM guidelines from MoonDragon Midwifery Practice
Midwifery Today e-news on premature (ie prelabour) rupture of membranes