Not long ago, a student returned to postnatal yoga after giving birth to her first child. I love seeing parents returning with their yummy new babies and hearing about their birth experiences. This one parent, upon telling me her birth story, laughed slightly and said, “I was the poster child for the ‘cascade of interventions.’” I paused and asked why. The story unfolded something like this:
Navigation
- The cascade of interventions
- Perception of birth experiences
- Understanding Premature Rupture of Membranes (PROM)
- What happens if you don’t get induced right away?
- The relationship between vaginal exams and PROM
- Are routine vaginal exams linked to PROM?
- Conclusion
- FAQs
The Cascade of Interventions
It was a few days before her due date, and she suspected that her water had broken. She called her doctor and was instructed to come to the hospital to be checked since her doctor was on call there at the time. It turns out that yes, her membranes had ruptured. It was a slow leak, not a big gush. The parent wasn’t feeling contractions yet, just mild cramping. So her doctor admitted her and started her on a small amount of pitocin (artificial oxytocin).
Slowly, after increasing the dosage over a 12-hour period, the student grew tired and very uncomfortable coping with the waves of strong contractions and opted for an epidural. This allowed her to rest and relax for a bit. Labor continued to move slowly, and after another 8 hours, her cervix stubbornly stayed at 7 cm. The doctor declared she was a “failure to progress” and delivered her baby via cesarean.
The student seemed somewhat disappointed but resigned that there was nothing that could have changed this outcome, and this was best for her and her baby.
Perception of Birth Experiences
After a birth—especially one that carries some disappointment—it may not be helpful to dwell on what could have been done differently. My goal is to provide you with tools and insights for decision-making in similar situations, rather than promoting feelings of self-doubt. Many birth stories, like the one above, often carry a tinge of disappointment that things did not go as planned.
Understanding Premature Rupture of Membranes (PROM)
There are several ways in which ruptured membranes before labor is managed. Some care providers opt for active management, inducing labor soon after PROM occurs, while others prefer expectant management, waiting to see if labor begins naturally. It’s important to understand how your care provider handles PROM and whether there’s any flexibility in their approach.
What to Remember About PROM:
- Only 8-10% of expectant parents experience their water breaking before labor begins. (source)
- If this happens, check the color and odor of the amniotic fluid. Ideally, it should be clear and slightly yellowish.
- A strong odor or greenish-black fluid could indicate meconium, a sign of fetal distress, which may require immediate medical attention.
If you’re unsure whether your water has broken, your care provider can confirm this with a nitrazine paper test.
Key Advice:
- If your care provider is comfortable with you staying at home longer after PROM, remember that nothing should enter the vagina to avoid introducing bacteria.
- During labor, minimize vaginal exams to further reduce the risk of infection, which is heightened after membranes rupture.
For a more comprehensive view of what to do when your water breaks, I highly recommend you read the blog post: Everything you want to know about your water breaking!
We also recommend that you listen to our podcast episode Everything You Need To Know About Being Induced With Trish Ware which we aired on Yoga|Birth|Babies, the Prenatal Yoga Center’s very own podcast!
What Happens If You Don’t Get Induced Right Away?
According to Rebecca Dekker from Evidence Based Birth, here’s what research reveals about the timeline for labor onset after PROM:
- 45% of birthing people will go into labor within 12 hours (Shalev et al., 1995; Zlatnik, 1992).
- 77% to 95% of birthing people will go into labor within 24 hours (Conway et al., 1984; Pintucci et al., 2014; Zlatnik, 1992).
- In one study, 83% of birthing people went into labor on their own within 72 hours and had a normal vaginal birth (Shalev et al., 1995).
However, management will depend on the health of both parent and baby. If there are signs of infection or umbilical cord compression, medical intervention is likely necessary.
The Relationship Between Vaginal Exams and PROM
The story that sparked this discussion involved interventions before labor even began—due in part to routine vaginal exams starting at 37 weeks. This practice often leads to mixed results and can be emotionally misleading. Some expectant parents might feel hopeful upon hearing of cervical changes, only to wait for weeks without progress, while others may feel discouraged when no progress is detected.
Back when I was pregnant, I asked my own care provider, Dr. Harry Lee, if he was going to do a vaginal exam. I was ready for a bit of a fight to oppose the exam. Instead he just said, “I don’t routinely do a vaginal exam until 40 weeks if there are no signs of labor. Most patients want to know when they will go into labor and the exam gives no such information. And it’s uncomfortable. I was taught to do them routinely starting at 36 weeks but stopped a long time ago. I got tired of shrugging my shoulders when patients asked what their exam meant.” I really appreciated his honesty and his willingness to change the practices he was taught when he was a young doctor.
Are Routine Vaginal Exams Linked to PROM?
Two major studies often cited on this topic reached conflicting conclusions.
- The McDuffie Study concluded that there wasn’t a significantly higher rate of PROM in women who underwent routine vaginal exams starting at 37 weeks (PubMed Study on PROM).
- The Lenihan Study found that birthing parents who received weekly vaginal exams from 37 weeks had a higher incidence of PROM (18%) compared to those who did not receive exams (6%) source.
Given these mixed results, it’s essential for pregnant people to weigh the risks and benefits of routine exams and discuss with their care providers how evidence-based practices can be incorporated into their care.
Conclusion
It’s incredibly helpful to have a conversation with your care provider ahead of time to understand their expectation of labor progression should your water break ahead of the onset of labor. By gathering information and discussing options with your healthcare provider, you can approach birth with confidence, knowing that you are making choices aligned with your comfort zone and the best evidence available.
At the Prenatal Yoga Center, we hold both in-person and online classes for expectant and postpartum folks. To view our list of classes for Prenatal and Postnatal Yoga click the button below.
FAQs
What can’t I do if my water breaks?
When your water breaks, the risk of infection becomes greater. As such, it is important not to let anything enter your vagina and to decrease the number of vaginal exams to as few as possible. This means that when your water breaks, you should not have sex and use any sex toys.
What should I look out for if my water breaks?
It is important to notify your care provider if your waters have a strange or unpleasant odor, has a dark color or if there is any bright red blood. The amniotic fluid should have a clearish or yellowish color with maybe some brown or blood specks. It should also have no odor.
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