Prolonged rupture of membranes

10 percent of all births start with the breaking of the membranes. Most of the time (60%) the contractions will start within 24 hours. Sometimes (40%) it takes longer. If your contractions do not start within 24 hours after the breaking of the membranes the care for your birth is, by protocol, transferred to the hospital. You then have a medical indication for the birth because of the slightly higher chance of getting an infection. If the first vaginal exam is done after the contractions have started this chance will be 2%.

Tips to keep the chance of an infection to a minimum:

- Don’t take a bath
- Only use sanitary towels and NO tampons
- Don’t have sex
- Take your temperature rectally every 4-6 hours. If the temperature gets above 37,7 degrees, call us immediately.

What happens in the hospital?

If you don’t get regular contractions within 24 hours after the breaking of the water we will contact the hospital of your choice to make an appointment for you. That same day you will go to the hospital for a check-up. A non-stress-test (CTG) will be done and they will take a culture from the skin between vagina and anus to look for a specific bacteria that sometimes causes an infection with you or the baby. The results from the culture take a few days. Most of the time you will already have given birth by then. But the results can be important if, after birth, an infection occurs with you or the baby. They can start giving the right medication right away.

If you and your baby’s check-ups are all normal, it is fine to wait up to 72 hours after the breaking of the water. Ofcourse you have a say in this too. If you decide to wait, you go home and come back to the hospital every day for a check-up. When the contractions start you will call the hospital (they will provide you with the correct phone-number).

Call the hospital:

- if you have regular contractions (every 5 minutes)
- if you have a temperature >37.7 degrees 
- if the color of the water changes to green or brown
- if you feel less movements than you are used to
- if you loose a lot of blood (more than a sanitary towel full in 30 minutes time)
- if you have questions

Of course you can always contact us too, but because the care is transferred to the hospital it is sometimes easier to call the hospital directly.

If your contractions haven’t started after 72 hours, your labour will be induced. The way this happens depends on the ripeness of your cervix. If your cervix is not ripe yet some medicines will be given or a balloon filled with water will be placed in your cervix. Riping can take a few hours to a few days. The hospital will give you information about the ripening process. When the cervix is ripe enough, a drip with hormones to start contractions (oxytocin) will be given.

During labour the heartbeat of the baby will be continuously registered. Your temperature will be taken regularly. If there are signs of an infection during birth (fever with you and/or a high heartbeat with the baby) the hospital will offer to start antibiotics trough a drip. This way the medicine enters your body quickly and it can get to the baby quickly too. Sometimes it is advised to give the baby antibiotics after birth. He or she will get a drip and is admitted to the children's ward for a few days. You are then admitted to the maternity ward so you can be as close to your baby as possible. The pediatrician will tell you when it’s time to go home.

Most deliveries will occur without complications. The hospital will then advise you to stay for observation for the first 24 hours after birth. Your baby and you will be regularly checked to see if no infection occurs. Observation is done at the maternity ward where both of you are staying. After 24 hours you can go home.

The care for you will be transferred to us as soon as you are discharged from the hospital. The hospital will give us a call to tell us that you are going home. We will visit you during our visitation days (Monday, Wednesday and Friday). Please contact your maternity nurse as soon as you are back home. She will come to your house that same day.

If you have any questions you can call us at the emergency number.