Water Break Early? Hang in There!

Inducing labor or waiting for natural labor have equal outcomes if water breaks early

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) You're nine months pregnant and ready to pop - but the due date is still a few weeks away. What do you do if your water breaks early?

The answer, according to a recent study, is wait. A good course of action, researchers found, is for women with an early membrane rupture to be monitored until labor naturally begins because being induced doesn't lead to a better outcome.

"If your water breaks early, induction is probably not necessary."

David van deer Ham, of the Department of Obstetrics and Gynecology at Maastricht University Medical Center in The Netherlands, led a study to find out the recommended method to deal with pregnant women whose water breaks early.

The researchers divided 532 pregnant patients from 60 hospitals in The Netherlands into two equal groups. All of the women experienced a rupture of the membranes, also called the water breaking, between the 34th and 37th week of pregnancy.

One half of the women were induced to labor following their membrane rupture. In the other group, women underwent "expectant management," which simply means the doctors observed the patient to be sure she was stable and experiencing no problems until she naturally went into labor.

The trial ran from January 2007 to September 2009, during which seven of the newborn in the induction group (2.6 percent) and 11 of the newborns in the expectant management group (4.1 percent) experienced some kind of infection.

Respiratory distress syndrome was seen in 21 of the babies whose mothers were induced (7.8 percent) and in 17 of the babies whose mothers were observed until labor began (6.3 percent).

Both groups had almost identical rates of necessary C sections: 36 of the induced women and 37 of the observed-until-labor women had a C section.

A condition called chorioamnionitis, in which the baby's membranes have inflammation from a bacterial infection, was slightly lower in the induced group, but no serious problems occurred.

The researchers then analyzed the data taking into account the mother's age, smoking status, ethnicity, education level, weight and gestational week of pregnancy when the rupture occurred. They also considered in their calculations whether it was a mother's first or additional child and whether it was a twin or single pregnancy.

After conducting this analysis, they found no significant differences in outcomes for the babies of either the induced group or the group who were observed until labor began.

The researchers therefore concluded that inducing labor for women whose water breaks early does not significantly improve the outcomes for the babies. Women who are under the care of a doctor and observed fare just as well.

In addition, they stated that the risk of infection for the baby is low for women who experience a preterm rupture of the membranes.

"This appears to be a well-designed study with sufficient power to evaluate the primary outcomes," said Jennifer Mushtaler, MD, an obstetrician in Austin, Texas.

"The study findings are consistent with American Congress of Obstetricians and Gynecologists guidelines that recommend induction of labor versus expectant management to reduce incidence of chorioamnionitis," Dr. Mushtaler said.

"Patients should feel reassured that in this setting, the rate of c section are not increased and outcomes are improved," she said.

The study appeared online April 24 in PLoS Medicine. The research was funded by The Medical and Health Research Council of The Netherlands. The authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
April 25, 2012
Last Updated:
April 25, 2012