The rupture of membranes is a completely normal physiological event. And it’s also an event we preferred happens in later active labor.This is especially true for the unmedicated birth. In this episode I touch on why it’s important to build a strong sac and exactly what you need to focus on with your nutrition and supplements to help prevent a premature rupture of membranes.
More on PROM, Listen to Episode 27
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We’re going to talk about building a strong amniotic sac. I got this question several times after talking about premature rupture of membranes, and why you want to avoid premature rupture of membranes, especially if you’re having an unmedicated birth and the number one question I got was, well, how can I prevent my waters from breaking early? How can I build a strong amniotic sac? So here we are, first of all, let’s cover premature rupture of membranes just very quickly. This is when your waters break before contractions really start. And when your waters break, that IS labor starting, but ideally, we want contractions to start before our waters break.
Premature rupture of membranes is a normal physiological event, in most cases, and it’s possible that the waters breaking before labor starts even though it’s not ideal. It is normal. Our membranes are programmed to weaken towards the end of labor so our waters can break when our baby is born. It’s part of the physiological process. There’s a combination of factors that leads to the weakening of the sac, specifically near the cervix. For example, your body increasing the production of prostaglandins, baby has dropped, there’s some increased pressure there on the sac at the cervix and then of course, the contractions, increasing pressure even more, causing that sac to break- which we want.
And there are certain inflammatory reactions of the immune system that can make this process go faster. Which is why a prenatal infection can sometimes lead to a premature rupture of membranes. Most commonly, it’s the pressure of the contractions that causes the membranes to finally break and it’s only in 10-20% of moms that we see waters breaking before contractions actually start. And I have a podcast episode on this. It’s episode 27. I’ll link to it in the show notes where I talk about the three ways waters break and I talked a little bit more about PROM there. But let’s talk a little bit about why.
So we went over, a little bit, some of the physiological reasons why it could, but there is also some research that found that more women who experienced term PROM had a yeast infection than women who did not have PROM at term. And so the microbiome could be tied into how strong your sac is and if it’s going to break prematurely. People who did not have term PROM, so who’s water stayed intact longer, we’re more likely to have lactobacillus which is a good bacteria of the vagina. And so it’s possible that having that good bacteria, and having that good gut health leading to the good bacteria in the vagina might protect someone from PROM. So microbiome could be tied to one reason why our waters may break too early.
Of course, another reason waters could break is cervical checks. So in 1984 study there showed a relationship between weekly vaginal exams and PROM. In this study, 349 women were randomly assigned to weekly vaginal exams/cervical checks starting at 37 weeks or no cervical checks until after 40 to 41 weeks. The group with the weekly cervical checks starting at 37 weeks had a three times higher chance of having PROM (18%) compared to those who had no weekly exams until 40 or 41 weeks, they had a 6.6% chance of PROM, and I will linked to this study and a couple of the other studies that I’m going to mention in the show notes so if you want to dig a little deeper, you can. Now on that same note, we’re still talking about cervical checks causing preterm rupture of membranes, there was another study that took place in 1992 where 587 women were randomly assigned to weekly vaginal exams/cervical checks, or no exams. They found no difference in the rates of PROM between the two groups. While they concluded there was no relationship between prenatal cervical checks and term PROM, they also found no benefit to the weekly cervical checks. And you guys, we talked about this in like three podcast episodes about cervical checks. You absolutely do not need cervical checks while you’re pregnant. And the research is out. It’s 50/50. Some research shows there is an increase in waters breaking and some shows there is not an increase in waters breaking.
And really we can’t talk about cervical checks without of course talking about the membrane sweep. So who knows what was happening during those cervical checks, maybe in the study where there was more PROM these providers were doing membrane sweeps along with the cervical checks. The study doesn’t really specify and then maybe in the other study they’re trying to maybe make the data more favorable for cervical checks. They’re not doing membrane sweeps to show what is true of cervical checks not causing your waters to break. But remember that providers are STILL doing sweeps without telling moms beforehand.
And just a reminder that while the evidence is nice to know and nice to have, you don’t have to consider anything but your preferences when you’re making YOUR choice in what you want in your prenatal care and in your birth. Meaning you can go against the evidence if you want. It’s your choice.
Well, we want our waters to break during labor, preferably during later active labor or during the pushing stage to decrease that risk of infection and also to remove that time clock. A lot of providers want you to have your baby within 24 hours once your waters break, which is not usually the case. Or they want you to go into labor within 24 hours which is a lot more reasonable if you look at the evidence. In the absence of risk factors, so if you don’t have any risk factors, it’s okay to wait up to 72 hours for labor to start. But that is very rare to find a hospital provider who will support that decision. Remember, ultimately it’s your decision and in this case, the evidence is supporting that decision to wait. And remember, if you are having an unmedicated birth my number one tip is avoid Pitocin at all costs. So that’s why we don’t want our waters to break too early. We don’t want our provider to have any ammo to push us into an induction, to pressure us into an induction, ot to use scare tactics to get us to agree to an induction.
And the ironic thing here is that that time clock that’s put on our labor if our waters break before labor starts is largely in part due to the risk of infection if our waters are broken, the sac is open and bacteria can enter. You can get infection in your uterus, and that is for the most part, the logic behind rushing labor along. Also it’s because providers tend to be impatient. But the ironic thing is they tell you to hurry up and come in because of the risk of infection yet at the same time providers are rushing things along and doing multiple cervical checks, which also increases the risk of infection.
Cervical checks, PROM, GBS– these are definitely things you need to research if you’re wanting an unmedicated birth, and I have a full checklist for you of all the important intervention topics to research. If you go to fiercelizzie.com/diychecklist you can download that and it’s a great place to start when you don’t know where to start but you know you want an unmedicated birth. In fact, it is so important I want you to pause this episode and go download that list right now, it’ll go straight to your inbox then you can come right back to this episode and we can finish talking about strengthening the sac.
Okay, you downloaded it, perfect. Now…
First of all, it’s important to note that there’s not a lot of research on strengthening the sac. And when you actually go look for the evidence on this topic you most likely find research on PROM, preterm ruptured membranes, and what causes PROM and infection, and that sort of thing. Not a lot of research on natural ways to strengthen your sac. Go figure right? Okay.
The first thing that we need to talk about is nutrition. Nutrition is so important for so many things in pregnancy and it’s a good place to focus if you want a healthy pregnancy, a healthy baby, a strong baby, a healthy birth and a positive birth experience. Nutrition is helping you do so many things right now. It’s growing your baby, it’s growing the placenta, it’s developing the bag of waters, it’s expanding your blood supply, and many many more physical, physiological and metabolic changes that happen in your body while you’re pregnant.
When we talk about nutrition and pregnancy, the key takeaways that we want to focus on are getting enough calories, getting enough protein- it is more protein than you think, you are building a human inside of your body. You need extra protein. Salt is another one that’s very often overlooked. You need enough salt in your diet. And it’s really just about focusing on a well rounded diet, rich in a variety of nutrients from having a variety of whole foods. In addition, there are some particular foods that have traditionally been thought to contribute to a strong sack of waters including eggs, leafy greens and dates. And dates we know are good to prep for labor as well.
Now, let’s talk about some supplements that you can include. There’s some evidence that vitamins such as vitamin C and vitamin E can help the bag of water stay strong and also protect from infection. Zinc is another great vitamin for preventing infections and may also contribute to a soft and strong bag of waters. Calcium and iron are also two important ones to include with a strong sack as well. And it’s a good time to share that a quality prenatal is one way you can get these things in. And it is important. It doesn’t trump good nutrition, but it is important to include alongside good nutrition. My favorite prenatal is Needed Prenatals. I love them for a couple of reasons. But the number one is they focus on optimal levels of nutrients, not just the bare minimum. So if you go to Target and you go get the Target brand or some gummy prenatals they’re really focusing on the bare minimum of the nutrients that you need to prevent birth defects and Needed is all about making the mama feel optimal and feel good and that starts with getting the nutrients that you need to sustain pregnancy and to create this little tiny human that you’re building.
Another thing that you can include is vitamin C. Vitamin C is an important nutrient and I want you to look into the high dose vitamin C regimen specific to pregnancy. And I talk about this a lot more in my FREE Birth Prep Class, and I talk about dates here as well. This is a free class and downloadable bundle on all the things that you need to start now to prep for birth and I talk about the high dose vitamin C protocol and I have a few resources on the clickable resource page in the bundle. It is an amazing freebie, so go grab it. You can find it at fiercelizzie.com/birthprepclass. And with the high dose vitamin C regimen there’s again is not a lot of evidence on this but many, many women swear by vitamin C therapy in pregnancy, myself included. I followed the high dose protocol with my last pregnancy. And I was pretty good about following it, I stayed very consistent during the first, second and third trimesters, and it’s the only birth where my waters didn’t break before labor started.
And then another supplement that you can include and you should include for multiple reasons, but a strong stack of waters being one, is a probiotic. Now this can be with probiotic rich foods like kimchi, or a quality raw sauerkraut (Wildbrine at Costco is my favorite). This is important because having plenty of good bacteria, healthy microbiome in the vagina and in the birth canal, can decrease the risk of infection. And like I mentioned earlier, there is some evidence tying a good microbiome to waters staying intact. And there’s some other benefits to having those probiotics all the time. Not even just when you’re pregnant, but also while you’re pregnant.
So let’s recap here. Building a strong sack of waters is going to start with a whole foods diet, low processed foods with a variety of nutrients and a variety of good healthy foods to increase the vitamins and minerals that you’re consuming. And remember we want to focus on that good food first and we also want to focus on enough protein, enough calories and enough salt and then the vitamins you want to focus on again, including foods that are rich in these vitamins but also including a prenatal to fill in the gaps are vitamin C, vitamin E, zinc, calcium and iron. Now real quick I do want you to know if you are interested in using vitamin C to strengthen the sac, that is an additional supplement that you have to take. What is inside your prenatal is a normal dose, it is not high dose vitamin C therapy. So I just wanted to clarify that. And then lastly, the probiotics for improving the vaginal microbiome.
I hope that’s helpful. Go start some of those things today. Go get in the Birth Prep Class because I have some of those resources linked in the bundle for you. And as always if you enjoyed this episode I would appreciate it so much if you took a minute to leave a review or share it with a mom that you know is expecting and until next time, stay fierce moms.