This infection is called chorioamnionitis, or chorio (core-ee-oh) for short. It's a diagnosis by symptom that is sometimes confirmed with blood work. It's an infection of the amniotic sac (amnion and chorion) caused by bacteria. It's generally diagnosed when two of the following three symptoms are present: baby's heart rate is elevated, mom's heart rate is elevated, and/or mom develops a fever (typically above 100.4 degrees). Most of the time mom and baby fully recover with antibiotic treatment, though in rare cases babies can develop life-threatening conditions like meningitis and others. Beyond the risk of serious complications, this diagnosis is really unfortunate for a number of important reasons. Not being able to use the placenta for encapsulation is one reason but there are a few others that can also have long-term effects on the physical and emotional health of both mom and baby.
PROM in this context stands for Premature Rupture of Membranes and is when a pregnant person's water (amniotic sac) breaks before waves/contractions begin. And this, my friends, is not a fun PROM to attend. PROM is one major risk factor for chorio. Despite what we see in movies, it's only about 10-15% of the time that labor starts with the water breaking, and this is definitely not optimal.
As a doula who attends births in all settings (hospital with OBs, hospital with midwives, birth centers, and home birth) I see vast differences in how providers deal with PROM. Highly medical providers want to induce moms with PROM, usually using pitocin, as quickly as 4-6 hours after the water breaks. Other providers, especially in out-of-hospital settings, might be comfortable waiting 24 hours or more, sometimes even 2-3 days!
Now, interestingly, there is research to support induction quickly after PROM AND research to support the choice to wait and watch when the pregnant person's risk factors are low. You can read a very thorough article detailing the research for both sides at the EvidenceBasedBirth.com website. In the end it's important that each family feels like they made an informed choice about what is best for them in this instance.
Can anything be done to prevent PROM and subsequently chorio? Anecdotally we hear that eating eggs and vitamin C can help grow a strong amniotic sac though as you'll read in the EBB article the evidence on that is lacking. She does discuss research that showed taking fish oil for DHA reduced inflammation and PROM.
What about vaginal exams during pregnancy? The research here is also old and mixed but it makes sense that having routine vaginal exams at the end of pregnancy, especially if the care provider does a membrane sweep, could lead to a higher risk of PROM and infection. And since those vaginal exams and the numbers they produce tell us nothing about when labor will start, how long it will last, or if baby will fit through the pelvis, they can be declined all together.
How meaningless are those numbers? Well I worked with a mom expecting her fifth baby who went to her doctor's appointment and had a cervical check. She was told nothing had changed yet with her cervix. Zero centimeters dilated, not effaced, etc. Her doctor said he'd see her at her appointment next week! Well, she went into labor that night and things went so fast she had her baby in the parking lot of a gas station on the way to the hospital! All was well with mom and baby of course. Then there are the pregnant people who walk around for weeks being 4, 5, or even 6 centimeters dilated!
One thing we know for sure is that vaginal exams during labor increase the risk of chorio. These numbers come straight from the EBB article:
"Compared to those who had fewer than three vaginal exams:
- 3-4 vaginal exams lead to 2 times the odds of having chorio
- 5-6 vaginal exams lead to 2.6 times the odds of having chorio
- 7-8 vaginal exams lead to 3.8 times the odds of having chorio
- >8 vaginal exams lead to 5 times the odds of having chorio"
Moms with PROM also need to avoid sex after their water breaks, should not attempt to check their own cervix at home, should practice excellent hygiene when going to the bathroom, and should only bathe in a freshly cleaned tub. For moms who stay home it is recommended they take their temperature every hour while awake and every 4 hours while sleeping and call their provider if their temperature reaches 100 degrees. If the amniotic fluid leaking out is foul smelling or tinged with black, brown, or greenish material (meconium), mom should check in with her care provider immediately.
Why is chorio bad? Well for one thing it means antibiotics for mom and baby. In most Twin Cities hospitals this means a two-day stay in the special care nursery for the baby, though some progressive hospitals are treating babies right in the postpartum room with the mom. It's a manner of nursing resources though. Which means many newly postpartum moms are dragging themselves back and forth from their room to the nursery which is terrible for recovery, breastfeeding, and bonding. And it is traumatic for babies to be separated from their parents for their first two days of life.
Keep in mind most of the babies are not symptomatic when they are born but receive antibiotics just in case. This means a rough start to their gut flora and same for mom. Antibiotics wipe out her good bacteria as well as any bad which may lead to yeast overgrowth and breastfeeding challenges. And of course, a chorio diagnosis during labor can lead to a cesarean birth if mom isn't close to birthing yet and cesareans have their own long list of risks.
And for a mom planning to use her placenta, it is just adding insult to injury that she must endure all the challenges that a chorio diagnosis brings and lose her ability to encapsulate!
So, eat a healthy diet, take your vitamins and Omega 3 supplements, avoid vaginal exams during pregnancy, and limit exams during labor to give yourself the best shot at avoiding PROM and it's ugly step-sister chorio. Talk to your care provider during pregnancy about how they deal with PROM and make sure their approach is in alignment with your goals and desires!
And just for fun.... two pictures from my own Senior Prom (the fun kind!) in May of 1996!