Spontaneous rupture of membranes before the onset of labor at term is commonly referred to as PROM (either premature or preterm rupture of membranes) and occurs in about 8% of term pregnancies. PROM is associated with an increased risk of infection. Many controversies exist regarding the optimal management of PROM, including the choice of induction or expectant management, use of digital vaginal exams, and routine administration of antibiotics. This article reviews the literature on PROM and illustrates some of the management issues encountered by presenting approaches used in three midwifery services.