When your waters break after 37 weeks and before labour begins

Sometimes a woman’s waters break before labour starts, this is known as pre-labour rupture of the membranes (or PROM). When this happens, about six out of 10 women will go into labour naturally within 24 hours and most will go into labour within 48 hours.

The risk of infection is increased the longer the time between breaking of the waters and the start of labour, and also by the number of internal vaginal examinations carried out. It is therefore recommended that vaginal examinations are avoided with the exception of the use of a sterile speculum if your midwife wants to confirm that your waters have definitely broken.

Because of the risk of infection, we aim to start (induce) labour within 24 to 36 hours, so that your baby is born within 48 hours of your waters breaking.

What risks are involved?

• The risk of inducing labour immediately is that your cervix is not quite ready to dilate and needs to have time to prepare. Trying to force this process too soon can lead to a longer labour and an increased chance of an assisted birth (for example forceps, ventouse, caesarean section) and fetal distress.

• The risk of leaving your waters broken for too long is that your baby is at risk of getting an infection.

Why has my midwife suggested I come into hospital?

If your waters break but you are not in labour you may be invited into hospital for assessment. Your midwife will record your pulse and temperature and listen to your baby’s heart beat. If there are any concerns your midwife may monitor your baby with a 20 minute heart trace, before you are discharged home to await the start of labour.

Will I need to be induced?

Before going home your midwife will arrange a day and time for your labour to be started, should you not begin labour naturally. The arranged time will be approximately 24 hours after your waters first broke, unless you prefer immediate induction or you have been told you are Group B Haemolytic Streptococcus positive, in which case you will be offered immediate induction.

Why have I been given antibiotics?

Where your waters have been broken for more than 24 hours it is our policy to recommend antibiotics in labour. These are given through an intravenous drip in your arm.

Babies of mothers who do not receive antibiotics in labour (if the waters have broken for more than 24 hours) may need blood tests and antibiotics after birth. Paediatricians advise that this group of babies remain in hospital for observation for 24 hours after birth.

What should I do when I am waiting for my labour to start?

• Get plenty of rest.

• Eat and drink normally.

• Check your temperature every four hours while you are awake.

• Avoid having sex as this will increase the risk of you getting an infection in your womb.

• Wear a sanitary pad and change it regularly; do not wear a tampon as this increases the risk of infection.

• You can have a bath or shower as usual; this will not increase the risk of infection.

• While you are waiting for your labour to start you may have a ‘show’. This is a lump or strands of mucous that is sometimes streaked with blood. This is normal and is a sign of your labour starting.

• You may also experience some mild period-like pains or tightenings of your tummy; these are not labour contractions. The pains will become more regular and much stronger when your labour starts. If you start to get some mild pains you can take two 500mg paracetamol tablets every six hours.

When you go home you should contact us immediately (see contact details below):

• If the colour of the loss on your pad, the water (liquor) is no longer clear or is smelly.

• If you feel unwell or feverish with a temperature of 38 degrees or higher.

• If your baby is moving less than normal.

• If regular contractions begin or you have abdominal pains.

Who can I contact if I have concerns?

Please contact our Maternity telephone triage service on 01227 206737 for help and advice.