What happens when your waters break?

Waters breaking is a pregnancy term you hear all the time but what really happens when your waters break? And will it be as dramatic as it sounds?

The truth is that not everyone will experience waters breaking in the same way. In around 10% of mums, the waters will break before the labour starts. Sometimes, the waters don’t break at all and the baby is born inside the amniotic sac. This is referred to as ‘in caul’ and some believe it to be a good omen.

Your waters will most probably break during labour at the peak of a contraction.

If your waters break before labour is underway, you’ll most likely go into labour within 24 hours. But if this doesn’t happen, and you are already 37 weeks or more, your health care professional will probably recommend that your labour be induced so as to reduce the risk of any infection.

What does amniotic fluid look like?

Amniotic fluid resembles urine and is a pale straw colour. When your waters break, the colour may be a little blood stained to start with.

Amniotic fluid protects your baby from germs and infection. If your waters break before labour begins, you should contact your midwife or hospital for advice.

If you are losing blood or the waters are smelly or dark coloured you should also contact your hospital/midwife immediately.

What does it feel like when your waters break?

Again, it’s different for everyone. Some women experience a slow trickle while others feel a sudden gush. It’s a good idea to keep a sanitary towel (not a tampon) handy or use a waterproof sheet on your bed.

What are fore waters and hind waters?

As your baby moves lower down the pelvis, the amniotic sac can get squashed meaning some of the fluid is in front of your baby’s head while the rest of is left at the back of your baby’s head. The water in front is known as fore water and the water behind as hind water. There’s barely any difference between fore and hind waters, and it doesn’t matter in which order your waters break except that with hind water leaks it can be trickier to tell if it’s urine or fluid. In any case, your midwife will be able to confirm.

SROM -  Spontaneous Rupture Of Membranes

Your midwife will write this in your notes if your waters break naturally at 37 weeks or more and in labour.

PROM – Prelabour Rupture of Membranes at term

If your waters break before labour at 37 weeks or more, it is known as a prelabour rupture of membranes at term and is fairly common.

PPROM – Preterm Prelabour Rupture of Membranes

This is when your waters break before 37 weeks gestation and happens to around three percent of women. If you suspect that your waters have broken, call your maternity unit and stay calm.

A midwife or doctor will assess you before discussing what should happen next. They will ask:

• if your waters broke with a gush or a trickle
• what colour the fluid was
• whether you are having contractions or cramps

They will also listen to your baby’s heartbeat to make sure your baby is not in distress if they are not sure whether the waters have gone. They may also examine you vaginally to check for fluid escaping.

If your contractions have not yet started and you are at term (37 weeks) you can choose what to do next from the following options:

• to have your labour induced
• to wait for 24 hours to see if you go into labour naturally
• to wait over 24 hours, however, this can risk infection

Most likely your contractions will start between 24 and 48 hours of your waters breaking. So waiting for at least 24 hours before you're induced is likely to be the best course of action and what your midwife will advise.

However, you will be offered an induction straight away if you tested positive for group B streptococcus (GBS) during pregnancy to reduce the chances of your baby becoming infected.

What if you don’t want to be induced despite your waters breaking early?

If your doctor or midwife deems you and your baby fit and well you will most likely be allowed to go home for 24 hours to see if your contractions start naturally.

During this time you can have a bath or a shower but shouldn’t have sex, as this could increase the risk of infection for you and your baby.

Waiting for your contractions to start after 24 hours carries a marginally increased risk of infection. Around 1 per cent of babies develop an infection, compared with half a percent where the waters hadn't broken prior to labour. 

Should you decide not to be induced you will need to monitor yourself and the baby closely.

• Have your baby's heart rate and movements checked by a midwife or doctor every 24 hours until you go into labour, or have your labour induced.
• Take your temperature every four hours.
• Observe any changes in the colour and smell of the amniotic fluid and report them to your midwife.
• Be mindful that your baby is moving as usual.

Contact the hospital immediately if you notice any signs of infection such as a high temperature, shivering or decrease in your baby’s movements.

If an infection is detected it will be treated with antibiotics intravenously and labour will be induced immediately to minimize any risk to your baby.

If you have no signs of infection and go into labour naturally over 24 hours after your waters have broken, you’ll be advised to have a hospital birth in case your baby needs to be cared for in a special care baby unit. (SCBU). 

You'll be asked to remain in hospital for at least 12 hours after the birth too so your baby can be monitored for signs of infection.

What are the risks of declining induction after 48 hours?

If your waters have been broken for over 48 hours and labour has not yet begun you should seriously consider your choices. The risk of infection to both you and your baby increases the longer it is between your waters breaking and your baby's birth. 

The risk of infection needs to be carefully weighed against the chances of you going into labour naturally. You will be offered the opportunity to discuss this with your doctor and/or midwife.

Keep calm and remember, that being induced after your waters have broken doesn’t increase the likelihood of your having a caesarean birth.

Try to shelve any concerns about induced labour being more painful. You will be offered the same pain relief options as if you had gone into labour spontaneously.