Released Waters (a.k.a. Ruptured Membranes,Water Breaks) – What to Do!

Your waters just released – now what?  Waters can release as a few drops at a time or in a gush.  Only 10% of women will experience waters releasing before labour has started.  In that case labour usually starts within 24 hours.  The other 90% of women’s waters will release at some point during labour, usually in active labour.  Below is info on self-care and warning signs.  

About 75% of women with PROM at term (“premature rupture of membranes” i.e. before labour starts, from 37 weeks on) give birth within 24 hours, 90% within 48 hours and 95% by 72 hours.  People often worry about infection after waters release.  Risk of infection increases with internal exams (vaginal exams), fever in mother and being confirmed GBS-positive.

Warning Signs

If any of these occur, seek medical attention in a timely manner.

  • If waters release before 37 weeks, contact your medical care provider and/or go to hospital.
  • If fluid is coloured (yellow, green, brown) or has a strong smell, then contact your medical care provider.
  • If you have any signs of fever contact your medical care provider.
  • If your baby isn’t moving normally, then contact your medical care provider.
  • This is a 911 call! If you feel a cord between your legs or at the vaginal opening, assume a “child’s pose” with bum in the air (on hands and knees with chest on the ground) and call 911.

Self-Care

  • Nothing inside! That includes internal examinations unless there’s a good reason to do one. There’s a correlation between time on first internal exam and onset of infection; the earlier the initial internal exam, the higher the risk of infection.  Risk of infections goes up with number of internal examinations.
  • Baths in your own tub at home are fine. Once you’re in active labour then baths are also fine in your private birth room.  Use showers instead when in public spaces (e.g. hotel, hospital assessment washroom).
  • Be aware of signs of infection such as fever. Take your temperature every 4-8 hours during awake hours.
  • Stay hydrated. Consider if you’ve had a steady stream of fluid or just that early trickle.  It’s also possible to have a little “high leak” without membranes fully  releasing.  A healthy mama/baby will continue to make amniotic fluid.
  • Take care of hygiene:
    • Wear a clean pad and change it often
    • When using the toilet, one wipe from front to back per tissue
    • Wash hands before and after using toilet or changing pads

Go to Hospital… or Not

This should be discussed with your midwife or doctor at prenatal appointments ahead of time in case they have specific instructions for you.  If fluid is clear then you may have the  choice to stay home or contact your medical care provider for options. Generally there are 3 things assessed at hospital:

  1. Baby’s health (by listening to fetal heart tones)
  2. Maternal health (vital signs and interview)
  3. Presence (or absence) of amniotic fluid (the “waters”) present

If you go to hospital and you’re not in active labour, you will likely be offered a sterile-speculum exam (think PAP test); the purpose being to confirm your waters actually released.  This is optional, although it’s not usually presented as such.  Other ways to determine if waters actually released may included simply asking the pregnant woman or dipping the testing swab into her wet pad.

  • If you previously tested “GBS positive” then your medical care provider may recommend induction.
  • If you previously tested “GBS negative” then may be offered induction but will more likely be sent home to wait for labour to start.  If labour hasn’t started within 24 hours then your medical care provider may recommend induction.

Your Options

  1. Go to hospital for maternal and baby assessment but decline internal examination.
  2. Go to hospital and consent to all of it – sterile speculum exam, maternal and baby assessment.
  3. Stay home and wait for labour to start, barring any warning signs or health complications.  Practice good self-care, be aware of warning signs, and pay attention to your baby’s movements.

Further Info:

Excellent article about obstetrical care of women with Premature Rupture of Membranes (PROM) at term (37+ weeks), including discussion of differences in outcomes with GBS positive and negative, options, and when labour typically starts.