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Some women will already be in labour before their waters break; for others the waters can break before the start of labour. Either way, they are part of the final journey of pregnancy and mark one step closer to you meeting your baby.
What are your waters?
While the baby is in the uterus, they are protected by amniotic fluid. This fluid is contained in a bag of membranes. When this bag tears, the amniotic fluid is able to escape and it exits the body via the vagina. This occurrence is what people mean when they describe 'waters breaking'. In medical terms, this is referred to as your membranes rupturing.
When will they break?
Your waters will usually break at the end of the first stage of labour. For about 10% of women, their waters will break before they are in labour. For approximately 2% of women, their waters will break before they are full term, i.e. before they are 37 weeks pregnant.
What if they break early?
The first thing to remember is: don't panic! In some cases the amount that comes out will be a trickle, in others it may seem like a big gush. If you are expecting your waters to break, you can prepare with a sanitary pad or an old towel for protection. This will also enable you to establish the colour of the fluid. It will usually be clear with a little yellow and possibly a small amount of blood.
What should I do once my waters have broken?
Regardless of whether you are in labour or not it is important to seek medical advice quickly as, once your waters have broken, the baby has less protection from infection. You may be admitted to the delivery ward or assessed at an antenatal clinic, or, if you are planning on a home birth, your midwife may visit you at home. The person assessing you will want to make sure that both you and the baby are fine and that you are not simply leaking urine, as this is common during the later stages of pregnancy.
What if I'm still not in labour?
If you are more than 37 weeks pregnant you will be able to choose between being induced, waiting 24 hours and then being induced, or waiting for labour to start naturally. There are risks and benefits to all three options.
The advantage of opting to be induced is that it reduces the risk of infection and reduces the chance of your baby needing antibiotics. The main disadvantage is that once you have had one form of medical intervention, you are more likely to need others. For example, you are more likely to have a drip and more likely to require monitoring if you are induced. Also, being induced means that you will be unable to have a home birth or use a birthing pool.
Waiting 24 hours
For most women (approximately 60%), labour will start on its own within 24 hours of their waters breaking. During this time you will be asked to monitor your temperature every 4 hours while you're awake. You should report any change in vaginal loss and/or changes to the baby's movement patterns. You can have a bath or shower while waiting for labour to start but shouldn't have sex, as this can increase the risk of infection.
If you opt to wait for labour once your waters have broken, you may need to stay longer in hospital after the birth to ensure that your baby does not have an infection.
Waiting for labour to start naturally
Many hospitals are reluctant for you to wait longer than 24 hours for labour to start naturally due to the increased risk of infection and an increase in the rate of stillbirth and neonatal deaths. You can, however, request to be monitored rather than induced. You should be offered induction again at 41 weeks as well as additional monitoring.
Group B streptococcus
If you have tested positive for group B streptococcus then it is likely that you will be induced as soon as possible once your waters have broken. This is because there is an increased risk of a GBS infection with the more time that passes between your waters breaking and the onset of labour.
Your waters breaking can be an exciting time as it signifies that you will finally meet your baby soon. It can also be daunting, particularly if you are not yet in labour. If this is the case, in the absence of any medical emergency, it is always worth speaking to your caregivers about the available options to ensure that you make the most appropriate choice for you and your baby.