Pre-labour Rupture of Membranes at Term is when your waters have broken after 37+0 weeks of pregnancy and labour has not yet started or established (you may be experiencing some tightening’s and discomfort).
‘Membranes’ are the layers of thin tissue that enclose your baby and amniotic fluid (waters, also called liquor) inside the uterus (womb). Once the membranes have ruptured (broken) the amniotic fluid around your baby leaks out. Sometimes this can be a large gush and is really obvious, sometimes it can be a slow trickle. This can happen if the hole in the membranes is small or not directly in front of the baby’s head (also called a hind-water leak).
Pre-labour rupture of membranes at term occurs in 8-10% of all pregnancies. Of these, 60% of women will go into labour within 24 hours. Pre-labour rupture of membranes increases the risk of neonatal infection from 0.5% to 1% With these factors in mind we encourage women to wait for 24 hours after their waters have broken to see if labour starts on its own. If it does not, then we will offer induction/augmentation of labour after 24 hours have passed. Ideally, we like to have all babies born within 96 hours of the waters breaking.
If there are concerns about yours or your baby’s well-being, we would recommend immediate induction/augmentation of labour.
Waiting for Labour to start Whilst you wait for labour to start there are a few things we would like you to do to encourage labour and to keep you and your baby safe:
- Keep active and upright as much as possible – upright positions will help your baby to descend into the pelvis and put pressure on your cervix, which can help labour to start. When you need a rest avoid lying flat on your back, lie on your side or prop yourself up with pillows
- Eat and drink as normally as possible to help keep your energy levels up. Isotonic (sports type) drinks can be particularly beneficial in labour.
- Gain support from your birth companion(s) – they can help to keep you comfortable and give you essential encouragement
- Monitor the water you are losing – sometimes you may get a large gush, especially if you are getting contractions, sometimes it may be a small trickle or nothing much at all. The water should be clear but may have bits of ‘show’ in it. This may be small clumps ofjelly like substance and may have streaks of blood. Normal amniotic fluid does not have a very strong smell. You should change your sanitary pad at least every 4 hours. If your waters are anything other than described here (discoloured, smelly) you must phone the hospital.
- Check your temperature every 4 hours when you are awake. If you do not have a thermometer, we will give you some disposable ones, please make sure you know how to use these. If your temperature is 37.5˚c or above, phone the hospital.
- Bath or shower as you wish
- Monitor your baby’s movements
- We recommend avoiding sexual intercourse once your waters have broken as this may increase the risk of infection
You should phone the hospital if:
- You think labour has started / is progressing (you may be in early labour when you go home)
- You think you may have an infection – feeling unwell / shivery and/or temperature 37.5˚c or above.
- You have concerns, or are unsure about your baby’s movements
- The water is discoloured or smelly
- Any other concerns about yourself or your baby
After 24 hours:
If you have not needed to come to the hospital before this point, then we would like to see you now – please follow the instructions below of who to call. If labour has not started, we will offer to start it for you (see induction of labour leaflet).
If you do not wish to have your labour started, we will be happy to support this after a discussion of the risks and benefits. If you are not contracting at all we will probably recommend a ‘Propess’ pessary to start labour.
If you are contracting, we will probably recommend an oxytocin infusion (hormone drip). We will discuss with you the preferred method along with risks and benefits. Because of the increased risk of infection once your waters have broken, we will avoid performing vaginal examinations as much as possible.
Further Information
For further information about pre-labour rupture of membranes at term or induction of labour and all aspects of pregnancy and childbirth, please talk to your Midwife or Doctor.
After 24 hours have passed: You should have been given a time to return to Delivery Suite when you attended to confirm if your waters had gone, if this is not the case, please call above to confirm when you should return.
A midwife is always available in the maternity assessment centre or on delivery suite to talk to if you need some advice or reassurance. Single point of contact: 01423 557531, if you are unable to speak on the phone and need urgent care – please just attend maternity assessment centre (MAC) First floor, Strayside Wing (follow the signs for Central Delivery Suite/Pannal Ward).
References:
NICE (2014, updated 2017) Intrapartum Care For Healthy Women and Babies. CG190. For information about NICE clinical guidelines programme you can visit their website at www.nice.org.uk