Ruptured membranes after 37 weeks of pregnancy

This information is for you if your labour has not yet started (and you have not commenced an induction of labour), and the membranes which contain the fluid around your baby have ruptured or released, commonly known as ‘the waters breaking’.

This is not unusual and occurs in 8-10% of all pregnancies at term (after 37 completed weeks of pregnancy).

What will happen?

You are recommended to phone the hospital for advice as soon as you are able to, the contact numbers will be available to you on the front of your hand-held notes.

Usually, you will be invited into triage or the Birth Centre, depending on where you plan to give birth, for assessment of both you and your baby’s wellbeing and to discuss with the midwife or doctor your options for the safe birth of your baby. If you are planning a home birth you will need to contact the maternal assessment unit/delivery unit for assessment and care planning in the first instant. When you are first seen by a midwife, either in hospital, or at home, following the possible rupture of the membranes the following will take place.

Please remember as with all procedures it is your choice which course of action you follow. Your midwife will be happy to discuss with you the reasons for each intervention and their possible risks and benefits.

1. The midwife will take a detailed history from you to ascertain if your waters have broken. The midwife will also take your temperature, blood pressure, pulse and respiratory rate; this is so that any signs of infection or deviations from normal can be observed and considered when making plans for the birth.
2. The midwife will also palpate your abdomen to ascertain where the baby is lying in relation to your pelvis and will listen to the baby’s heartbeat.

This can be done either by a handheld doppler, a pinard, (commonly known as a ‘trumpet’ stethoscope) or if the midwife has any concerns, or you have had other risks identified in your pregnancy, an electronic recording of the heart rate known as a ‘trace’ or CTG.

You can also request to have a CTG even if your pregnancy has been low risk and there is no clinical need to do so.

Waters can break suddenly in a large gush (sometimes associated with a ‘pop’ sensation), or as a trickle that can sometimes be harder to notice or identify as waters breaking with certainty. If you and your midwife feel you cannot confirm if the waters have broken based on your experience, he/she will offer an internal examination using a speculum so that pooling of the water (liquor) can be seen around your cervix. If the history is very clear, and there is obvious liquor to be seen on your pad or underwear a speculum may not be necessary.

If you have been advised IV antibiotics , please tell your midwife so that they can consider this when she discusses your options for the birth with you. See Group B Streptococcus (GBS) – Your pregnancy and your baby (opens in a new tab)

When all of this has been discussed with you and the procedures you consent to have been carried out; you will be given the following options.

Choice 1: Waiting (expectant management).

If there are no risk factors identified, you may prefer to go home and await events. You can contact maternity assessment line for advice when you feel your labour has started.

Statistics show 60% of women and birthing people will go into established within 24 hours, 90% within 48 hours and 95 to 98% within 72 hours. If labour has not established within 24 hours you will be offered the option of induction of labour. Induction will be recommended after48 hours with the aim of the birth being achieved within 96 hours of the membranes rupturing.

The time for induction of labour will be discussed with you before you go home and contact details and when to telephone documented in your notes for you to refer to. If you change your mind at any time after going home, you are welcome to telephone the unit and discuss your options further with the midwife coordinator.

The liquor (‘waters’) will continue to drain until your baby is born. Whilst at home you can bath and shower if you want to, as there is no evidence to support this increases the incidence of infections but having sexual intercourse may increase this risk.

If you choose this option, of waiting, you should contact the hospital immediately if any of the following occur:

1. You feel unwell or have a raised temperature – we recommend you take your temperature every four hours while at home. You will need to call the maternity assessment line if your temperature is 37.5 or more. You can purchase a thermometer from any local chemist store if you do not already have one at home.
2. You experience regular contractions.
3. The amniotic fluid is no longer clear, particularly green or brown or becomes very smelly. Pinky amniotic fluid due to ‘show’ is normal but fresh bleeding is not normal.
4. Your baby has an altered or reduced pattern of movements.
5. You have any queries or concerns.

You may labour and give birth on the Rosie birth centre if you experience ruptured membranes providing the interval from your waters breaking to the onset if labour does not exceed 48 hours. In which case, birth on the delivery unit will be recommended to enable continuous monitoring of your baby’s heartbeat.

Choice 2: Stay in hospital and be induced (active management)

You may prefer that your labour is induced as soon as possible.

However, please remember the workload on the delivery unit may not allow this to be undertaken straight away, as there may be other women and birthing people with risk factors who will need care.

The midwife on the unit will liaise with you until a safe and appropriate time for the induction to commence can be made.

You may need to be transferred to the antenatal ward to wait for this.

Sometimes there may be additional risks or complications in your pregnancy which will determine the risk to yourself or your baby (for example previous caesarean section) associated with the time of induction, these will be discussed with you on an individual basis by your midwife or the doctor.

How will labour be induced?

The same methods are used whether you opt for immediate induction or wait to see if labour establishes. More detail is available in the Guide to induction of labour (IOL) (opens in a new tab) and on the Induction of Labour at the Rosie Hospital video (opens in a new tab).

What are the risks to me and my baby?

The risk of infection to your baby increases the longer your waters are broken: the chance of serious infection affecting your baby before your waters break is 0.5% (1:200). This increases to 1% (1:100) after 24hrs of your waters being broken.

You and your baby will be monitored closely throughout for any signs of infection and should there be any concerns the midwife/doctor will discuss this with you, and you may be offered treatment such as antibiotics during labour.

We recommend that you stay in hospital for a minimum of 12 hours after your baby is born if the time interval from membrane rupture to birth is equal to, or greater than, 18 hours or more, to monitor for any signs of infection in your baby. Your midwife will discuss at the time what observations are recommended and for how long.

The midwives/doctors will be happy to discuss any issues you feel uncertain about and will support you in whatever your decisions.

References

NICE (2025) Intrapartum care. Clinical guideline National Collaborating Centre for Women’s and Children’s Health. RCOG Press, London.