When-your-water-breaks-before-labour-English.pdf

When your water breaks

before labour

What is PROM?

PROM means that your water breaks before labour begins. Labour is when you have regular

contractions, or labour pains, in your uterus.

Even though the reasons for PROM are not well understood, it can occur with a healthy pregnancy.

About one in 10 people with healthy pregnancies experience PROM.

If PROM happens before you are 37 weeks pregnant, it is called preterm prelabour

rupture of membranes, or PPROM. The information provided in this document only

applies to PROM at or after 37 weeks. Contact your midwife if you think you might be

experiencing PROM and you are less than 37 weeks pregnant.

How will I know

if my water

has broken?

Many pregnant people wonder

how they will know when their

water breaks. For example,

sometimes it can be hard to tell

the difference between amniotic

uid, pee and regular discharge

from your vagina.

FEELING APPEARANCE SMELL

You may:

• Hear or feel a pop inside

your uterus or vagina.

• Have wet underwear.

• Feel a big gush of uid

that you can’t stop.

• Feel a slow, steady trickle

of uid from your vagina.

Amniotic uid is usually clear or

straw coloured. It may also:

• Look green or yellow (this

happens when the baby has its

rst bowel movement, called

meconium, in the water).

• Contain streaks of blood and

mucous.

• Have little white bits in it (this is

vernix, a creamy white substance

that covers and protects the

baby’s skin).

Some people think amniotic uid

smells sweet or like bleach, or

that it has no smell at all.

Amniotic uid does not smell like

urine and should not smell bad.

This could be a sign of infection.

What is the bag of water,

or amniotic sac?

Your baby grows inside the amniotic sac.

• This is a membrane lled with a liquid

called amniotic uid.

• It acts like a cushion, protecting your baby

from the outside world.

• It allows your baby to move

around freely.

PRELABOUR RUPTURE OF MEMBRANES (PROM)

The AOM is committed, through our statement on Gender Inclusivity and Human Rights, to reect and include trans, genderqueer and intersex

communities in all aspects of our work. In this document, the term “vagina” refers to the birth canal. This is to increase understanding of

important concepts related to PROM across all English literacy levels.

Some signs that your water may have broken include:

Call your

midwife

right away...

What should I do if I think my water has broken?

Your midwife will talk to you about when and how to contact them if you think your water has broken. They will

explain when you may need to contact them right away, and when it may be okay to wait until morning to contact

them if your water breaks in the middle of the night.

*You can check your baby’s

movements anytime.

1. Lie or sit down.

2. Count all movements (kicks,

utters, rolls).

3. You should feel at least six

movements in two hours or

less.

4. If you do not feel six

movements in two hours, call

your midwife.

...if your water breaks and:

• You are less than 37 weeks

pregnant, or

• Your midwife has told you that

your baby’s head is high, or

• You have a fever (38°C or

higher), or

• The amniotic uid is green or

yellow, or

• The uid has a strong smell or

smells bad, or

• You have heavy bleeding, or

• Your baby is moving less than

usual*.

Ask your midwife what to do and when to contact them if your

water has broken. Write down those specic instructions here:

Helpful tips if you think your water has broken:

• Remember that PROM is common and, in most cases, is NOT an emergency.

• To help lower the small chance of infection:

» Do not put anything into your vagina (no ngers or tampons, no sex).

» Do not take baths until active labour (showers are okay).

Active labour means your contractions are:

REGULAR AND STRONG LESS THAN FIVE MINUTES APART CHANGING YOUR CERVIX

• Put on a pad. If your water is broken, it will keep leaking. You will need to wear a pad to keep you dry.

• Take note of:

» The time your water broke, or when you think it broke if you aren’t sure.

» How much water is leaking.

» The colour of the uid.

• Eat and drink normally.

• Get some rest. You can continue with your usual activities, but remember that resting is important to

help you get ready for labour. It’s a good idea to lie down and take naps.

What about infection?

If you have PROM, the risk of infection for you and your baby is very low.

There are three types of infection that can happen with PROM:

Chorioamnionitis: an infection in the uterus

Endometritis: an infection in the uterus after the baby is born

Newborn infection: an infection in the baby’s bloodstream

The chance of getting an infection due to PROM:

• Is lowest in the rst 24 hours after your water breaks (75% of people will have their baby in this time even

without a medical induction). Even if your baby is born after 24 hours of PROM, the chance that you or your

baby will develop an infection is still very low.

• Increases slightly the longer your water is broken before you give birth.

• Is similar whether you wait for labour to start on its own or choose a medical induction if you have no internal

exams until you are in active labour. An internal exam is when a health care provider puts their ngers in your

vagina to check on how your cervix is opening. Internal exams can increase the chance of infection by putting

bacteria into the vagina.

100

75%

deliver

within

HOURS

90%

deliver

within

HOURS

95%

deliver

within

HOURS

What happens after we know

my water has broken?

Once your water has broken, you will likely go into labour

on your own within the next few hours or days. Many people

experience an initial quiet period without contractions.

Most people (75%) have their baby within 24 hours after their

water breaks.

Almost all people (95%) have their baby within 72 hours after

their water breaks.

What options do I have after my water has broken?

Your midwife will discuss two options with you:

MEDICAL INDUCTION

(taking a drug that gets

your labour started)

WAITING FOR LABOUR TO START ON ITS OWN

(this may include natural methods

of starting your labour)

Although both of these are generally safe options, sometimes there are reasons your midwife may recommend a

medical induction, such as:

• You have signs of infection. There is a small chance that you or your baby could develop an infection

following PROM. Some signs of infection include:

» Fever

» Your baby’s heart rate is high

» Your amniotic uid smells bad

• Your baby passed meconium (its rst bowel movement) into the amniotic uid.

• You are group B streptococcus (GBS) positive.

Medical induction of labour Waiting for labour

What is it?

Your labour is started with a drug: misoprostol

and/or oxytocin.

Waiting for labour to begin on its own.

• This may include non-medical ways of starting

labour:

» Castor oil.

» Nipple stimulation, often with a breast

pump.

» Acupuncture.

How long will it take for labour to start?

Most people will go into labour within 24 hours

from when the medical induction starts. Most

people will give birth within six to 28 hours of

going into labour.

Most people will go into labour within 24 hours

of their water breaking.

Where will it take place?

Medical inductions must take place in the

hospital.

Waiting for labour to start on its own usually

happens at home.

What can I expect?

Some people need a drug called misoprostol to

help get their cervix ready for labour. Misoprostol

is a pill that you swallow.

When your cervix is ready for labour, you will be

given a drug called oxytocin through an IV drip.

Oxytocin and misoprostol lead to strong

contractions that may be stressful for babies.

Their heart rate needs to be watched carefully.

This is done with a machine called an electronic

fetal monitor (EFM).

It can be hard to move around with EFM because

you are attached to a machine. This may make

labour feel more painful. Some hospitals have

wireless EFM, called telemetry, which allows you

to move around more. You can ask if telemetry

EFM is available at your hospital.

Hospital staff may or may not be part of your

care during the induction. Some hospitals have

policies that mean midwives need to transfer your

care to a doctor for induction. If this happens,

your midwife will continue to provide supportive

care, comfort and information. Care will be

transferred back to your midwife after the birth.

You will be able to rest at home while you wait.

Your midwife can discuss with you natural ways

to start labour.

Your midwife will check in with you regularly to

make sure that you and your baby are healthy.

Medical induction of labour Waiting for labour

For every 100 birthing parents

who were INDUCED

For every 100 birthing parents

who WAITED FOR LABOUR TO START

For every 100 pregnancies

that were INDUCED

For every 100 pregnancies

that WAITED FOR LABOUR TO START

What about pain management?

You may be more likely to ask for an epidural

during a medical induction of labour. An

epidural is a form of pain relief that involves

using a needle to put a small tube into the

space around your spinal cord. Pain medication

is given through the tube to block pain in the

lower half of your body.

You may be less likely to ask for an epidural if

you wait for labour to start on its own.

What happens after I decide?

If you have decided to have a medical induction

of labour:

Your midwife will let you know when to go to

the hospital to get things started.

If you have decided to wait for labour to start

on its own:

Your midwife will let you know when you should

contact them, for instance:

• If you go into active labour.

• If you develop signs of infection.

• If you would like a change in plan.

• If you have questions or concerns.

*Infection rates are based on cases where no internal exams were done before active labour started.

Note that the difference in infection rates between medical induction of labour and waiting for labour to

start on its own are “not statistically signicant.” This means that the differences could be due to chance.

10%

12%

10 developed an infection 12 developed an infection

1.7%

2.5%

1.7 newborns developed an infection 2.5 newborns developed an infection

Remember:

• Even though there is a small increase in the chance of infection the longer your water is broken, it is most

likely that you and your baby will NOT get an infection at all. Most people who choose to wait for labour

to start on its own will have their baby within 24 hours of PROM, when the chances of infection are lowest.

• If you choose a medical induction of labour, it may involve more birth interventions (drugs, IV, EFM,

epidural) than if you waited for labour to start on its own.

• The best ways to lower the chance of infection after PROM are to avoid putting anything in your vagina

and to avoid internal exams until you are in active labour.

Talk to your midwife if you are interested in non-medical ways to start labour, such as castor oil, nipple

stimulation (often through a breast pump), acupuncture and other methods. No matter what you choose, your

midwife will support you in your decision.

How can I decide what’s best for me?

There are many things to think about when you decide whether to have a medical induction or wait for labour to

start on its own.

For example, you may want to think about these questions:

• How do you feel about the chances of infection?

• Where do you want to labour? Where do you want to have your baby?

• How comfortable are you with having birth interventions?

» How do you feel about pain medications and an epidural? Do you want them? Or do you hope to avoid

them?

» How do you feel about having an IV drip?

» How do you feel about the idea of EFM?

Do you have other questions for your midwife?

Write them down here: