My waters have broken and I’m not having contractions

Read our guide below to help you make choices about managing your labour if you’re more than 37 weeks pregnant and don’t have contractions after your waters break.

You can also download a PDF version of this patient information by following the link on the right.

Does it matter if my waters break before labour starts?

Waters breaking before labour starts happens in about 1 in 20 (5%) of pregnancies. It’s known as pre-labour rupture of the membranes (PROM).

The length of time between your waters breaking and contractions starting varies. We can’t predict on an individual basis how long it may be but we know that about 6 in 10 (60%) women will start labour naturally within 24 hours.

This information, and advice from your midwife or obstetrician will help you make an informed choice about how to manage your labour if you don’t contractions after your waters break.

Does it matter if I do not start having contractions as soon as my waters have broken?

It’s unlikely that the delay will affect your labour or the health of you and your unborn baby. This is particularly the case if your contractions start within 24 hours of your waters breaking.

But there can be an increased risk of infection to you and your baby if contractions haven’t started within 24 hours of your waters breaking.

How is the risk of infection reduced?

If labour starts more than 24 hours after your waters break, we recommend that you have intravenous antibiotics in labour (into a vein). These antibiotics prevent infections in both mother and baby that could lead to serious consequences.

If you’re a known carrier of Group B Streptococcus, the risk of infection increases. We strongly recommend that you have intravenous antibiotics straight away after your waters break and induction of labour as soon as possible.

What do I need to do when my waters break (PROM)?

Call the labour ward or birth centre where you’re planning to have your baby.

If you’re planning a home birth, call the birth centre or labour ward as advised by your community midwife at your home birth booking.

What will happen when my waters break?

We’ll ask you to come in to the labour ward for assessment.

A midwife will do a routine check of you and your baby. This may include a speculum examination and a vaginal swab (similar to a smear test). This confirms the membranes have ruptured and tests for infection.

If your pregnancy history and the routine check are normal, we usually recommend that you return home to await the start of natural labour.

You have the option to request an induction of labour as soon as the unit has capacity, which we’ll do as soon as we can.

What are the maternity unit recommendations?

Unless you have any known pre-existing medical or infection risks, we recommend that you wait for contractions for up to 24 hours. This will maximise your opportunity for natural labour to occur.

After 24 hours we recommend induction of labour and give you intravenous antibiotics to safeguard your baby against possible infection. We don’t advise waiting longer than 48 hours before inducing labour.

You’ll be given a date and time to return to the labour ward for induction if your labour doesn’t start spontaneously.

Option	Benefits	Comments
Induction of labour prior to 24 hours after PROM	Induction of labour and birth within 24 hours reduces the risk of infection to you and your baby. Antibiotics are not given in labour.	Induced labour involves the use of either a prostaglandin vaginal tablet and/or an intravenous hormone drip. You will need continuous fetal monitoring in labour. Induced labour may be associated with increased need for pain relief (National Institute for Health and Care Excellence)
Waiting for up to 24 hours	By waiting up to 24 hours after PROM, natural labour is more likely to start. 6 in 10 (60%) women will start labour within 24 hours.	Natural labour is associated with less need for pain relief and less medical intervention. If labour does not start spontaneously within 24 hours after PROM, induction of labour is recommended.
Waiting for longer than 24 hours	If you wait more than 24 hours, you may still be able to have your baby with a minimum of medical intervention.	If you have PROM for more than 24 hours there’s an increased risk of infection to you and your baby. Infection risk for your baby increases from 1 in 100 (1%) to between 2 to 9 in 100 (2-9%). Infection risk to you increases from 4 in 100 (4%) to 7 in 100 (7%). We strongly recommend continuous fetal monitoring and intravenous antibiotics in labour if your waters have broken for more than 24 hours before birth. If you have not had antibiotics in labour 4 hours before you give birth, we advise monitoring your baby for 24 hours after delivery. We may advise that your baby receives intravenous antibiotics if any concerns arise.

What should I do after returning home with PROM?

You should:

ahower or bath as you would normally
avoid sexual intercourse due to the risk of infection
eat and drink normally.

Callthe labour ward or birth centre immediately if:

your waters become brown or green or the odour changes. Please wear a sanitary pad so that you can check the waters.
you feel unwell, feverish or have flu-like symptoms
you have any bleeding or your waters become blood-stained
your baby’s not moving as normal
you have any other concerns at all.

Will the maternity unit need to contact me?

If the swab taken during the routine check shows that you’re carrying an infection such as Group B Streptococcus we’ll call you and ask you to return to the hospital.

The normal time frame for processing a swab in microbiology is 48 hours. Your result may not be available until after the birth of your baby. If you’re unsure of your result, please ask.

What should I do if I don’t start labour naturally within 24 hours?

Return to the Labour Ward at the agreed time.

If you choose to wait longer than 24 hours, talk to your midwife and doctor about further precautions you should take at home and when you should return to the hospital. We recommend that you attend the hospital for daily checks on you and baby.

Possible side effects and if you have concerns

This information explains some of the most common side effects that some people may experience but it’s not an exhaustive list.

If you have other side effects and want to ask anything else related to your treatment contact your community midwife or Stoke Mandeville Hospital Labour Ward on 01296 316103/4. Or call Wycombe Hospital Birth Centre on 01494 425513.