Your waters have released (waters have broken) – what are your options?
Often the waters release (waters break) during labour, either spontaneously or are broken by a midwife or doctor to induce labour. For approximately 1 in 10 women the waters release before labour starts.
After your waters have released there is a small increase in the chance that you and your baby could develop an infection. Before the waters release there is a 1 in 200 chance of infection and after they release (and within the first 24 hours) this increases to 1 in 100. At each 24 hours after this that chance doubles, so at 48 hours the chance is 2 in 100 and at 72 hours it is 4 in 100.
These are the different options for management once waters have released:
| Advantages | Disadvantages | |
|---|---|---|
| Active management (immmediate induction of labour once activity allows)—recommended for women who have tested positive for GBS in their pregnancy | Decreased chance of infection for you and your baby. | Continuous monitoring of your baby’s heart rate and intravenous access is required if the synthetic hormone drip is used for induction. Continuous monitoring of your baby’s heart rate and the synthetic hormone drip will take place on the labour ward meaning that this cannot be facilitated at home or on the Birth Centre. |
| Delayed induction of labour (wait up to 24 hours before induction of labour) | For up to 6 in 10 women, labour will start naturally within 24 hours of waters releasing | Increased chance of infection for you and your baby. |
| Expectant management (wait more than 24 hours)—this option is not recommended in national guidance but will be supported by your maternity team | Labour will start naturally in up to 6 in 10 women within 24 hours without intervention. Benefits of waiting beyond 24 hours are not clear. | Increased chance of infection for you and your baby. Increased likelihood of your baby requiring intravenous (through a drip) antibiotics. |
When making this decision, you may find different things important to you. Some women will focus on timing issues, their individual birth preferences, some on the potential risk to themselves and their baby. We have therefore summarised different outcomes from research studies below to help you come to your decision. The research presented here combines 12 studies that have looked at the outcomes for 6814 pregnancies.
Research shows us that women who had an induction of labour soon after their waters release have a much shorter time (an average of 9-10 hours sooner) between their waters releasing and the birth of their baby.
Around 6.8% of women who opt for an induction of labour after their waters release develop a serious infection (called chorioamnionitis), compared to 9.9% of women who waited. This is a 3.1% difference.
There appears to be no differences in the type of birth (vaginal birth, caesarean section or instrumental birth) women experience depending on if they choose an induction or to wait.
Around 12.6% of babies born to women who had an induction of labour soon after their waters released required admission to a neonatal unit (NICU or SCBU) compared to 17.1% of women who waited. This is a 4.5% difference. However, this may reflect different hospital policies rather than clinical need as there was no differences on the immediate health outcomes of the babies, including serious harm, condition at birth or need for help with breathing at birth.
The chance of a baby getting an infection after birth increases the longer the waters have been released for, with a 9.7% increased chance of an infection if waters are released for 24-48 hours (compared to 12 hours) compared to a 12.5% increased chance if beyond 48 hours. We monitor for infections in babies after birth, and if we are concerned then we may recommend you stay longer in our postnatal wards to complete additional monitoring. Treatments for infections could include your baby having intravenous (through a drip) antibiotics.
References
If you have opted to wait for labour to start without immediate intervention and whilst at home you experience any of the following please call the Maternity Assessment Suite on 020 3315 2924 ( If you are booked at Chelsea and Westminster Hospital) or Maternity triage on 020 8321 5839 (If you are booked at West Middlesex Hospital) and return to the hospital for assessment straight away:
- Temperature – above 37.5°C or feeling unwell or feverish (please check this every 4 hours whilst awake)
- Reduction or change in your baby’s movements
- Change in colour of the waters – normally this should be clear / pink in colour – please come in straight away if waters become green/yellow in colour
- Continuous abdominal pain that doesn’t come and go like contractions
- Vaginal bleeding that appears red, fresh and not part of the mucus plug or ‘show’
- Or you have any other concerns
If you choose expectant management we recommend that you return at or before 24 hours of your waters releasing and at every 24 hours thereafter so that we can offer some additional monitoring for you and your baby