Inducing your labour when your waters break before labour starts

For some people, the waters break (membranes rupture) before the start of labour. This is not unusual. Most of the time labour starts soon after.

6 in 10 people will go into labour within 24 hours of their waters breaking (NICE 2023).

If you are not already in labour and do not go into labour, your midwife or doctor will offer to start your labour (induction of labour) as soon as possible or 24 hours after your waters break.

Why does this matter?

• Your baby is in a protective sac of fluid in the womb
• When your waters break, it means the sac now has a hole in it that lets the water drain away. This will carry on until the baby is born
• The sac that surrounds your baby in the womb helps protect your baby from infection. The risk of your baby getting an infection goes up slightly the longer you wait for labour to start
• The risk of your baby getting a serious infection is 1 in 100 rather than 1 in 200 for women whose waters have not broken. 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 (NICE 2023)
• Your baby is also more likely to have antibiotics and be admitted to the neonatal unit if your waters broke more than 48 hours before your baby is born

What will happen if I decide to have my labour induced?

When you come to the hospital for your induction of labour:

• The midwife will do a full antenatal check, like the one you have when you visit your community midwife
• Your baby’s heartbeat will be monitored using a cardiotocograph (CTG) machine that gives a paper recording of your baby’s heartbeat
• You might also have a scan to check your baby’s position
• To start your induction of labour, your midwife or doctor will do an internal (vaginal) examination to check the neck of your womb (cervix). This will tell them which is the best method to start your induction of labour

Methods of starting your induction

1. If your cervix is closed, your doctor and midwife are likely to recommend a tablet called Prostin. This is placed next to the cervix. It dissolves which releases a hormone called prostaglandins. This hormone works to soften and open your cervix, which is helpful for labour.

• You may notice a creamy discharge after a short time but this is normal
• You may have period type cramps and the mucus plug (show) might start to come away
• If you have Prostin, you will remain on delivery suite and will not be transferred home or to the antenatal ward
• After 6 hours you will have a vaginal examination to assess whether there are any waters in front of baby’s head (see below). You will then be advised to start the oxytocin hormone drip

2. If there are waters in front of your baby’s head that are still intact, your doctor and midwife will advise that these are broken. Breaking your waters involves making a small hole in the membranes using a plastic tool with a small hook on the end. This is done during a vaginal examination. Following this, you will be advised to start the Oxytocin hormone drip.

3. If your cervix is open and there are no waters in front of baby’s head, you will be advised to start the Oxytocin hormone drip.

Oxytocin is produced naturally by your body during labour. It helps to make your womb contract and helps your cervix to open. The Oxytocin given to you through a drip is the ‘man made’ form of Oxytocin.

• Oxytocin is only given after your waters have been broken
• Oxytocin is used to try and start and/or make strong regular contractions of the womb (every 2 to 3 minutes)
• It is given through a drip that is inserted into a vein in your hand/arm
• The drip starts slowly and builds up over time
• The flow of Oxytocin through the drip is altered by your midwife or doctor depending on how your labour is going
• It is more common to use an epidural for pain relief when the Oxytocin drip is being used during labour
• Your baby’s heartbeat will need to be monitored all the time whilst you are having the Oxytocin drip
• The time you will be on the Oxytocin hormone drip is different for everyone, but you will be monitored regularly and have vaginal examinations to check how your labour is going

What will happen next?

You will be offered to start your labour either as soon as possible or within 24 hours after your waters have broken. Waiting 24 hours gives you the best chance of going into labour on your own. If you would like to be induced as soon as possible, this can be arranged but it depends on how busy the maternity unit is at the time. If your waters have been leaking for longer than 24 hours before labour, it is advised that your baby is closely monitored for signs of infection for at least 12 hours after they are born.

Things to consider

Having an induction as soon as possible

• Reduces the chance of infection
• Your baby may be born sooner

Waiting 24 hours before having an induction

• The chance of infection doubles every 24 hours (within the first 24 hours 1 in 100 chance)
• More chance you might go into labour without intervention: assisted birth, epidural, artificial hormones (6 in 10 women will go into labour after their waters break without induction within 24 hours)

Please note, if you have a history of Group B Strep infection, it is advised that you have an immediate induction of labour using the oxytocin hormone drip once your waters have broken.#

If I decide to wait, what should I do when I am at home?

You should get plenty of rest and eat and drink normally whilst you wait for labour to start. You can take a bath or shower at home as this does not raise the risk of infection. You should not have sexual intercourse as this can increase your risk of infection. It is important that you contact the maternity department straight away if you have any of the following as they may be signs of infection and your baby may need to be delivered sooner:

• The colour of water changes to yellow or green or has an offensive smell
• You feel unwell, hot, shivery, or sweaty
• You have a temperature over 37.5 degrees centigrade

It is also important you contact the maternity department if:

• You lose any blood other than your mucous plug ‘show’
• You feel your baby’s movements change
• You have sharp pains that are there all the time
• You are worried at all

There is someone available to answer your call 24 hours a day – please contact the maternity department if you are worried at all on 0116 258 6111.