Giving birth - waters breaking

'Waters breaking', or rupturing of membranes, occurs when the amniotic sac holding your baby breaks. This releases the amniotic fluid that has protected your baby during pregnancy, which leaks out of your vagina.

This is a normal and healthy part of late pregnancy or early labour and means your baby is getting ready to be born.

If your waters break, the fluid may gush or trickle. You may feel as if you have wet yourself. It usually isn't painful, and you may not feel anything at all.

When your waters break, the fluid is usually clear, but can be yellow, straw coloured or pink.

In most pregnancies, waters will break during the first stage of labour. Every pregnancy is different, so it's hard to predict when your waters will break.

Sometimes, waters will break before labour starts. This is called pre-labour rupture of membranes (PROM). When this happens at term (from 37 weeks of pregnancy), most people will go into labour naturally within 24 to 96 hours. If your waters break 18 hours or more before birth, your baby will need to have their vital signs checked for their first 24 hours.

If your waters break after week 37, your midwife or doctor will discuss your options with you. These may include waiting for labour to start on its own (expectant management) or inducing labour to reduce the risk of infection (active management).

Your choices, preferences and cultural needs will always be respected. Your healthcare team will consider your baby's wellbeing, your medical history and any risk factors when helping you decide what feels right for you.

What are the risk factors that may complicate the management of PROM?

Risk factors that may make the management of PROM more complicated include if you:

• are group B Streptococcus (GBS) positive
• had a previous birth affected by GBS disease
• have an infection
• have amniotic fluid with signs of meconium
• had a caesarean birth before

If you have tested positive for GBS, your healthcare team will recommend antibiotics (Opens in new tab) during labour. This lowers the chance of GBS being passed to your baby. They may also recommend active management or an induction as soon as possible.

If the membranes rupture before you are 37 weeks pregnant, it is known as preterm PROM (PPROM). If this happens there is a higher chance of early birth or infection. Put on a sanitary pad, call your midwife or doctor — they will most likely advise you to go to hospital.

At the hospital, a midwife will ask about your medical history, examine you and monitor your baby. They may take blood tests (Opens in new tab), a urine test (Opens in new tab), a vaginal swab and do an ultrasound to check on your and your baby's wellbeing.

The membranes form a protective barrier around the baby. After these have broken, there is a risk of infection getting into the womb, which is why they will recommend antibiotics (Opens in new tab). They may also ask you to stay in hospital for treatment and to monitor you and your baby.

If you are out in public, stay calm and ask for help if you need it.

If your waters break before labour, put on a sanitary pad and contact your midwife, doctor or birth centre. They will advise you when to stop what you're doing and go to the place you plan to give birth.

If your doctor or midwife thinks that your waters have broken, they will examine your vagina using a speculum. If they are still not sure, they can check for amniotic fluid proteins in the vaginal fluid, which will confirm if your waters have broken.

When your waters break, if the fluid is any shade of green or brown, this may mean that your baby is distressed. When a baby is distressed, it will sometimes pass a bowel movement (meconium or newborn poo) into the amniotic fluid making the amniotic fluid a green or brown colour.

If your waters are blood coloured, it could be a sign of placental abruption. This is very rare.

Call your midwife, doctor or hospital immediately if your waters break and:

• your waters smell bad
• you are bleeding from your vagina
• you have a temperature of 37.5°C or above
• you feel unwell or have flu-like symptoms
• you notice a change in your baby's movements
• you are having regular painful contractions or abdominal pain

If you'd like more information or support, the following organisations and services can help:

• Safer Care Victoria has a fact sheet: When your waters break early patient information (Opens in new tab).
• NSW Health has a fact sheet on when the waters break after 37 weeks (Opens in new tab).
• The Australian Government has a range of pregnancy information resources (Opens in new tab).