Spontaneous Rupture of Membranes before Labour

Introduction

This leaflet has been produced to give you general information about your procedure.

It should answer most of your questions but is not intended to replace the discussion between you and your doctor or midwife. It may act as a starting point for discussion.

If you have any concerns or require further explanations after reading, please discuss them with a member of the healthcare team.

What is a pre-labour rupture of membranes?

Pre-labour rupture of membranes is the term used when your waters have broken prior to your labour starting.

This means that the protective sac of fluid around your baby now has a hole in it that is allowing water to drain away. This draining will continue until your baby is born.

Evidence indicated that 60% of women with pre-labour rupture of membranes will go into labour within 24 hours.

If you have pre-labour rupture of membranes you will be offered to go home and await labour for up to 24 hours and an induction will be offered near to the 24 hour mark.

There are some circumstances where immediate induction is offered, this will be discussed with you.

Can there be any complications or risks?

In a very small number of women following rupture of membranes, infection can begin in the fluid surrounding the baby.

The risk of serious neonatal infection is 1 in 100, rather than 1 in 200 for women with intact membranes.

However, research shows that there is no greater risk to you or your baby if you go home rather than stay in hospital to wait for your labour to start.

Advice to follow at home

General hygiene is important to prevent infection, to assist with this you should:

• Check your temperature at home every 4 hours whilst awake.

• Change your sanitary pad frequently, at least every 4 hours during the day (whether it is wet or not).

• Not use tampons.

• Bathe and shower as normal, but do not use bubble bath or bath oils.

• Not go swimming.

• Not use any deodorant, talc or perfumes around the genital area.

• Refrain from any forms of sexual intercourse as this may be a source of infection.

You should contact the hospital for advice if you are concerned in any way about your pregnancy, baby, or experience any of the following:

• Feeling unwell, hot, feverish or if the temperature you are taking goes over 37.5ºC.

• The colour of the waters you are draining changes, becomes cloudy, brown, green or blood stained.

• The waters you are draining become smelly.

• The pattern of your baby’s movements changes significantly.

• Contractions or tightening you may experience become increasingly stronger.

If you have any other worries or concerns about your well-being.

What will happen if spontaneous labour starts?

If you go into labour within 24 hours and there are no signs of infection, continue with your original birth plan.

What will happen if I do not go into labour?

If your labour does not start by itself, we recommend inducing your labour. You will be given an appointment to be admitted to delivery suite a few hours before the 24-hour mark.

If you choose to wait longer than 24 hours, it is important that we check both you and your baby on a daily basis.

You will be asked to come to the hospital for an antenatal check and a cardiotocograph (CTG), this is an electronic means of monitoring your baby’s heartbeat.

This is to make sure that you and your baby are healthy.

What happens if I accept induction?

You will be given a time to attend Delivery Suite (Floor 1); when you arrive the midwife or a health care assistant will complete a set of observations on you; a midwife will then commence you on the CTG to monitor your baby.

Once you have been on the monitor for approximately 30 minutes, the midwife will offer to perform a vaginal examination.

At this examination they will assess how dilated your cervix is and administer “prostin”; this is a pessary used to soften the neck of the womb as part of the induction process. It is gently inserted into the vagina during the vaginal examination. Once you have had this examination, you will stay on the monitor for at least an hour.

If the monitoring of your baby is normal, you will then come off the monitor and will be encouraged to mobilise. 6 hours after your initial examination you will be put back on the CTG and have a 2^nd vaginal examination.

This is to assess whether there are any membranes (waters) in front of your baby’s head; if there are, these will be broken.

At this point, they will usually start syntocinon (hormone drip) to start contractions; from this point, your baby will be continuously monitored via CTG. You can still mobilise on the CTG if you would like to.

What if I tested positive to Group B streptococcus (Group B Strep or GBS)?

This would be a reason to advise induction of labour as soon as possible, with antibiotics in labour.

What happens afterwards?

After your baby is born, if your membranes were ruptured for more than 24 hours, we recommend that you stay in the hospital for at least 24 hours after birth to make sure your baby shows no signs of infection.

They will do this by monitoring your baby’s observations (heartrate, temperature, breathing rate) at regular intervals through the 24 hours.

Contact numbers

University Hospital of North Tees

Antenatal Day Assessment Unit

Telephone: 01642 624 239

Delivery Suite

Telephone: 01642 382 818

Antenatal/Postnatal ward

Telephone: 01642 382 822

References

1. National Institute of Health and Care Excellence Clinical Guideline NG235 Intrapartum Care (2023) – Recommendations | Intrapartum care | Guidance | NICE

2. National Institute of Health and Care Excellence Clinical guideline NG207 Inducing Labour (2021) Inducing labour (nice.org.uk)

Comments, concerns, compliments or complaints

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Leaflet feedback

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