What If My Waters Break but Contractions Don’t Start?

For some women, labour begins exactly as it does in the movies: waters break, contractions start and things quickly get underway.

But sometimes your waters break…and then not much happens.

No contractions. No dramatic rush to the hospital. Maybe just a slow trickle of fluid and a lot of wondering, what am I supposed to do now?

If this happens to you, it doesn’t necessarily mean anything is wrong. Labour may begin soon after your waters break, but for some women there can be a bit of a wait.

What does it actually mean when your waters break?

During pregnancy, your baby is surrounded by amniotic fluid inside the amniotic sac. When the membranes of this sac rupture, the fluid can begin to leak through the vagina. This is what we mean when we say your “waters have broken.”

Despite what we see on television, it isn't always an unmistakable gush of water all over the floor.

It might be a sudden gush, a small pop followed by fluid, a slow trickle or simply a feeling that you seem to be continually damp.

And because pregnancy already comes with increased vaginal discharge and the occasional bladder leak, it isn't surprising that women sometimes aren't sure what they're experiencing.

First, are you sure your waters have broken?

Amniotic fluid is usually clear or pale and may sometimes have a slight pink tinge. Unlike urine, you generally can't control the leaking by tightening your pelvic floor, and you may notice more fluid when you stand up or change position.

If you're unsure whether it is your waters, urine or increased vaginal discharge, put on a pad and contact your midwife. They can talk through what you're noticing and advise you about what to do next.

You don't need to wait until you're absolutely certain before calling.

What if there are no contractions?

When your waters break before labour has established, it is known as prelabour rupture of membranes, often shortened to PROM when you are at term.

Your waters breaking and contractions beginning are both parts of the process of labour, but they don't necessarily happen at the same time.

For some women, contractions begin fairly soon afterwards. For others, several hours may pass before there is much happening at all.

This can feel surprisingly anticlimactic. You've spent months hearing that waters breaking is one of the big signs of labour, so it can be confusing when your body appears to hit the pause button afterwards.

It doesn't mean your body has forgotten what to do.

Your midwife will guide you based on your individual circumstances, how many weeks pregnant you are, what the fluid looks like, how your baby is moving and any other factors that may be important.

Give your midwife a call

Even if you feel completely well and aren't having contractions, let your midwife know if you think your waters have broken.

Before you call, it can be helpful to take a moment to notice what's happening.

Think about:

• Approximately what time you first noticed the fluid

• Whether it was a gush or a trickle

• The colour of the fluid

• Whether there is an unusual smell

• Whether it continues to leak

• How your baby is moving

• Whether you're having any tightenings or contractions

• Whether you're experiencing bleeding, pain or anything else unusual

Don't worry if you don't have all the answers. These are simply some of the things your midwife may ask about.

Will I need to go straight to hospital?

Not necessarily.

Your midwife may want to assess you, or you may be advised to stay at home for a while and see whether contractions begin naturally. What happens next will depend on your pregnancy and individual circumstances.

If an assessment is recommended, this may include checking your temperature, pulse and blood pressure, listening to or monitoring your baby's heartbeat and discussing your baby's movements. Your maternity team may also want to confirm whether your membranes have ruptured if it isn't clear.

Once your waters have broken, vaginal examinations are generally kept to those that are clinically necessary because repeated examinations can increase the chance of infection.

While you're waiting

If you and your midwife have decided that staying at home is appropriate, there often isn't anything special you need to make happen.

Keep things simple.

Eat and drink normally unless you've been advised otherwise. Rest if you're tired. Have a shower, watch something, potter around the house or try to get some sleep if it's nighttime.

It can be tempting to immediately launch into every labour-starting trick you've ever heard of, but you may be better served by conserving your energy. If labour begins later, you'll be glad you didn't spend the previous several hours exhausting yourself trying to get it going.

Keep paying attention to your baby's usual pattern of movements and continue to monitor the fluid you're losing.

Wearing a maternity pad rather than a tampon makes it easier to see the colour and amount of fluid.

What should I avoid after my waters have broken?

Once the membranes have ruptured, the protective barrier between your baby and the outside world has changed. This means infection becomes an important consideration.

Avoid putting anything into the vagina, including tampons, unless you've been specifically advised otherwise by your maternity care provider.

Your midwife can also advise you about things such as bathing, swimming and sex based on your individual situation.

This isn't about becoming frightened of infection. It's simply about taking sensible precautions while you wait for labour to begin.

Keep an eye on the colour of your waters

The appearance of your waters can provide useful information.

Clear, straw-coloured or slightly pink fluid can be normal.

Green or brown fluid can mean your baby has passed meconium, their first bowel motion, into the amniotic fluid. This doesn't automatically mean something is wrong, but your maternity team needs to know because it may change the recommendations for monitoring you and your baby.

Contact your midwife promptly if the fluid is green or brown, heavily blood-stained, develops an unpleasant smell or you're concerned about what you're seeing.

What about Group B Strep?

If you know you are positive for Group B Streptococcus (GBS), make sure your midwife knows your waters have broken.

GBS is one of the factors your maternity team will take into consideration when discussing what happens next, including recommendations around antibiotics and the timing of labour management.

Your plan may therefore look a little different from that of someone who doesn't have the same risk factors.

When should I seek help sooner?

Contact your midwife or maternity unit if you're concerned at any point.

In particular, seek advice promptly if:

• Your baby's movements have reduced or changed

• Your waters are green or brown

• You have significant vaginal bleeding

• You develop a fever or begin feeling unwell

• The fluid develops an unpleasant smell

• You have constant or unusual abdominal pain

• You have been told you have GBS

• You are worried about something, even if you can't quite explain why

And if you are less than 37 weeks pregnant and think your waters may have broken, contact your maternity care provider promptly rather than waiting to see whether contractions begin.

What happens if labour still doesn't start?

If contractions don't begin naturally, your maternity team will talk with you about what happens next.

One of the considerations after your waters have broken is infection. The longer the membranes have been ruptured, the more this becomes part of the conversation.

Depending on your circumstances, you may be offered induction of labour rather than continuing to wait indefinitely for contractions to begin naturally.

If induction is recommended, it is okay to ask questions.

Why is induction being recommended now? What are the benefits of waiting longer? Are there additional risks in my particular situation? What would induction involve? How will my baby and I be monitored?

Understanding why something is being recommended can make decisions feel much less overwhelming.

And what if contractions do start?

If contractions begin while you're waiting, pay attention to how they're changing rather than focusing only on the clock.

Early contractions may be irregular and manageable before gradually becoming stronger, longer and closer together as labour establishes.

Follow the plan you've discussed with your midwife about when to call again or when to come into your planned place of birth.

And remember, you can always call sooner if something changes or you're unsure.

The big takeaway

Your waters breaking doesn't always mean you'll immediately be having strong contractions and heading off to have your baby.

Sometimes labour gets underway fairly quickly. Sometimes your body takes a little longer.

If you think your waters have broken, let your midwife know. Pay attention to your baby's movements, notice the colour and smell of the fluid and follow the advice you've been given about what happens next.

Most importantly, you don't have to work out whether something is “important enough” before asking for help.

If you're sitting at home thinking, I'm really not sure about this, that's a perfectly good reason to pick up the phone and check.