Your waters have broken: what should you do and when should you call?

When your waters break, you’ll lose amniotic fluid. This can be a sudden gush, or a steady trickle of fluid. Contractions may not start straight away. What you do next depends, amongst other things, on how far along you are in your pregnancy, the colour of the fluid, how you and your baby are doing, and the arrangements you’ve made with your own healthcare provider.

If you are less than 37 weeks pregnant, the fluid is green or brown, or your midwife has told you that the baby’s head has not yet engaged, call your midwife or the hospital straight away, even at night. You should also call immediately if you notice reduced foetal movement, have a fever, feel unwell, experience heavy bright red bleeding, or feel concerned. If in doubt, do not wait for contractions and do not use an online article to delay seeking an assessment.

How can you recognise amniotic fluid?

Amniotic fluid is often clear or slightly whitish, sometimes with white flakes. It can come out suddenly or continue to leak slowly. You usually cannot stop the flow, unlike when you urinate. However, the difference between amniotic fluid and urine or vaginal discharge is not always clear. Nor does the amount of fluid indicate with certainty whether your waters have broken.

If necessary, use a clean sanitary towel so you can check the fluid and its colour. Make a note of when you first noticed it. Call your midwife if you’re unsure; they can assess whether a check-up or examination is needed. You don’t need to be absolutely certain yourself that it’s amniotic fluid.

Should you always ring straight away, even at night?

Follow the personal arrangements you have made with your midwife or hospital. From 37 weeks onwards, if the amniotic fluid is clear, it may sometimes be agreed that you rest at night and ring in the morning, provided that you and the baby are both well. This is not a general permission to wait and see.

Call immediately if any of the signs listed at the top of this article apply, if you have been given specific instructions on when to call, or if you are unsure which arrangements apply to you. Whether the baby’s head has engaged and whether there are any other medical concerns can make a difference. You may also call simply because you need help or reassurance.

Are you having contractions? If so, follow the guidelines for when to call regarding your labour. There is no single fixed rule about the number of minutes between contractions that applies to everyone.

What should you say when you call?

This information helps your healthcare provider assess your situation:

• How many weeks pregnant are you?
• Since what time have you been losing fluid, and is it still coming?
• What colour is it, and has the smell changed?
• Can you feel your baby moving as usual?
• Are you experiencing contractions, bleeding, a fever or any other symptoms?
• What specific arrangements have been made with you previously?

Do you speak very little Dutch? Say straight away which language you understand well. You can start by saying: ‘I am … weeks pregnant. I’ve been losing fluid since … o’clock. I think my waters have broken.’ Ask for a clear explanation and repeat what you have understood about the next step and when you should ring again.

What if you haven’t had any contractions yet?

It may take a while for contractions to start. If you are at least 37 weeks pregnant and both you and the baby are doing well, your healthcare provider can discuss with you whether you can wait and what check-ups are involved.

Ask specifically when the first check-up is, who will be looking after you afterwards, and what you need to keep track of at home. There is no general guideline allowing you to decide for yourself whether to wait 24, 48 or 72 hours. Arrangements vary by region, and your health and that of your baby may mean that action needs to be taken sooner.

If you are less than 37 weeks pregnant, you should be assessed in hospital. Do not apply the ‘wait-and-see’ advice for a full-term pregnancy to this situation.

Why is induction sometimes discussed?

The amniotic sac provides protection against bacteria. Once it has ruptured, the risk of infection may increase, particularly if labour is delayed. That is why healthcare professionals will, at some point, discuss the pros and cons of waiting longer and of induction.

The decision also depends on check-ups and any signs of infection. Ask why a recommendation is being made in your situation, what the alternatives are, and what monitoring will involve if you decide to wait. If you or your baby require extra care, the advice may differ from that given for a pregnancy without such specific circumstances.

Can you shower, have a bath or have sex?

If you are waiting for contractions after your waters have broken, hospitals advise, amongst other things, not to use tampons, not to have sexual intercourse and not to have a bath or go swimming. Showering is usually permitted. Follow the instructions your own healthcare provider gives for your specific situation and check with them if you are in any doubt.

Also discuss whether and how often you should take your temperature. If the fluid changes colour or smell, if you develop a fever, if you feel unwell or if your baby is moving less, call immediately. Do not stick to a previously agreed check-up time if anything changes in the meantime.

Agree when to call before labour starts

During your pregnancy, discuss which number you can call day or night and what your healthcare provider wants you to do if your waters break. Save that number and make sure your support person is also aware of the arrangements.

In module 3 of the course, Geke explains how labour can begin when your waters have broken and how to prepare for calling your healthcare provider. These two lessons are part of the free first three modules. Your healthcare provider’s personal instructions remain the guiding principle.

Find out for free how your labour might start and when to call your healthcare provider (videos in Dutch).