The Waters Have Gone - What Now?
Once it is confirmed that your waters have gone, your obstetrician will discuss with you the plan until delivery. There is no simple definition of what is the right thing to do, and it will depend very much on exactly how far on the pregnancy is and if there are any signs to suggest the presence of infection.
Infection is the main risk to the continuing pregnancy once premature ruptures of the membrane (PROM) is confirmed.
The amniotic membranes and liquor represent a formidable barrier to infection, and now bacteria may work their way from the lower genital tract into the womb, causing infection around the baby.
The other main risk to the baby is that of prematurity, should she be born now. Prematurely born babies face several problems, the most severe of which can be breathing difficulties, as the lungs are not adequately developed.
All the baby's systems are immature and premature infants face many weeks on a special care unit depending on the age at which they are born.
On the whole, the risks of prematurity are the greater of the two, as long as there's no obvious signs of infection - such as a fever, tenderness over the womb, or even pus-stained liquor.
Once infection sets in, the balance of risk is almost always in the other direction and delivery would be expedited - often labour starts itself because of infection, sometimes induction is needed.
How Long Until Labour Starts Naturally?
At the end of pregnancy when the waters go, about 80% of women will start contracting within 24 hours.
The earlier PROM occurs, the longer is the latency period until contractions begin. At 30 to 32 weeks, the average is about one week, and at 25-26 weeks, it is two weeks with half having delivered after the first week.
Can the Membranes 'Reseal'?
Sometimes there can be an ongoing loss of water, but the pregnancy lasts until term. 'Resealing' of the membranes is also possible: one study found this to happen in three of 31 women (9.7%) with PROM at less than 26 weeks and five of 189 (2.6%) at 26 to 34 weeks. So, it does happen, but is unusual.
Steroids and Stopping Labour
Studies have looked at trying to stop labour when it starts after the waters have gone, but there is no real benefit in terms of significant prolongation of the pregnancy.
Steroid injections are prescribed (usually in pregnancies before 34 weeks) to help mature the baby's lungs. They aren't the type of steroids that make you muscular, but they stimulate the baby's lungs to prepare for breathing air.
Should you not go on to deliver, this doesn't do any harm, so there are really no draw backs to having them.
Sometimes drugs are used to stop labour to allow the steroid course to be completed; this normally takes about 24 to 36 hours. Also, labour may be stopped while mum is transferred to a hospital so she is able to deliver a premature infant.