“My Water Broke at 20 Weeks”: PPROM, Infection After Cerclage and What Happens Next
In this guide
If your waters broke at 18, 20 or 22 weeks, with or without a cervical stitch, this guide is for you. It explains what PPROM is, what should happen in hospital, the decisions you may be asked to make, whether a stitch should stay in, and the signs of infection that need acting on fast. It also explains when care after the waters break may have fallen short.
Quick answer · updated November 2026
If your waters break early, call your hospital straight away and go in. You should be examined, given antibiotics, and watched closely for infection. Before about 23 weeks you’ll be asked to make hard decisions, with counselling. If you have a stitch, its removal should be discussed. Infection signs need acting on the same hour.
After your waters break, stage by stage
- 1The momentA gush or a trickle. Call, put on a pad, go in.
- 2AssessmentSpeculum examination, swabs, scan and antibiotics.
- 3The decisionsWaiting or birth, steroids, and the stitch.
- 4WatchingTemperature, pulse, tummy and discharge, every day.
- 5What comes nextBirth, NICU or going home, and the questions after.
At any stage: you can ask, “What are my options, what are the risks of each, and can I have time to decide?”
I’m an emergency nurse, so I knew what it was before I’d even looked down. I was standing at the medication room bench at twenty weeks and four days, the stitch in since sixteen weeks, and there was a warm rush and then the slow, unstoppable trickle. Clear. Sweet-smelling. Not urine.
A colleague drove me over. In the birth unit they did a speculum and the registrar said, gently, “Your waters have gone, and there isn’t much fluid around the baby.” Then the words I’d only ever said to other people: options, prognosis, comfort care.
We chose to wait. They started erythromycin, and every morning someone listened to her heartbeat on the Doppler, galloping along like nothing had happened.
On the fourth night I woke up shivering. I asked for my obs. Thirty-seven point nine, pulse one-twelve. The midwife said, “It’s warm in here, love. Let’s recheck in four hours.” I knew. I said so. I was the patient, though, not the nurse.
Our daughter was born at twenty-one weeks and one day, in the early afternoon. She lived for a little while, on my chest.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
If you are reading this in a hospital bed with a pad and a monitor, I am so sorry you are there, and I hope this helps you understand what is happening and what to ask. If you are reading it afterwards, I hope it helps you make sense of what happened, and whether it should have gone differently.
This article is part of a series on failed cerclage and second-trimester loss. It covers what to do when your waters break early, what should happen in hospital, the decisions around 20 to 24 weeks, what happens to a stitch, the signs of infection, and how the law looks at care after the waters break.
Why I can write this
I have been a medical negligence lawyer since 2013 and have worked on many hundreds of claims, a great many of them about pregnancy and birth. My doctorate looked at patterns of failure in medical negligence. I am not medically qualified. Clinical facts here are checked against Pregnancy, Birth and Baby, the Australian Government-funded information service, and a published NSW hospital procedure for preterm prelabour rupture of membranes, and every source is listed at the end. If your waters have broken, please contact your hospital now rather than relying on this article.
Start with your question
- My water broke at 20 weeks: what do I do?
- What is PPROM?
- What should happen in hospital?
- What decisions will I have to make?
- What happens if your water breaks with a cerclage?
- What are the signs of infection after the waters break?
- When is it negligence?
What PPROM is
Definition
PPROM, preterm prelabour rupture of membranes, is when your waters break before 37 weeks of pregnancy and before labour starts [1]. Pregnancy, Birth and Baby says it happens in about 4 in 100 pregnancies, and that once the sac has broken it can’t be closed [1].
In plain terms: the bag of fluid around your baby has opened months too soon, before labour.
At 20 weeks, PPROM is far rarer than that figure suggests, and far more serious. The fluid protects your baby from infection, cushions the cord, and helps your baby’s lungs develop. Pregnancy, Birth and Baby lists the main risks as infection inside the uterus, cord prolapse, premature labour, underdeveloped lungs (pulmonary hypoplasia), and the placenta separating early [1].
A stitch and PPROM are closely linked. A stitch can’t stop the membranes breaking, and if the cervix has already started to open, the membranes are more exposed. Waters breaking is also one of the main ways a stitch “fails”, as the hub article “What Happens If a Cerclage Fails?” explains.
My water broke at 20 weeks: what to do
If your waters break early
- Call your birth unit or doctor straight away, and go in
- Put a clean pad on, not a tampon, so the fluid can be checked
- Notice the colour: clear or pink is usual; green, brown or bright red needs urgent attention
- If you feel something in your vagina, call 000 and get on your hands and knees, bottom in the air
- Don’t wait to see if it stops, even if it’s only a trickle
- Tell them if you have a stitch, and how many weeks you are
In plain terms: a trickle counts. You don’t need to be sure to be checked.
Source: Pregnancy, Birth and Baby, Waters breaking early, last reviewed September 2025 [1]. Feeling something in the vagina can mean the cord has come down, which is life-threatening for your baby.
It can be hard to tell a slow leak from urine or discharge, especially with a stitch, which can cause more discharge than usual. That is exactly why it should be tested. Pregnancy, Birth and Baby notes that a doctor or midwife can test the fluid [1]. If you are told “it’s probably just discharge” without an examination, it is reasonable to ask to be checked. The series article “How Do You Know If Your Cerclage Is Failing?” explains how to escalate if you aren’t being heard, including NSW Health’s Raise It line, 1800 777 333 [2].
What should happen in hospital
A published procedure from a Sydney women’s hospital sets out the usual steps [3]. It is a local document, last approved in 2016, so practice in your hospital may differ in detail, but the shape is widely shared:
- A speculum examination, with swabs, rather than a finger examination, which is avoided unless labour is suspected.
- An ultrasound to check your baby’s position and the fluid around them, and a urine test.
- Screening for infection, including your temperature and pulse, and your baby’s heart rate.
- Antibiotics. The procedure uses oral erythromycin for 10 days if there are no signs of infection, and intravenous antibiotics if there are [3]. Pregnancy, Birth and Baby confirms antibiotics are offered to prevent infection [1].
- Counselling about the risks, how long the pregnancy may continue, and your options.
Pregnancy, Birth and Baby notes that about 1 in 2 people with PPROM go into labour within 24 to 48 hours, and most within 7 days [1]. Some pregnancies continue much longer.
The decisions around 20 to 24 weeks
The care you are offered depends heavily on how many weeks pregnant you are. The NSW procedure sets out different approaches by gestation [3].
Under 20 weeks
With very little fluid, counselling on a poor outlook; induction advised, with a second opinion if you want to wait.
20 to 22+6 weeks
Induction discussed; a specialist second opinion and newborn team consultation if you want to wait.
23 to 25+ weeks
Counselling on risks for you and your baby; the newborn care team told; monitoring individualised.
24 to 34 weeks
Steroids for your baby’s lungs, when active care is planned; magnesium sulphate considered if birth is near at 30 weeks or less.
Based on a NSW hospital procedure, 2016 [3]; Pregnancy, Birth and Baby also describes steroids and, under 30 weeks with birth expected within 24 hours, magnesium sulphate to help protect the baby’s brain [1]. Your hospital’s thresholds may differ.
Definition
Expectant management means waiting, with monitoring and antibiotics, to give the pregnancy more time. Induction means starting labour with medication.
In plain terms: before about 23 weeks, families are often asked whether to wait or to end the pregnancy now. There is no right answer, only the one that fits your values, with honest information about the risks.
These conversations should be unhurried, with a senior obstetrician and, where active care is possible, a neonatologist. You are entitled to understand the risks to you as well as your baby: waiting can mean a serious infection for the mother. You are also entitled to time, to ask questions, and to a second opinion. If you felt rushed, or felt the decision had been made for you, that is worth noting. What happens if your baby is born at the edge of viability is covered in “Baby Born at 22 Weeks”.
Questions to ask
- “What are the risks to me if we wait, and to my baby?”
- “How much fluid is there around the baby?”
- “Can I speak to a neonatologist, and a senior obstetrician?”
- “If we wait, what will you check each day, and what would make you recommend birth?”
- “Can I have time to decide, and a second opinion?”
What happens to the stitch
This is one of the most common questions people search, and the evidence is genuinely uncertain.
What one NSW procedure says
Recommend removing a stitch that can be reached through the vagina. The trial behind it showed no clear difference, but a trend towards less infection with removal straight away [3].
Because the evidence is uncertain, this is exactly the kind of decision that should be discussed with you, with the reasons explained, the options set out, and your view recorded. A UK hospital leaflet, for example, tells women the stitch will still be removed to lower the risk of infection, and that their doctors will decide when [6]. If your stitch stayed in for days after your waters broke and no one explained why, or it came out with no discussion, that’s worth asking about.
The signs of infection
Definition
Chorioamnionitis is infection and inflammation of the membranes around the baby and the amniotic fluid.
In plain terms: an infection inside the womb, around the baby. It is the main danger after the waters break early, for mother and baby.
A raised temperature
The NSW procedure lists a temperature above 37.5°C [3]. Shivering or chills count.
Ask: “What’s my temperature?”
A fast heart rate
Yours, or your baby’s, on the monitor or Doppler [3].
Ask: “What are my pulse and the baby’s heart rate?”
Tummy and discharge
A tender uterus, or smelly or changed discharge or fluid [3].
Say: “Something smells different.”
The procedure says that if there are clinical signs of infection, birth should be advised, by induction or caesarean depending on the circumstances, and antibiotics given intravenously [3]. Infection can move quickly. A temperature of 37.9 with a fast pulse is not a “recheck in four hours” finding after PPROM; it needs a doctor. If you are in a NSW public hospital and worried that you are getting worse, you can ask for a clinical review and then call Raise It on 1800 777 333 [2].
What comes next
Some families go home after a few days of monitoring, if there are no signs of labour or infection; Pregnancy, Birth and Baby notes that some can go home after 72 hours [1], and the NSW procedure describes outpatient care for selected women with close follow-up [3]. Some go into labour within days. Some babies are born too early to survive, and some are born alive and go to a neonatal intensive care unit. Whatever happened, the placental pathology report is important: it usually shows whether infection was present, and when.
If your baby was born at or after 20 weeks without signs of life, the law treats it as a stillbirth; if your baby was born alive at any gestation, both the birth and any death are registered. The series article “Is 20 Weeks a Miscarriage or a Stillbirth?” covers what that means for certificates, leave and payments, and Red Nose has information on your rights and decisions when a baby is born still or dies soon after birth.
Eight months later I asked for the records. I told myself it was professional curiosity. It wasn’t.
The obs chart was there. 0200: temp 37.9, HR 112. A note: “Pt feels warm, room warm. For recheck.” The next set was at 0610: 38.6, 128. The registrar was called at 0640. The stitch had stayed in for four days. I searched the notes for a discussion about it, about why, about whether. There wasn’t one.
When the independent obstetrician’s report came, I read it twice. It said, carefully, that a raised temperature with a fast pulse after PPROM should have led to a medical review at the time, and that keeping the stitch in should have been discussed with me. It didn’t say anyone was careless or unkind. It said what should have happened.
I’ve taken obs a thousand times on other people. I still do. But now when a patient says, “I feel wrong,” I write it down, and I call someone.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
What to look for in the records
| Record | Why it matters |
|---|---|
| Phone or triage notes | Shows when you rang, what you described, and whether you were told to come in. |
| Admission and speculum findings | Shows how PPROM was confirmed, what the cervix looked like, and whether the stitch was visible. |
| Ultrasound reports | Shows the fluid around your baby and their position. |
| Counselling notes and consent forms | Shows which options were explained, by whom, and what you chose, including about the stitch. |
| Medication chart | Shows when antibiotics, steroids or magnesium were given, and whether doses were missed. |
| Observation charts | Temperature, pulse and your baby’s heart rate over time, and how quickly changes were acted on. |
| Swab and blood results | Shows signs of infection, and when the results came back and were read. |
| Medical review and escalation notes | Shows when a doctor was called, and why. |
| Birth and stitch removal notes | Shows when the stitch came out, the timeline of labour, and your baby’s condition at birth. |
| Placental pathology | Usually shows whether infection was present, which often decides causation. |
My guide to getting and reading your birth records explains how to request them, and the Information and Privacy Commission explains your right to your own health information in NSW [7].
How the law looks at it
PPROM itself is usually no one’s fault. The legal questions are about what happened afterwards.
Standard of care. Under section 5O of the Civil Liability Act 2002 (NSW), care isn’t negligent if it was widely accepted in Australia by peer professional opinion as competent practice [8]. Hospital procedures like the one cited here are evidence of competent practice, not the law itself. An expert would ask, for example, whether you were assessed promptly when you rang, whether antibiotics were started, whether infection was screened for and acted on, and whether steroids were given when active care was planned.
Causation. The law asks whether better care would probably have changed what happened. A lost chance alone isn’t enough: Tabet v Gett [2010] HCA 12 [9]. After PPROM at 20 weeks, this is often the hardest question. Earlier recognition of infection may have protected the mother from a serious illness even if it couldn’t have saved the pregnancy, and that can matter too.
Consent. Under Rogers v Whitaker [1992] HCA 58, you are entitled to be told about material risks and reasonable options [10]. After PPROM, that includes the choice between waiting and induction, the risks of each to you and your baby, and what would happen to the stitch.
Who can claim and when. The mother may claim for her own injury, including a serious infection; the family if a baby was born alive and died; or the child, if a baby survived with lasting injury. If your child was born early, their time limits don’t always wait until they turn 18, so please ask early. The series article “Can I Sue the Hospital for My Miscarriage or Stillbirth?”, my page on pregnancy loss and stillbirth claims and my guide to time limits in NSW explain more.
In my practice
PPROM files are often about hours, not weeks. The pattern I see is a slow drift of observations: a temperature a little up, a pulse a little fast, a note that the room is warm, a plan to recheck. Then a jump. The chain is short and very human: a woman who says she feels wrong, a busy night shift, a chart that isn’t trending in one place, an escalation threshold that is technically not yet met. The other recurring gap is the stitch: a decision with real uncertainty, made by default rather than with the woman. Not every one of these files shows negligence. Sometimes infection was there from the start, and nothing done in those hours would have changed what happened. But the records almost always show whether the woman’s own words were heard.
Both can be true
The midwife who sat with you through the night may have been kind and exhausted, and the observations may still have needed escalating sooner. A decision to wait may have been the right one for your family, and the risks may still not have been explained properly. You can hold both. Asking what happened isn’t an accusation; it is how the next woman’s temperature gets a doctor, not a recheck.
The bigger picture
Antenatal steroids and magnesium sulphate are now standard in Australian preterm care, and both depend on recognising early who is likely to give birth soon [1]. RANZCOG’s cervical length statement notes that an internal scan is safe even after the waters have broken [11]. Whether a stitch should stay in after PPROM remains an open research question [4], which makes how that decision is shared with women all the more important. NSW Health has supported patients and families to escalate concerns about deterioration since 2013, now through Raise It [2]. In NSW, the Select Committee on Birth Trauma reported on 29 May 2024, with 43 recommendations [12]. If you have concerns about a practitioner or service, the Health Care Complaints Commission can receive a complaint.
Support
These services are free.
- Miracle Babies Foundation NurtureLine, 24-hour support for families with a threatened pregnancy or a baby in NICU: 1300 622 243 [13]
- Red Nose Grief and Loss, 24/7 support after pregnancy loss, stillbirth or the death of a baby: 1300 308 307 [14]
- Bears of Hope, pregnancy and infant loss support: 1300 11 4673 [15]
- Pregnancy, Birth and Baby, a free call with a maternal child health nurse: 1800 882 436
- PANDA, the National Perinatal Mental Health Helpline: 1300 726 306 [16]
- Lifeline, if you are in crisis: 13 11 14
My guide to finding support after birth trauma in Australia has more.
The nurse in the stories still works nights. She keeps a photo of her daughter’s tiny hand in her locker, and she has stopped waiting four hours to call someone when a patient says they feel wrong.
With care,
Rosemary
Frequently asked questions
What do I do if my water breaks at 20 weeks?
Call your birth unit or doctor straight away and go in, wearing a pad. If you feel something in your vagina, call 000 and get on your hands and knees.
Can a baby survive if your water breaks at 20 weeks?
Sometimes the pregnancy continues for weeks and the baby survives, but the risks are high, especially with very little fluid. Your team should explain your specific situation and options.
What happens if your water breaks with a cerclage?
Removal of the stitch should be discussed. One NSW procedure recommends removing a stitch that can be reached vaginally, but research hasn’t settled the question, so the reasons should be explained to you.
What are the signs of infection after your water breaks?
A raised temperature or chills, a fast pulse in you or your baby, a tender tummy, and smelly or changed discharge. Any of these needs a doctor promptly.
Will I be given antibiotics?
Usually, yes. Antibiotics are offered after PPROM to reduce the risk of infection.
Can I go home after my waters break?
Sometimes, after a few days of monitoring with no signs of labour or infection, and with close follow-up. Some women stay in hospital until birth.
Questions about care after your waters broke?
When you’re ready, and not before, I can go through what happened and your records with you, and tell you honestly whether there are questions worth asking.
When the Stitch Doesn’t Hold: the series
- “What Happens If a Cerclage Fails?” Failed Cerclage and Losing a Baby in the Second Trimester
- “Can I Sue the Hospital for My Miscarriage or Stillbirth?” Time Limits and Compensation After a Second-Trimester Loss
- “Do They Check Your Cervix at the 20-Week Scan?” Short Cervix, Funnelling and Missed Risk Factors
- “How Do You Know If Your Cerclage Is Failing?” Signs of a Failing Stitch or an Incompetent Cervix, and When They’re Brushed Off
- “Emergency Cerclage at 20 Weeks”: Rescue Stitches, Bulging Membranes, Risks and Success Rates
- “My Water Broke at 20 Weeks”: PPROM, Infection After Cerclage and What Happens Next (you are here)
- “Baby Born at 22 Weeks”: Survival Rates, NICU and Comfort Care
- “Is 20 Weeks a Miscarriage or a Stillbirth?” Giving Birth, Funerals, Certificates, Leave and Payments
- “Why Am I So Angry After My Miscarriage?” Anger, Blame and “Is It My Fault?” After a Second-Trimester Loss
- “Transabdominal Cerclage in Australia”: Before Pregnancy, Success Rates and When It Fails
- “Pregnant Again After a Second-Trimester Loss”: How Long to Wait, a Preventative Stitch and Progesterone
More: Pregnancy loss and stillbirth claims · Birth trauma and obstetric negligence · HIE after birth · Asking for a birth debrief · Complaining to a hospital
References
- Pregnancy, Birth and Baby (healthdirect Australia), Waters breaking early, last reviewed September 2025.
- NSW Health, Raise It; Clinical Excellence Commission, REACH and Raise It.
- South Eastern Sydney Local Health District (Royal Hospital for Women), Rupture of membranes – preterm prelabour – assessment and management, local operating procedure, approved October 2016.
- Story L, Shennan A, Cervical cerclage: an evolving evidence base, BJOG 2024;131(12):1579–1586.
- Women and Newborn Health Service (King Edward Memorial Hospital, WA), Cervical cerclage: patient information, 2025.
- University Hospitals of Leicester NHS Trust, Having a cervical stitch (cerclage) in pregnancy, 2024.
- Information and Privacy Commission NSW, Fact sheet: Accessing your health information in NSW.
- Civil Liability Act 2002 (NSW), s 5O.
- Tabet v Gett [2010] HCA 12.
- Rogers v Whitaker [1992] HCA 58.
- RANZCOG, Measurement of cervical length for prediction of preterm birth (C-Obs 27), current November 2021.
- NSW Legislative Council Select Committee on Birth Trauma, Birth trauma, Report 1, May 2024.
- Miracle Babies Foundation, NurtureLine.
- Red Nose, Grief and Loss Support Services.
- Bears of Hope Pregnancy & Infant Loss Support, bearsofhope.org.au.
- PANDA, National Perinatal Mental Health Helpline.
The stories in this article are composites, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. They do not describe any individual client.
About the author
Dr Rosemary Listing, PhD (Law), specialises in medical negligence, has been in practice since 2013, and is Of Counsel at Peter Evans & Associates in Newcastle, NSW. Her doctorate looked at patterns of failure in medical negligence, and she teaches health law at the University of Newcastle. She is not medically qualified; clinical information in this article is checked against the sources listed.
Last updated: November 2026 · First published: November 2026 · Next review: May 2027
Cite this article: Rosemary Listing, ‘“My Water Broke at 20 Weeks”: PPROM, Infection After Cerclage and What Happens Next’ (Reframe Legal, November 2026) <https://reframelegal.com/water-broke-at-20-weeks/>.
This article is general information, not legal or medical advice. Every situation is different; please get advice about your own circumstances. If your waters have broken, contact your hospital now. If you or your baby need urgent help, call 000. If you are in crisis, call Lifeline on 13 11 14.
Legal services are provided by Peter Evans & Associates.
