Pregnant parents face many unknowns, and as you reach the end of your pregnancy, worrying about where and when your water will break may rate pretty high on the list. Heard of the pregnant mom who lugged around a glass jar of pickles to drop if her water broke in public?
Contrary to your nightmare scenario, this is one worry that you can put to rest: Most women find that their water breaks after labor is well established. You’ll probably have plenty of forewarning.
What moms call water breaking, medical providers call ruptured membranes. It means that the amniotic sac surrounding your baby has developed an opening, letting out some of the amniotic fluid.
What triggers this? Probably changes in the composition of the membranes and enzymes work in tandem with the pressure of your baby’s head.
Your water will most likely break when you are at full term (at least 39 weeks) while you’re in labor. You can smile… soon your baby will be in your arms!
Premature rupture of membranes (PROM)
However, it’s very important to contact your doc or midwife if your water breaks before labor contractions begin. This is called premature rupture of membranes (PROM) and occurs in only about 8 to 10 percent of pregnancies.
What causes PROM isn’t known for sure. Most women who experience it don’t have any risk factors. Some of the possible causes include:
- an infection in your vagina, cervix, or uterus
- overstretching the amniotic sac, which can happen if there’s too much fluid or you’re having more than one baby
- having PROM with a previous pregnancy
- having surgery or biopsies of your cervix
- smoking cigarettes
Preterm premature rupture of membranes (PPROM)
If your pregnancy is less than 37 weeks and your water breaks, it’s called preterm premature rupture of membranes (PPROM), and it may be serious.
As with PROM, the cause of PPROM isn’t known. Some of the risk factors may include:
- PPROM with a previous pregnancy
- short length of your cervix
- vaginal bleeding in your second or third trimester
- smoking cigarettes
If you’ve felt a small trickle or flow and want to know if your water broke or if you’ve got bladder trouble, here’s how to run a quick check on your own. Just be sure to also call your OB or midwife, who can confirm whether it’s urine or amniotic fluid.
Most likely, you’ll notice that your underwear is wet. A small amount of fluid probably means that the wetness is vaginal discharge or urine (no need to feel embarrassed — a little urine leakage is a normal part of pregnancy).
But hold on, as there is a chance it could also be amniotic fluid. The amount of runaway fluid when your water breaks depends on a few things:
- how much amniotic fluid you have to start with
- where in the sac the rupture is positioned
- whether your baby’s head is low enough in the pelvis to act like a plug
Depending on these factors you may experience a trickle of amniotic fluid instead of what movies have you expecting — a popping sensation and a gush of liquid. If the amount isn’t giving you a clear indication, move on to color.
See a yellowish color? Then you can probably put the wetness on your underwear down to urinary incontinence. And it’s not surprising — your baby’s head is putting a tremendous amount of pressure on your poor bladder.
Does it appear clear to white and bit creamy? Then you’re likely dealing with vaginal discharge. It can feel very liquid when it’s coming out, but it will appear thicker in consistency when it collects.
But what if the color you see is clear or much paler than urine and completely liquid? In this case, you’re probably seeing amniotic fluid. Check with your OB or midwife if you are still not sure.
A green or green-yellow color means that your amniotic fluid has been colored by meconium. This happens when your baby has had a bowel movement. Make sure to let your OB or midwife know as this might affect steps they take during delivery to keep your baby safe.
Urine smells like… urine. It’s hard to miss that acidic smell, right? Amniotic fluid, on the other hand, has no smell or a slightly sweet smell.
If you are not sure, you should consult your medical professional.
If you’ve run through the checklist above and you’re still not sure, here are two more easy ways to help you decide if it’s amniotic fluid or urine.
- Remember the Kegels that you’ve been practicing? Well, it’s time to do a few. If this nifty exercise doesn’t stop the trickle that you feel, you’re probably dealing with broken water.
- Put on clean, dry underwear, add a panty liner, and lie down for about 30 minutes. Notice fluid pooling in your vagina? Feel a larger gush when you stand up again? Then it’s probably amniotic fluid.
If you’re not already in labor, contact your healthcare professional right away.
- Make a note of the time when you first felt the wetness and the color of the fluid.
- Make a mental check of what you need to take to the hospital or birth center and get ready to leave. (Or contact your midwife if you’re planning a home birth.)
- Use panty liners to soak up the wetness.
- Give your doctor or midwife a call to discuss your options.
- Don’t use tampons, take a bath, or have sex. Your amniotic sac has kept your baby protected in a sterile environment. Now that it has ruptured, you need to protect your baby from infection.
On that note, you may want to discuss the necessity of vaginal exams after your water has broken with your healthcare professional. There is no current research, but
Still not sure whether that trickle is urine or amniotic fluid? When in doubt, the best practice is to contact your OB or midwife and discuss your symptoms. Here are three tests that can help you healthcare team determine what that wetness really is:
- Sterile speculum exam. This involves the medical professional having the patient lie down for a while, then inserting a sterile speculum to allow the healthcare professional to examine whether there is pooling of fluids in the back of the vagina.
- Litmus test. This sometimes involves a vaginal exam. Your healthcare professional inserts a small strip of litmus paper or a special swab into your vagina. It changes color when it comes into contact with amniotic fluid, but not with urine. If your underwear or pad is wet enough, your provider might be able to use that fluid without doing a vaginal exam.
- Ferning test. By examining a small sample of liquid on a slide under the microscope, your healthcare professional can tell if the liquid is amniotic fluid or urine. Dry amniotic fluid makes a pattern that looks like a fern leaf.
These three exams may be used in conjunction to diagnose whether your water has broken. Other hospitals may use proprietary tests, but they also involve getting a swab of fluid from the vagina for testing.
If you’re unsure whether your water has broken, be sure to reach out to your midwife or doctor to discuss your concerns.
Because your baby is no longer in the sterile environment provided by an intact amniotic sac, it’s important to give birth soon after your water breaks.
As long as you’re at full term (at least 39 weeks), it may be safe to wait
If you’re at least 37 weeks pregnant and your healthcare professional determines that it’s PROM, they may recommend inducing labor to avoid the chances of infection.
But if you’re less than 37 weeks pregnant and it’s determined to be PPROM, your healthcare professional may opt to stall delivery until your baby is better developed. They may also recommend giving you steroid injections to help your baby’s lungs mature.
If you notice meconium in the fluid (remember that green-yellow color?) or if you’ve tested positive for Group B strep (GBS), call your midwife or doctor.
In the very rare chance that you can feel something in your vagina or notice something at the opening of your vagina, call 911.
While it is highly unlikely, the umbilical cord can enter the vagina ahead of the baby and could be compressed, reducing oxygen to the baby. In medical lingo it’s called a prolapsed umbilical cord and it requires immediate emergency care.
Chances are, if your water does break, it will be a small trickle of fluid and not that gush you see in the movies.
If you haven’t started labor yet or your pregnancy is not at least 39 weeks along, it’s important to contact your OB or midwife.