As you get closer to your due date, you might be feeling anxious about your water breaking when you’re out and about. But what exactly does it mean when it “breaks”?
Your baby is surrounded by amniotic fluid — your “water.” It’s contained in a sac inside your uterus. When this sac breaks, it typically happens soon before or during labor. If it breaks before your contractions begin, it’s called premature rupture of membranes (PROM).
Here’s the thing: PROM only happens in
That said, here’s what you need to know about how PROM might affect the timing of your labor and delivery.
Amniotic fluid is made up of hormones, nutrients, and antibodies. It’s a protective cushion for your baby that starts collecting around 12 days after conception. Your baby actually drinks the water-like fluid — and eventually pees into it as well.
The fluid is responsible for keeping your baby warm and for helping develop their lungs, digestive system, and even musculoskeletal system.
But after week 23, your baby doesn’t rely as much on the amniotic fluid for survival. Instead, they receive nutrients and oxygen from your placenta. In later pregnancy, the amniotic sac serves more as protection only. If the sac is broken, your baby is more prone to infection and other risks, like cord prolapse.
How long a baby can live once your water breaks depends on a number of factors, so there’s really no straight answer with all things considered.
- In cases where your baby would be premature, they may survive just fine for weeks with proper monitoring and treatment, usually in a hospital setting.
- In cases where your baby is at least 37 weeks, current
research suggests that it may be safe to wait 48 hours (and sometimes longer) for labor to start on its own. (But your caregiver may have a different protocol, like 24 hours.)
The key is monitoring. If your water breaks and you don’t get medical attention, your baby could face some serious risks and even die. You, too, are at risk of infection and other complications.
Related: How do babies breathe in the womb?
In later pregnancy, you likely have a lot of discharge and other leaks going on. You may even have trouble telling if your water has broken or if you’ve simply peed yourself. (It happens more than you’d think!)
The basics
Why might your water break before you’re in labor?
Possible risk factors include:
- natural weakening of the sac from contractions
- uterine infection
- chlamydia, gonorrhea, and other sexually transmitted infections (STIs)
- history of preterm birth
- smoking cigarettes
- socioeconomic status (not enough prenatal care)
Signs your water has broken:
- feeling of wetness in your underwear/vagina
- constant leaking of fluid, small or large amounts
- intermittent leaking or gushes of fluid, small or large amounts
- seeing fluid that is either clear or light yellow in color
- observing fluid that is odorless (urine typically has some odor)
If you’re unsure, call your doctor or labor and delivery unit. Your medical team may suggest you get your discharge tested (using special papers that show pH levels) to see if it’s amniotic fluid or something else. You may also have a physical exam, ultrasound, or other tests to assess the situation.
What happens next
Once confirmed, your care provider will take into account the following before creating your game plan:
- your baby’s presentation (head down, breech, etc.)
- your current health status (signs of infection)
- your baby’s current health status (signs of distress)
- any risk factors (group B strep, for example)
The likely scenario you’ll face is being given the option to induce or augment your labor using pitocin and other interventions. Alternatively, if you have no risk factors, you may be given a short window of time in which you can wait and see if labor will start on its own.
Labor will begin naturally within 24 hours for a majority of women.
With this data in mind, you may have heard that doctors will give you just 24 hours before trying induction techniques.
Again, remember: After your water breaks, your baby is supported by the placenta for oxygen and other needs. The main concern of your water breaking early is infection for both you or your baby.
While more and more
If you have no risk factors, your doctor may follow what’s called “expectant management.” This basically means you’ll wait and see if/when your labor begins on its own.
This management and exact timeframe may vary from provider to provider. You’ll likely have your temperature taken regularly (as well as other signs, like white blood cell count) to monitor for infection.
If you’re positive for group B strep (GBS), your doctor will probably recommend you begin antibiotics upon your water breaking to protect your baby from infection. Augmenting labor is also more likely in this scenario since the potential for complications is higher.
In one
PROM is labeled as the cause of 0.8 percent of stillbirths. The main way this happens is through bacterial infection that goes up the vaginal canal and reaches the uterus. Logically, the longer it takes to deliver your baby, the more opportunities there are for possible infection.
Interestingly,
Researchers concluded that stillbirth (and other concerns) aren’t necessarily reasons to induce after PROM if there are no other risk factors.
Related: Understanding and recovering from stillbirth
In reality, PROM really is a dance of sorts. Your healthcare provider must balance the benefits and risks. So, the approach you follow in this scenario has a lot to do with your doctor, your hospital’s procedures, and your individual health.
For this reason, you may want to discuss the course of events with your doctor to know what to expect if your water breaks before your contractions begin.
When it comes to PROM after 37 weeks, the American College of Obstetricians and Gynecologists (ACOG) recommends labor induction for women who plan to birth vaginally. However, they do explain that doctors can present the idea of “limited” expectant management for between 12 and 24 hours with continual monitoring.
The ACOG also states that women who are GBS positive should be given antibiotics when admitted to the hospital. And while GBS-positive women may follow expectant management, many caregivers and women choose to augment labor without waiting.
While less common (and more present in literature outside the United States), your caregiver may give you up to 96 hours after your water breaks to begin labor on your own. This is, of course, if you aren’t showing signs of infection and your baby shows no signs of distress.
Related: How to prepare for labor induction
The risk of infection can be for either mom or baby. Fortunately, doctors and nurses know what to look for and will watch you carefully and act accordingly.
If you choose to labor at home (with guidance from your caregiver), you may want to familiarize yourself with signs of infection so you can get prompt medical care when needed. Chorioamnionitis, for example, is an infection of the uterus. It doesn’t cause symptoms in every case.
Possible signs of infection include:
- fever
- fast heart rate (in either the mom or baby)
- sweating
- tenderness around the uterus
- pain that’s constant (not passing contractions)
- foul-smelling discharge
While in the hospital, your doctor can monitor your temperature, heart rate, and other vital signs. Your baby will also be monitored (using an external or internal fetal monitor) during this time to look for signs of distress, like:
- fast heart rate
- slow heart rate
- decelerations
- decreased movements
Call your doctor right away if the fluid you see is green, yellow, or tinged with blood/brown. These may be signs of infection or that your baby has had a bowel movement (meconium), which may cause issues with breathing after birth.
Related: Natural ways to induce labor
It’s possible for your water to break before you reach 37 weeks in your pregnancy. This is called preterm premature rupture of membranes (PPROM) and it’s responsible for up to
The course of action here is a different balancing act than with PROM, because doctors must weigh the benefits versus risks of delivering a baby early versus exposing them to infection and other complications.
If your water breaks before week 37, you’ll likely be admitted to the hospital for monitoring. Your amniotic fluid is continually regenerating, so being hydrated and staying in bed may buy you some time.
In a few cases, the break in the sac may seal back up on its own. In others, you may need to deliver your baby sooner than you may have expected.
The good news is that you may be able to cook baby a bit longer while being hospitalized and monitored. Before your baby is born, doctors can give you medication to prevent infection as well as steroids to help your baby’s lungs develop.
If everything is stable, you may deliver at around 34 weeks. If you have complications, your doctor may choose to deliver you before this milestone.
Related: Second trimester pregnancy complications
Unfortunately, there’s really nothing you can do to prevent your water breaking prematurely. However, some
Be sure to keep an eye on the discharge/fluid you have throughout your pregnancy. Your doctor’s office has likely fielded thousands of false alarms before, so don’t worry about bugging them if you’re concerned or have questions.
And if your water has broken, work together with your doctor to decide what birth plan is right for you. In cases where you’re low risk, as long as you are regularly monitored, you can wait within reason for labor to start on its own. Otherwise, there are other options in place to get your baby into your arms safe and sound.
