Waters Breaking – What To Do

According to popular movies and drama shows, labour always starts with a pop – the heavily pregnant woman’s waters break and there’s a sudden puddle to deal with.

You might be feeling nervous about going into public at the end of your pregnancy incase your waters break, but in actual fact your labour is much more likely to begin with contractions.

Around 10-15% of women experience a rupture of the membranes (ROM) at the start of labour. Even so, those women rarely deal with a large puddle of fluid. In most cases the waters slowly leak rather than gush. Whether a gush or a slow leak, this happens most often overnight or as you get up in the morning, so it’s a good idea to put a waterproof mat on your mattress just in case.

One mother explains her experience, “I woke up at 1am to go to the toilet, still three weeks away from my due date. I went back to bed, and as I was falling asleep my waters broke. In my tiredness I actually thought I was wetting the bed! I got up and walked to the shower where they gushed. My husband was at work, so I called him to come home. Contractions started a couple of hours later.”

When Do Your Waters Break?

Your baby’s growing in a sac surrounded by amniotic fluid. This sac and fluid protects your baby from infection, provides lubrication for growth and movement, and provides a warm overall protected environment.

As your baby gets close to being born, they usually assume a head down position head low in your pelvis – this is called engaging. The fluid between your baby’s head and your cervix is called the forewaters, and the fluid above your baby’s head is called the hindwaters.

For most women the amniotic membrane ruptures just before the pushing stage of labour, when your cervix is fully dilated. This is due to the pressure of your baby being pushed down.

If your baby is head down and engaged, only the forewaters can escape. This is usually seen as a small gush or trickle – the hindwaters are blocked from gushing by the baby’s head. If contractions begin and labour progresses, eventually the hindwaters will begin to leak, squeezed out in trickles or gushes.

It’s possible to have a hindwater leak, which may even reseal and stop leaking. This is more common if contractions don’t start after the amniotic sac ruptures.

If the waters break and the baby is high (not engaged) there’s a risk of cord prolapse, where the cord comes out before the baby’s head. This is an uncommon but serious situation, and requires immediate help.

While there’s no way to know when your water will rupture, there’s no need to confine yourself indoors just because you’re close to your estimated due date. It’s normal to feel anxious about the possibility of your waters breaking, but be assured for most women it isn’t a dramatic scene.

Being prepared for the possibility of an unexpected rupture might help alleviate some anxiety. Be prepared by keeping a stash of pads handy and towels in your car. Some new mothers have reported the waters seeping into the cars eat can cause a smell, and it can apparently erode the internal parts of your seat.

Signs Your Waters Have Broken

When the waters break, some women hear a pop sound, but some don’t. There may be a gush or just a trickle – it’s different for everyone.

The following are good indictors that your waters have broken:

Having no control over the flow of fluid
A panty liner is inadequate to absorb the fluid
The pad is wet more than once, needing to be replaced
The fluid is odourless and doesn’t smell like urine.

If your waters have broken, they should be clear or have a slight pink tinge to them. If there is a green, brown or other colour present contact your doctor or midwife immediately. Some women describe their waters smelling a bit like semen, so if you do notice a smell, mention this to the midwife.

What Happens After Your Water Breaks?

If you think your waters have broken, make a note of the time and pop on a pad (don’t use tampons).

Call your midwife or maternity ward. They will ask you a few questions to determine if your waters have broken and what to do next. There’s no need to feel embarrassed if it turns out you have had a bladder leak – it’s a common occurrence during late pregnancy.

Waters breaking doesn’t mean contractions will start fast and furious immediately. So if you are out or on your own, don’t panic. You are likely to have some time before active labour begins.

Amniotic fluid constantly replenishes itself so there’s no need to worry that you’ll have a ‘dry birth’. It’s important to remember once the amniotic sac has ruptured there is a risk of bacteria reaching your baby. Avoid having sex or inserting anything into your vagina (like tampons). You can have a bath if you wish.

How Long Will It Take For Contractions To Start?

When your waters break, contractions may or may not start right away. Some women may start to feel a ‘period pain’ sensation, which gets stronger and progresses to contractions.

Some women will wait for hours after the waters break before they feel any contractions. Some will even wait for days. In most cases contractions will start within 24-48 hours after waters breaking.

In some situations, contractions might not begin or are very irregular and spaced out. This may happen because the baby is malpositioned (posterior or head not in the best position). If this occurs then labour may be artificially started (induced). If this does happen to you, it doesn’t mean your body has failed or doesn’t know how to birth.

Most importantly, it doesn’t mean it will happen next time. So don’t blame yourself – malposition can be nothing more than bad luck! Read more about optimal fetal positioning and how you can help baby get into the best position for labour.

Waters Breaking And Infection

Once the waters have broken, the seal around your baby is no longer there to prevent bacteria reaching your baby.

For this reason, vaginal examinations are best avoided once your waters have broken. Even if your midwife or doctor is wearing gloves, there is the potential that bacteria can be pushed upwards towards the cervix. There’s also a risk of infection if an instrument such as an internal scalp monitor is used. These monitors are inserted into the vagina and clipped to your baby’s head, which allows bacteria to be pushed up as well.

If your waters are broken artificially to start labour, you may be told you need have antibiotics immediately or within 4 or so hours to prevent infection. You can ask to be monitored for signs of infection (increasing temperature) instead of opting for antibiotics straight away. Research is showing the use of antibiotics during labour is impacting babies’ future health.

Speeding Up / Inducing Labour By AROM (Artificial Rupture Of Membranes)

Some doctors or midwives will suggest breaking your waters to speed up labour if it has slowed or stalled. There’s actually little to no evidence that breaking your waters will speed up your labour. There’s also no evidence that a shorter labour is better for mother or baby. There is evidence that it does increase the risk of infection and also cord prolapse, which is a medical emergency.

If your waters are broken too early, there is the possibility that labour slows down or doesn’t change pattern. If this is the case, you may require antibiotics and need labour artificially started/augmented by artificial oxytocin. This drug is usually given via an IV drip and your baby needs to be monitored constantly, in case the contractions are too strong. You’re more likely to be lying down and restricted in movement. While contractions may get under way, you are more at risk for further interventions such as an assisted birth or c-section.

Find out more about the difference between natural labour and induced labour.

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If your waters break remember to stay calm. This is just the beginning of a process that can last anything from minutes to days before contractions actually begin. Get as much rest as you can. Don’t be tempted to be climbing the stairs or bouncing on your birth ball in an attempt to ‘get things going’. Your contractions will begin when the time is right and you don’t want to go into labour already exhausted.

If you know what your care giver or hospital policy is for time after waters breaking is, you can ask for more time. If you and your baby are healthy you may be able to continue to monitor your temperature and have daily wellness checks. It can be difficult to negotiate hospital policies but taking a wait and see approach might be the best option for you.