Leaking Amniotic Fluid | Signs, Causes And Treatment

You’ll experience lots of physical changes during pregnancy.

Sometimes it can be hard to know what’s going on with your body.

Leaking fluid, though, will definitely be one of the signs that won’t leave you feeling indifferent.

If the amniotic fluid leak happens when your pregnancy has reached full term, it’s a comforting sign that labour is approaching.

On the other hand, if you are like most women, suspecting you’re leaking amniotic fluid when your baby isn’t ready to come yet will definitely be a worry.

Leaking amniotic fluid

Inside your uterus is the amniotic sac – a closed ‘bag’, formed from membranes. 

The amniotic sac contains the baby, the amniotic fluid, commonly known as ‘water’ and the umbilical cord.

The water serves several purposes during pregnancy. It provides a space for the baby’s physical development, and also protects the baby and the umbilical cord from trauma and compression.

Amniotic fluid also plays an important role in the baby’s digestive and respiratory systems. 

In early pregnancy, amniotic fluid comes from the mother’s body. 

When a baby’s kidneys are fully functional, at around 16 weeks of pregnancy, they become the main producers of this unique fluid.

Wait a minute! Does this mean what it seems to mean? 

Yes, babies drink and pee in their own amniotic fluid while in utero.

You can read more about amniotic fluid here.

What happens if you are leaking amniotic fluid?

When referring to a pregnant woman, the expression ‘waters breaking’ is widely used. Your healthcare provider probably says it too.

As we all know, a fluid doesn’t break. Let’s bring the other protagonist onto the stage: the amniotic sac or membranes.

One of the best ways the amniotic sac protects your baby is by keeping germs out. This reduces the risk of infection while your baby is growing.

After the sac or membrane develops a hole or rupture, the amniotic fluid leaks out.  If the waters break before labour has started it’s called premature rupture of membranes or PROM. 

Don’t be alarmed by the word ‘premature’. It just means the water breakage has happened before labour has started. You might also hear a practitioner, midwife or doctor use the term ‘pre-labour rupture of membranes’ when talking to pregnant women.

As pregnancy reaches full term the part of the baby’s body engaged inside the pelvis will act as a plug. This, and the amount of fluid leaked, help us understand where the membrane rupture has occurred.

If the PROM is followed by a big gush, it means the breakage has happened very low down. 

The amniotic fluid between the baby and the cervix has come out as soon as it is released.

The rupture of membranes can also happen higher than the baby’s head (or bum). 

In this case, the amniotic fluid has to travel further: it must go through the hole between the sac and the uterus, then past the baby’s body part (which acts as a plug), before it comes out. In this case, only a small amount or a trickle of water will be discharged.

Once the premature rupture has occurred, the amniotic fluid behind the baby will continue to leak. 

This will happen as labour contractions start or as the baby moves.

Leaking amniotic fluid or discharge?

Sometimes it can be difficult to know what you are seeing on your underwear, or while wiping yourself after using the toilet. 

It could be amniotic fluid, vaginal discharge, or even urine.

It’s also possible for some women not to feel anything when the water breaks.

To help you work out whether or not you are leaking amniotic fluid, you need to be aware of the characteristics of healthy amniotic fluid, and how it is different from vaginal discharge or urine.

You are leaking amniotic fluid if:

• The fluid is odourless
• It has a clear, watery colour, possibly tinged white-pink.
• It continues to leak and is out of your control, even if you bring your pelvic floor muscles into action 
• The leak is steady, and you need to change your sanitary pad often You won’t have any doubt about whether to use a panty liner or a pad
• You also experience a bit of cramping and discomfort, although many women don’t notice anything beyond the steady leak of fluid.

It’s not so healthy amniotic fluid if:

• It doesn’t smell good. As in all things regarding our health, a foul smell suggests some kind of infection.
• It’s green/yellow in color. This can mean your baby has had a bowel movement (meconium). It can just be a sign of your baby being ready to be born or it can be a sign of distress. 

You are not leaking amniotic fluid if:

• There’s a urine-like odour. Urine is probably the body fluid we can identify best by its smell. If it smells like urine the likelihood of it being a urine leak is quite high
• It’s thick, like mucus, but not soaking through your pad. It’s most likely a heavy vaginal/cervical discharge or part of the mucous plug.
• There is a sudden leak associated with movement. If the baby kicks and your bladder feels full but after the initial discharge there is no further leak.
• You apply pressure to your pelvic floor (sneeze, cough, laugh…) and there is no discharge.

Can a baby survive with leaking amniotic fluid?

 If you’re between 26 and 37 weeks and your amniotic fluid is leaking, your healthcare provider will assess your situation and decide whether or not any intervention is needed. 

Most often, if the fluid is clear, you might be able to wait and see if contractions start. 

Leaking means the risk of infection is higher and most practitioners recommend waiting only 24-48 hours before taking action. 

If you have not reached 37 weeks of pregnancy and you’re leaking amniotic fluid, this is called a premature prelabour rupture of membranes (PPROM). A study indicates that 89.5% of babies born after 25 weeks will survive a premature rupture.

If this happens, don’t delay in contacting your healthcare provider. Your baby is still considered premature and might not be ready to be born just yet. 

A premature rupture of membranes might trigger labour to begin. 

Prompt action is needed to avoid future breathing complications. 

You can read more in Premature Labour – Signs, Symptoms and Management. 

Your healthcare providers will closely monitor your health and keep a close eye on your amniotic fluid levels.

Does amniotic fluid replace itself?

Yes, it does. In late pregnancy, babies produce most of the amniotic fluid by drinking and peeing out the fluid. 

The mother also contributes, if she stays well hydrated.

Should you go to hospital if water is leaking?

If you think you’re leaking amniotic fluid, it’s important to call your midwife or doctor. 

Your healthcare provider can help you determine whether or not you have an amniotic fluid leak, whether you need to be assessed (if you’re term) or what intervention is needed, if you’re less than 37 weeks pregnant. 

You should call your doctor or midwife or go in immediately if:

• You are preterm (less than 37 weeks gestation) and suspect PPROM
• You have an amniotic fluid leak and feel feverish
• The fluid is yellow in color, or tinged greenish, suggesting meconium
• The flow seems quite heavy and ongoing
• Anytime you’re concerned.

Does leaking amniotic fluid mean labour?

If you’re over 37 weeks, an amniotic fluid leak could simply be part of your body preparing for labour. 

This process is called spontaneous rupture of membranes or SROM.

If you’re preterm (less than 37 weeks gestation) and/or you haven’t had any contractions, it’s not always clear why the amniotic fluid might begin to leak. 

Some possible causes are:

• An untreated infection
• Previous cervical surgery
• Lifestyle choices that cause health complications, such as smoking, drug use or a very unbalanced diet
• An injury or trauma to the amniotic sac (e.g. car accident, fall, etc)
• A history of amniotic sac rupturing prematurely.

How long will amniotic fluid leak?

If you’re full-term and you and your baby are in good health, your midwife will probably suggest waiting for labour to begin on its own.

During this time, to reduce the risk of infection it’s important not to insert anything into your vagina.

Your midwife will want to see you immediately if premature rupture of membranes is suspected. 

The fluid will be tested to determine whether it’s actually amniotic fluid. 

You might or might not have an ultrasound to determine the level of fluid remaining.

If it’s a slow leak your care provider might take a ‘wait and see’ approach, to see if the leak seals. 

You could also be tested for infections, including group B strep. If anything returns positive, your maternity care provider will suggest treatment with antibiotics.

Find out more about group B strep here. 

If you are less than 34 weeks gestation and not in labour, your care provider will aim to prolong your pregnancy – especially if it’s just a small leak with the potential to seal. 

You and your baby will be monitored for infection and to check that baby is tolerating low fluid levels. 

If you’re over 34 weeks, maternity care providers might take a ‘wait and see’ approach. They might recommend encouraging labour naturally or via induction.

Be sure to discuss the benefits and risks of waiting or having an induction, and consider the risk of infection. 

If you don’t already have an infection, avoiding all vaginal exams can greatly reduce the risk of acquiring one.

Anytime you’re uncertain about what’s happening in your body, or how you or baby are doing, it’s important to contact your midwife or doctor. 

It’s also important to keep the lines of communication open, and to discuss the benefits and risks of continuing pregnancy with a leak, or encouraging or inducing labour.