In the movies, we see labor depicted as starting with a gush of water and rushing to the hospital. We all know that's not real, but it leaves many of us wondering: When will my water break? How do I know if my water broke? and What should I do if my water breaks?
Today we will discuss all things related to your water breaking including what you should do if your water breaks at home, options for artificial membrane rupture and my own stories about my water breaking.
Part Two: Artificial Rupture of Membranes
During my first pregnancy, I was 38 weeks pregnant sitting on the couch and my water broke! I was having contractions for weeks, so we thought my water breaking was the sign we needed that this set of contractions was "real". We excitedly made our way to the hospital, and they ran tests and hooked me up to monitors where they discovered I was indeed contracting, but my water had not, in fact, broken. After a few hours of seeing if the contractions progressed, we went home. Come to find out, I just peed my pants.
Fast forward to baby number two, my water didn't break until I was in labor with him for about 20 some hours. I was about 7 cm dilated when my water finally broke on it's own!
Third time around, my water began trickling a slow leak about an hour before contractions started.
My fourth.... he's my wild one. You can read more about how I thought my water broke here... I thought my water broke *mulitple* times... but apparently I was just peeing myself a lot and couldn't tell (*ahem* see a pelvic floor therapist!!!). Just like my first, these "false alarms" were in combination with contractions that were very convincing. Funny thing? My water didn't actually break until I was pushing him out... my membranes ruptured one minute before he was born. So what does all this rambling tell you: even experienced mothers can be confused about whether or not their water broke or they peed and it's a total gamble on when and how your water will break. But there is more to the story and more you should know. So lets answer some of your questions about your water breaking! Let's start with some of the technical stuff so you know the lingo, then go from there!
The technical term for "water breaking" is rupture of membranes.
PROM - Premature Rupture of Membranes - Your water broke before contractions started (estimated to occur in 10% of pregnancies)
P-PROM - Preterm premature rupture of membranes - Your water broke before you're full term and before contractions started
Spontaneous Rupture of Membranes - the water bag breaks on it's own before or during labor
AROM - Artificial Rupture of membranes - the OB or Midwife uses an amnihook to open your amniotic sac (aka break your waters)
amnihook - a tool that looks similar to a crochet hook which is used to puncture the amniotic sac and allow the amniotic fluid to empty
en caul - when the baby is born in the amniotic sac
Now that we know your water may break before or after contractions start, or maybe not even at all, the question is asked: What do I do when my water breaks?
What should I do if my water breaks?
Many people take the breaking of water as a sign they need to rush to the hospital. But I suggest you hold your horses just a second. Check in with yourself and your birth team before you make that decision.
Generally speaking, if you're preterm and you membranes rupture, you should call your provider immediately. If you're full term you will have more flexibility with your options.
When your water breaks you will want to take note of TACO... The Time, Amount of fluid, Color of the fluid, and any Odors. This information will be helpful in determining if it was indeed likely amniotic fluid (versus urine) and if there are signs of infection.
For instance, if your water breaks and is full of dark brown/yellow/green chunks, waiting at home probably wouldn't be a great option. But if the fluid is clear and odorless, you will likely be able to wait at home until contractions start and you're ready to head to your birthing location, or call your birth team.
Risk of infection when water breaks
Your amniotic membrane protects the baby from germs and infection. When this ruptures, the risk of infection during labor does increase. This isn't something to fear, rather it is something you need to understand. Cervical exams are contraindicated unless absolutely necessary when membranes are ruptured because they can introduce bacteria, increasing risk of infection. Additionally, the longer your water is broken, the higher the risk of infection. This risk increases if you are GBS positive, which is why many providers will want you to come in for IV antibiotics. However, just because you're GBS positive doesn't mean you have to rush in immediately, rather it will just be a factor in decision making as labor progresses, or doesn't. When your water breaks, we make note of TACO, remember? Well keep making note especially of the color and odor of fluid as this will be one sign of infection. Another sign of infection is developing a fever. Infection can sometimes be dealt with with IV antibiotics, however, an infection can be cause for an emergency cesarean as well, depending on various factors.
Infection can be prevented by avoiding anything entering the vagina, including for cervical exams. Infection can also be prevented with prophylactic antibiotics. Some people will, however, opt out of antibiotics for many reasons. My best advice is to try to prevent Premature Rupture of Membranes with a healthy diet during pregnancy. Vitamin C and high protein diet has been associated with stronger amniotic membranes, meaning often your water will not break until later in labor.
Another rare but real risk when your water breaks is cord prolapse.
Cord prolapse is when the umbilical cord comes through the cervix into the birth canal before the head. This is a serious and life threatening emergency. The risk for this is typically only when the baby's head is not engaged, therefore giving space for the cord to drop through first. If you know the baby's head is in fact engaged, it's extremely unlikely the cord would prolapse without warning signs such as fetal distress. This is why your provider will often consider baby's position in the pelvis before considering artificial rupture of membranes. Since this article is already getting longer than I expected, I'm going to go ahead and split it into two parts. Part two will discus artificial rupture of membranes to induce labor or during labor. In the meantime, what questions do you have about your water breaking?
If you're looking for help writing your birth plan, be sure to check out my on-demand Birth Plan Workshop! You can also schedule a birth plan consult with me by visiting www.littlebear.intakeq.com/booking -- I will help you with any confusion when writing your birth plan so that you can be confident walking into your birth.
Jaimie Zaki is an IBCLC, Doula, and Motherhood Photographer residing in Wichita Falls, Texas with her husband and four children.