Also known as 'spontaneous rupture of membranes'
If you are wondering whether your waters have broken, you're not alone. Many women expect their waters to break with a big gush like we see in films, but in reality, whilst it can be a big gush, it can also be a small trickle. This guide explains what is happening when your waters break, how to recognise it, and what you should do next.
What are the 'waters'?
During pregnancy, your baby grows in your uterus in a balloon like bag called the amniotic sac, which is filled with amniotic fluid. This sac creates a sterile environment for your baby, and amniotic fluid is important in providing cushioning, allowing your baby to move and develop, and it helps to maintain their temperature and to protect the umbilical cord.
From the second trimester onwards, amniotic fluid is mostly made up of your baby's urine - your baby swallows the fluid, and then excretes it out as urine!
What does it mean to say that your waters have broken?
When midwives say that your waters have broken, they mean that a hole has developed in that amniotic sac, causing amniotic fluid to start leaking out through the vagina. Although this can sound alarming, it is a completely normal part of many labours.
Sometimes it feels like a pop followed by a big gush of warm water, sometimes it is a continuous trickle. Your waters breaking may be painless, or it may be accompanied by painful contractions.
It can be hard to know for sure whether your waters have broken if you don't have that big gush. If liquid keeps leaking and it seems different to urine or discharge (because of the smell or consistency), suspect that it is your waters and contact your midwife. Remember, your midwife will want to hear from you even if you are unsure.
When do waters usually break?
Your waters can break at any point in your pregnancy, but ideally they break just before or during active labour at full term (from 37 weeks onwards). Most often, your waters break when your contractions start and you are in active labour.
Rarely, your baby is born in their waters (in the amniotic sac) and they have to be broken just after they have been born - this is often considered good luck by midwives!
If you think your waters have broken, make a note of the time, the colour and the smell, and make sure that you are happy that baby's movements remain normal.
Pre-labour rupture of membranes (PROM)
Sometimes, your waters break before you go into labour. This is called pre-labour rupture of membranes (or PROM).
50% of women whose waters break before they are in labour will go into labour in the next 24 hours, the other 50% of women usually need an induction of labour. From the time when your waters break, your baby is no longer in that sterile environment so they are more prone to infection - therefore the medical team usually want baby to be born within 72 hours of your waters breaking to minimise the risk of infection to them. This is why you may be offered an induction of labour if your waters break before your contractions have started.
Pre-term rupture of membranes (PPROM)
When the amniotic sac breaks before 37 weeks of pregnancy, it is considered pre-term rupture of membranes (PPROM). Preterm rupture of membranes is a major cause of preterm birth. The management of PPROM will depend on how many weeks pregnant you are - sometimes doctors will try to delay labour, and sometimes labour may be induced.
What should amniotic fluid look like?
Your waters should be
- Straw coloured, clear or pinkish
- Have the same consistency as water or urine.
Your waters should not be
- Green or brown
- Smell bad
- Have any fresh blood in them
If they are any of those things, call your hospital straight away.
If your waters are green or brown, it can be a sign that your baby has already done their first poo (called meconium). This can mean that your baby has a mature digestive system in good working order, but it can also be a sign of fetal compromise. Often we don't know which it means, and therefore we have to treat it as a possible sign of distress.
So it is important that your medical team know if your waters are meconium stained.
… top tip
Once your waters have broken, put a pad in because the waters will keep coming! Your body continues to produce amniotic fluid throughout pregnancy, which is why you may continue leaking after your waters have broken.
This will also help the midwives and doctors know for sure whether your waters have broken as they can assess the pad themselves.
When to call the midwife?
Even if your waters are a normal colour and smell, you should let your midwife know if you think they have broken. This is because your baby is no longer in that sterile environment so they are more prone to infection - therefore your maternity team will discuss when they recommend induction of labour. This recommendation aims to balance the chance of labour starting naturally with the gradually increasing risk of infection once the membranes have ruptured.
Usually, the midwife will invite you into hospital for an assessment to see whether your waters have broken or not:
- The midwife will ask to see your pad, which is why it is a good idea to keep one on once you think your waters have broken.
If it is wet and heavy and obviously amniotic fluid, they can confirm that your waters have broken.
- If it is unclear, as it often is, they will offer you a speculum to see if they can observe waters coming through the vagina.
As always, it is up to you whether you accept this or not.
- They will also offer to have a listen in to your baby's heartbeat with a doppler or a CTG machine to make sure that your baby is well.
- They will probably offer to do your observations, to make sure that you are well too.
If your waters have broken and you are not in labour, the team will then discuss the plan - you may be offered an induction of labour straight away, or you may be offered to wait 24 hours to see whether labour starts spontaneously. This decision will be based on your individual circumstances, and will take into account your preferences.
A note from the labour ward
As a midwife, I want to share with you the most commonly asked questions that women want to know about their waters breaking.
Q: Can my waters break without me noticing?
A: Yes they can. Especially when your waters break without a big dramatic gush, and the membranes develop just a small tear, allowing only a slow trickle of amniotic fluid to escape. Some women first realise their waters have broken when they wake up in the morning with wet bed sheets, others notice a leak after standing up, walking around or following a contraction. It's also possible for the baby's head to act like a plug, reducing the flow of fluid so that it only leaks occasionally.
If you're unsure whether your waters have broken, don't worry - this is an incredibly common question. A good rule of thumb is that amniotic fluid tends to continue leaking because your body keeps producing it. If you find that your underwear or a maternity pad continues to become wet, particularly if the fluid is clear and you can't control the leaking like urine, it's worth contacting your maternity unit for advice.
Q: Can I still shower or bath?
A: Yes. In most cases, it is perfectly safe to have a shower or a bath after your waters have broken, unless your midwife or obstetrician has advised otherwise. Many women find that warm water is comforting, particularly if contractions have started. A shower or bath can help you relax and may provide some pain relief in the early stages of labour.
Q: Can I have sex?
A: Once your waters have broken, it is generally recommended that you avoid having sex. This is because, after the membranes have ruptured, there is a direct pathway between the vagina and the uterus. Although the risk of infection remains low initially, avoiding penetrative sex helps reduce the chance of bacteria entering the uterus while you are waiting for labour to begin.
Q: Will my baby be born soon?
A: Not necessarily. Like we've said, it depends on when in your pregnancy and labour your waters break. For some women, contractions will start soon after their waters break whilst for others it may take longer.
Q: Will my baby run out of water after my waters have broken?
A: No. Even after your waters have broken there is usually still amniotic fluid around your baby, and your body continues producing more.