One day some years ago, I was a midwife staffing the triage unit at one of the busiest maternity hospital in Detroit, when a woman came in complaining of abdominal pain. When I examined her I was surprised to find that her water was not only broken, but the hair of the baby’s head, which I could feel through a slightly open cervix, was actually very dry. It turned out that her water had indeed broken long ago, but she could not remember when. She was admitted and she gave birth, but her baby did not do well. It was very sick. This was a very unusual case. But it teaches me that all pregnant women must know how to tell if their waters break!
The fetus is surrounded by the amniotic sac, which is like a water balloon. The amniotic fluid is made of baby’s urine and respiratory secretions. The fluid is usually clear with flecks of vernix and floating laguno. Vernix is the special substance that covers a fetus’s skin like a thick lotion until it thins and sheds as baby gets to term. Laguno is a fine layer of fine hairs that cover baby until new term. One way to distinguish between amniotic fluid and other fluids is by the presence of these small blobs of white lotion-like substance and hard-to-see hairs. The amniotic sac is made up of layers of stretchable, strong membranes, so another term for water breaking is “rupture of membranes.”
The intact amniotic sac is a barrier to infection, keeping pathogens from accessing the fetus. The amniotic fluid also cushions the baby, and her umbilical cord. Baby has room to move when there is adequate fluid surrounding her head and limbs. Babies carried for a prolonged period in a mom with low fluid (“oligohydramnios”), can have neck muscles that are too tight on one side (“torticollis”), for example, because they couldn’t stretch it out in that direction. They can have serious problems if the fluid is very low for a long time, such as under-developed lungs. When women go past their due date, we check the amount of the fluid every few days to make sure it is still adequate.
Most women go into labor before their waters break. Occasionally, health care providers break the water as a step in the labor process. This is sometimes done to restart a stalled labor, or to speed labor along. Midwives are trained to avoid breaking the water until medically necessary. Amniotic fluid lubricates baby’s descent through the pelvis and supports the umbilical cord during labor contractions.
Sometimes the water breaks before labor, all at once, with a big gush. Most women know almost instantly what has happened, once they get past thinking that they have peed on themselves. The water is warm, and is about as much as a woman can hold in a full bladder, so, in the first moments, many women think they have lost control of their bladders. But then they notice they still can feel their bladders are not empty.
In my first pregnancy, this happened while I was sleeping, and I was startled awake thinking, for a second, that I must have wet the bed, but then I realized the puddle I was in was my water broken.
Sometimes, less commonly, the amniotic sac can develop a slow leak. And here is where the trouble is. Usually, it turns out to be just vaginal discharge or a little lost urine. Unless it isn’t. Sometimes it is broken water. Because it is absolutely critical that we know if a woman’s water has broken, we have to figure this out. But here are a few things to try before running into the hospital.
Vaginal discharge stops. Amniotic leaks don’t. So, if you are thinking it might be water broken, change to dry underwear, and walk around for a few minutes. If you are soaked again in 5-10 minutes, it might be broken water. If you take a shower, and you are standing outside the shower drying off with a towel, and in the time it takes to dry off, water trickles down to your ankle, your water is probably broken.
What to do if your water breaks
If you conclude that it is probably or surely broken:
- Write the time down. Your health care provider will need to know this. The standard of care is currently that a woman should be in active labor within 24 hours of water breaking.
- Look closely at the water. It should be clear or clear with flecks of white and little hairs. If the water is anything but clear, this probably means that the baby has had a bowel movement before birth, which can be, but is not always, a sign of trouble.
- Note the odor of the water. It should not smell bad. Healthy amniotic fluid has a characteristic smell, which is sort of like a warm sea breeze. It is a mild smell. Not like urine. And certainly not stinky.
- Note your baby’s movements. Baby should move a bit, rather like he did before. If baby does not move at all after your water breaks, and you have had a glass of cold juice and given it a few minutes, there could be a problem.
- Do not put anything in your vagina after this point. No tampons, no fingers, no sex. The barrier to pathogens is gone if your water is broken. You can put on a menstrual pad or put a towel between your thighs.
- Contact your health care provider. If you cannot reach her, you will need to come to the hospital or birth center for confirmation, and to check on your baby.
- Prepare for labor, which usually starts shortly after the water breaks. Prepare by eating a light meal, and getting your things together.
Women who are negative for Group Beta Streptococcus (GBS) may be advised to return home to wait for labor to start on its own for a limited period. If your baby is active, your health care provider may skip the face-to-face evaluation and have you just stay home for a limited time to see if labor starts on its own. Women who tested positive for GBS will need to get started on their IV antibiotics and labor will be encouraged to begin rather than waiting. This is to prevent infection with GBS.
When the amniotic sac is left intact the entire time, and baby is born with the sac unbroken, we say that the baby is “born in the caul.” This is unusual, and kind of cool. Old wives’ tales and myths from many cultures have held that this baby would never drown, or be otherwise protected or lucky in some way. Like many old traditions, this may have some basis in fact. As the healthier and better nourished a mother is, the stronger her amniotic membranes will be, and the more likely that they will remain intact. Good health is a great step toward good luck!