What should I do if my waters break?

What are “the waters”?

Throughout pregnancy, the baby is surrounded by amniotic fluid commonly referred to as ‘the waters” within the amniotic sac. Amniotic fluid is made by the mother and the placenta, and it is recycled by the baby. The volume is around 800mls, and it consists of water, electrolytes, proteins, carbohydrates, lipids, minerals, urea and fetal cells. The fluid provides protective cushioning and supports fetal growth and development. Babies breathe in and swallow the fluid which helps with the development of their lungs, gastrointestinal system, and kidneys.

When will my waters break?

Your waters may break before labour, during labour, at the time of birth or they might be artificially broken (A.R.M Artificial rupture of membranes) by your caregiver. Ideally, they should not break before 37 weeks, as this is classed as preterm premature rupture of the membranes (PPROM) and may result in complications for you and the baby.

How can I tell if my waters have broken?

It’s not always obvious (unlike in the movies!) when the waters break. It may be a popping sensation, a gush, a trickle, or just slight dampness in your underwear. It will not be painful, and the fluid generally feels quite warm too.

What colour is the water?

Amniotic fluid is usually clear (not cloudy) and pale yellow/straw coloured. If it is pink or tinged with light blood streaks this is also normal. If the fluid is brown or green it may indicate that the baby has passed a bowel movement so you will need to be assessed and monitored straight away. The same applies if the water is heavily blood stained, as this can indicate a problem with placenta.

Does it smell?

The fluid is usually odourless, but it may have a slightly sweet smell. It should not smell bad. If it does this might be a sign of infection.

What should I do if my waters break?

If you think you are leaking fluid, put a thick maternity pad on. This will make it easier to identify leakage and colour. You should then call your midwife or doctor for advice, and to book in for assessment. If out of hours you should attend your maternity hospital. If it’s deemed OK by your caregiver, you can have a bath or shower before you go in as this won’t increase the risk of infection (sex might though, so it’s best to abstain).

Useful information for your caregiver:

• The time your waters broke
• The colour
• The smell
• The volume
• The movements of the baby
• If you feel unwell (feverish)
• Any risk factors (e.g., GBS positive, breech baby, high or low fluid levels)
  
  

Reasons for urgent assessment and advice if your waters break:

• Baby is breech (the baby is in a bottom-first or feet-first position)
• You have had a positive test result for group B streptococcus (a swab is usually done for this at around 36 weeks of pregnancy)
• You feel that the pattern of baby’s movements has changed or is less than usual
• You have been diagnosed as having excessive fluid levels in pregnancy (polyhydramnios) or low fluid levels (oligohydramnios)
• The water is brown or green
• There is a heavy amount of blood in the fluid
• You have signs of infection (you have a fever over 37.5 degrees Celsius, or the fluid smells)
• You are less than 37 weeks pregnant

How do I know for sure if my waters have broken?

You might not be sure. It can be hard to be 100% certain that it is your waters and not increased vaginal discharge, sweat or urine. A physical assessment or test by your doctor or midwife is advised.

How will my doctor or midwife check if my waters have broken?

Unless it's obvious (saturated maternity pads) then a speculum test can be done to see if water is leaking from the cervix. Another test which can easily be done by your doctor or midwife is a dipstick test. At OT&P, our doctors and midwives use Actim® PROM test strips. This involves the use of a vaginal swab to obtain some fluid for testing. The test is painless, and the result will be available within 5 minutes. The test will confirm if its amniotic fluid or not.

Why do the Actim® PROM test?

The test is simple to do in the clinic and saves time waiting for assessment in the hospital. It gives an accurate and rapid result to confirm if your waters have broken or not and will identify the next steps for care. If the test is negative, you can go back home, saving you the cost of admission and testing in a private hospital or the time and hassle of waiting for assessment and discharge from public hospitals.

If my waters are confirmed as broken, what are my options?

Once the waters have broken there is an increased risk of infection. Most labours will start spontaneously within 24 hours. In the absence of any concerns then the usual process is to await labour onset. If there are any concerns or if you have any risk factors your caregiver may recommend induction of labour. This is usually done with the use of an oxytocin drip.