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.
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.
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.
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.
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.
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).
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.
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.
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.
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.