As you get closer to your due date, you might be feeling anxious about your water breaking when you’re out and about. But what exactly does it mean when it “breaks”?
Your baby is surrounded by amniotic fluid — your “water.” It’s contained in a sac inside your uterus. When this sac breaks, it typically happens soon before or during labor. If it breaks before your contractions begin, it’s called premature rupture of membranes (PROM).
Here’s the thing: PROM only happens in 8 to 10 percent of pregnancies. So, in most pregnancies, your water will break after your contractions begin.
That said, here’s what you need to know about how PROM might affect the timing of your labor and delivery.
Amniotic fluid is made up of hormones, nutrients, and antibodies. It’s a protective cushion for your baby that starts collecting around 12 days after conception. Your baby actually drinks the water-like fluid — and eventually pees into it as well.
The fluid is responsible for keeping your baby warm and for helping develop their lungs, digestive system, and even musculoskeletal system.
But after week 23, your baby doesn’t rely as much on the amniotic fluid for survival. Instead, they receive nutrients and oxygen from your placenta. In later pregnancy, the amniotic sac serves more as protection only. If the sac is broken, your baby is more prone to infection and other risks, like cord prolapse.
How long a baby can live once your water breaks depends on a number of factors, so there’s really no straight answer with all things considered.
The key is monitoring. If your water breaks and you don’t get medical attention, your baby could face some serious risks and even die. You, too, are at risk of infection and other complications.
In later pregnancy, you likely have a lot of discharge and other leaks going on. You may even have trouble telling if your water has broken or if you’ve simply peed yourself. (It happens more than you’d think!)
Why might your water break before you’re in labor?
Possible risk factors include:
Signs your water has broken:
If you’re unsure, call your doctor or labor and delivery unit. Your medical team may suggest you get your discharge tested (using special papers that show pH levels) to see if it’s amniotic fluid or something else. You may also have a physical exam, ultrasound, or other tests to assess the situation.
Once confirmed, your care provider will take into account the following before creating your game plan:
The likely scenario you’ll face is being given the option to induce or augment your labor using pitocin and other interventions. Alternatively, if you have no risk factors, you may be given a short window of time in which you can wait and see if labor will start on its own.
Labor will begin naturally within 24 hours for a majority of women.
With this data in mind, you may have heard that doctors will give you just 24 hours before trying induction techniques.
Again, remember: After your water breaks, your baby is supported by the placenta for oxygen and other needs. The main concern of your water breaking early is infection for both you or your baby.
While more and more research is showing that longer windows of time may be safe, it’s true that there is a standard of 24 hours in many medical settings.
If you have no risk factors, your doctor may follow what’s called “expectant management.” This basically means you’ll wait and see if/when your labor begins on its own.
This management and exact timeframe may vary from provider to provider. You’ll likely have your temperature taken regularly (as well as other signs, like white blood cell count) to monitor for infection.
If you’re positive for group B strep (GBS), your doctor will probably recommend you begin antibiotics upon your water breaking to protect your baby from infection. Augmenting labor is also more likely in this scenario since the potential for complications is higher.
In one 2015 study of 100 women with PROM, 28 percent of their deliveries ended with a C-section. The reasons for this intervention include things like failed induction and fetal distress.
PROM is labeled as the cause of 0.8 percent of stillbirths. The main way this happens is through bacterial infection that goes up the vaginal canal and reaches the uterus. Logically, the longer it takes to deliver your baby, the more opportunities there are for possible infection.
Interestingly, a 2017 review of studies on PROM did not suggest a huge difference in stillbirth risk between those women who were induced after their water broke versus those who followed expectant management.
Researchers concluded that stillbirth (and other concerns) aren’t necessarily reasons to induce after PROM if there are no other risk factors.
In reality, PROM really is a dance of sorts. Your healthcare provider must balance the benefits and risks. So, the approach you follow in this scenario has a lot to do with your doctor, your hospital’s procedures, and your individual health.
For this reason, you may want to discuss the course of events with your doctor to know what to expect if your water breaks before your contractions begin.
When it comes to PROM after 37 weeks, the American College of Obstetricians and Gynecologists (ACOG) recommends labor induction for women who plan to birth vaginally. However, they do explain that doctors can present the idea of “limited” expectant management for between 12 and 24 hours with continual monitoring.
The ACOG also states that women who are GBS positive should be given antibiotics when admitted to the hospital. And while GBS-positive women may follow expectant management, many caregivers and women choose to augment labor without waiting.
While less common (and more present in literature outside the United States), your caregiver may give you up to 96 hours after your water breaks to begin labor on your own. This is, of course, if you aren’t showing signs of infection and your baby shows no signs of distress.
