When a person’s “water breaks” during pregnancy, the risk of infection increases. If a pregnancy is at term, doctors typically recommend inducing labor if it does not begin naturally within 24 hours.
When a pregnant person’s waters break, the amniotic sac can no longer protect against infection, and bacteria can potentially enter the uterus.
If a person’s water breaks, they need to seek medical attention right away. Delaying can increase the risk of complications.
This article outlines the signs of water breaking, when to contact a doctor, possible options regarding labor and delivery, and more.
When a person experiences water breaking, it means their amniotic sac has ruptured. The amniotic sac contains amniotic fluids that protect the fetus during pregnancy.
The most obvious sign a person’s water has broken is when fluid begins leaking from their vagina.
It is difficult to predict how much amniotic fluid they will lose. For example, some people experience a gush of fluids, while others experience a steady stream or trickle until the baby is born.
After their waters break, many people need to wear a sanitary pad until they get to the hospital.
Some people may confuse amniotic fluids with leaking urine or increased vaginal discharge. Differences include the following characteristics:
- Urine will typically be yellow and smell like ammonia.
- Vaginal discharge may be milky-white with the consistency of thin mucous.
- Amniotic fluid is generally clear or pale yellow and odorless or sweet-smelling.
What to do if a person’s water has broken
If a person’s water breaks, get advice from an OB-GYN. They will advise on what to do based on how many weeks into pregnancy a person is, among other factors.
In the meantime, it is important to take steps to reduce the risk of infection. This includes:
- using liners or pads to absorb amniotic fluid, not tampons
- changing sanitary pads frequently, even if they are dry
- being careful to wipe front to back after using the bathroom
- avoiding sex, swimming, or using products around the genitals
- staying clean by washing in the bath or shower, but not adding any additional products to the water
A pregnant person who tests positive for a group B Streptococcus (GBS) infection will need to go to the hospital immediately following their water breaking. There, medical professionals can give antibiotics to prevent GBS from developing in the baby.
If someone begins to feel unwell or show signs of infection, they should also seek medical attention immediately.
When membranes rupture at term, most pregnant people go into labor within 12 hours of their water breaking. Around 95% will spontaneously begin labor within 24 to 48 hours.
A person may consider contacting their doctor if they do not experience any signs of labor within several hours of their water breaking.
The American College of Obstetricians and Gynecologists (ACOG) recommends waiting no longer than 24 hours before inducing labor in people who have their waters break at term.
Waiting too long, especially without medical supervision,
For many pregnant people, the membranes rupture right before or during labor.
When they break after 37 weeks of gestation but before labor, doctors call this “prelabor rupture of the membranes (PROM)”.
The ACOG recommends inducing labor at this point, but says that OB-GYNs may offer a period of expectant management for a limited time, too. This means monitoring the person and waiting to see if labor begins on its own.
When waters break before 37 weeks, doctors call this “preterm premature rupture of the membranes (PPROM).” In that case, the doctor will measure the risks against the benefits when determining whether to induce labor or allow time for expectant management.
Once the doctor confirms a pregnant person’s water has broken, they will consider the following and develop a plan of action:
- how early the waters broke
- the pregnant person’s current health, including signs of infection
- the fetus’s current health, including signs of distress
- the fetus’s position or presentation
- risk factors, such as GBS
Typically, either labor induction or a short window of expectant management follows.
Induction
An OB-GYN may use a combination of medications and devices to induce labor. These include:
- Medications: Drugs for inducing labor include prostaglandins and oxytocin. Prostaglandins are hormone-like substances that a pregnant person may take orally or insert into their vagina to “ripen” or thin out their cervix. Oxytocin, or the “love hormone,” can kickstart contractions. Doctors administer oxytocin intravenously.
- Devices: These may include laminaria, which are thin rods a doctor inserts into the cervix, and catheters with balloons that inflate and help open the cervix.
As with labor that starts on its own, induced labor can last anywhere from a few hours to a few days.
Expectant management
Sometimes, expectant management is an option before induction.
Expectant management or “watchful waiting” involves waiting to see if labor starts independently.
The ACOG recommends labor induction for people who experience PROM after 37 weeks and plan on vaginal delivery. However, they also provide guidelines on offering expectant management for 12 to 24 hours for people experiencing low risk pregnancies.
During this time, doctors will monitor vitals and counsel the pregnant person on progress and potential next steps.
A person should contact their OB-GYN if their waters break and:
- they are only
37 weeks pregnant, or fewer - they have had a C-section delivery before and plan to have another this time
- they have GBS or do not know whether they have it
- they have a history of fast labor
- the fetus is not in the head-down position
- the fetus is high in their pelvis
They should go directly to the hospital if:
- they begin feeling unwell, hot, or feverish
- the fluid draining changes color or develops a bad smell
- they experience only a small, one-time gush of fluid, which may indicate that the fetus’s head moved and stopped the leak after their membrane ruptured, increasing the risk of infection
- they feel or see something in their vaginal opening
Although rare, prolapse of the umbilical cord can occur, meaning it sweeps into the cervix or vagina along with the amniotic fluid. A prolapsed umbilical cord can cause birth asphyxia.
Any intense pain or bleeding also warrants a trip to the hospital.
According to a
PPROM is less common, affecting only 1% of births overall. In at least half of all PPROM cases, birth takes place within the next 7 days.
The risks of PPROM are fairly high, and gestational age plays a significant role in the outlook. The more advanced the pregnancy is, the better the odds of a positive outcome.
It is dangerous to wait too long between the membranes rupturing and delivery. Without an amniotic sac, the pregnant person and the fetus have less protection against dangerous infections.
A healthcare team will consider the pregnant person’s current health, the gestational age of the fetus, and other factors when recommending the next steps after water breaks.
It is common for doctors to induce labor to shorten the period between the water breaking and delivery.