What to Know About Your Water Breaking

In Hollywood, it is usually the first sign of labor and happens with great fanfare and an exaggerated sense of urgency. In reality only about 10% of women experience their water breaking before labor begins (referred to as "PROM" - premature rupture of membranes). 90% of those women will go into labor within 48 hours. On the other end of the spectrum are women whose water breaks in active labor, during transition, while pushing, and some babies are born with their bag of waters intact (called born "in the caul").

If your water breaks and you are preterm (before 37 weeks), call your doctor or midwife right away. Depending on how early you are in your pregnancy, your care provider may prescribe bedrest to try and hold off labor to allow baby to mature, she may also suggest steroid injections to help baby's lungs mature, or, it may be recommended to induce your labor. If your water breaks after 37 weeks but you aren't in labor (regular contractions), you should still call your care provider, but the urgency to head to your place of birth may not be as great. Your care provider will have a policy for how long you can wait until labor begins. The biggest concern over your water breaking before going into labor is the risk of infection. Because of this, some care providers give women a overly short window of time before inducing (12-24 hours), and can impose restrictions and actions that may not be evidence-based. However, if you avoid certain activities that increase your risk of infection (vaginal exams, intercourse) and if you are periodically monitored through office/home appointments, you may be able to safely wait until your labor begins naturally.

When your water breaks, be sure to note specific details that your care provider will want to know. You can remember these with the helpful acronym "TACO":

T - Time it broke.

A - Amount that came out (a gush vs. a trickle).

C - Color. Was it clear or green/muddy? Anything other than clear could indicate that your baby has passed meconium (bowel contents) while still in utero, which could increase baby's risk of infection.

O - Amniotic fluid should be odorless. An odor could indicate infection.

If you are in labor and your water has not broken, some care providers will suggest artificially breaking your water (AROM) to speed up your labor. While it is a painless procedure, there is usually no medical reason to break your water, and in fact, the practice carries risks that may not be worth the perceived benefit. In the hospital setting, breaking your water usually puts you on a time limit that can increase your chance of cesarean birth. If breaking your water is suggested, find out why your care provider is recommending the procedure -- are you or your baby in danger? What's the risk of not breaking your water? What are some alternatives?

Unlike Hollywood scenes, water breaking does not call for an emergency response in most situations. It is, however, important to educate yourself about what can happen when your water breaks -- or when it doesn't. Water breaking is one of those variables in labor that can invite interventions, some necessary and some not. Knowing the evidence-based choices ahead of time can help increase your chance of having a safe and healthy birth experience.

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