Has My Water Broken?
Signs of Spontaneous Rupture of Membranes and What You Should Do
Most mothers begin their labor with slow but increasing labor contractions over several hours. However about 10-15% of mothers find that their labor starts with their water breaking. Let's take a look at how and why your water can break differently, as well as what to do when your water has broken.
Ways that Your Water can Break
There are two different ways that mothers will typically notice their bag of waters has broken. One way is with a small trickle, every now and again. You may notice that your amniotic fluid may trickle out more when you change positions. You might even wonder if you are losing control of your bladder or even if it is watery discharge. The trickle of fluid happens when there is a break in the amniotic sac up higher in the body of the sac instead of below the baby's head. It is known as a "high leak" and is notorious for causing only little trickles of amniotic fluid to come out at a time. It is also unlikely that your water breaking with a high leak will stimulate enough oxytocin (your body's own labor hormones) for contractions to start right away.
The other way that your water can break is with one or several big gushes of fluid. This is hard to miss since there will be enough amniotic fluid to saturate your clothing. The first big gush can be followed by several more gushes of fluid. It is more likely that these gushes of amniotic fluid will cause your baby's head to move directly onto your cervix, causing the release of oxytocin and contractions to begin within a few hours.
When Does Your Water Break?
Each mother and each labor is different so predicting when your bag of water will break is impossible. However there are some times when it is more likely to happen spontaneously. About 10% of mothers will notice that their water breaks as the first definite sign of labor. For the rest, it is likely to break when contractions are intense and frequent during active labor.
Is it possible that your water would never break? Some mothers might think that their water would never break on its own and that their care provider would need to break it. Your amniotic sac could be in place even as late as when your baby is being born. This is referred to as being born "in the caul" and would not be a problem since the sac could be broken at the time of birth.
What to Do When Your Water Breaks
If your water breaks spontaneously with a leak or a gush of flush, you should pay attention to the following items that spell the word TACO:
T - Time - When did it break? After 24 hours, the risk of infection increases so your provider will like to see your labor well on the way typically within 24 hours.
A - Amount - Was there a trickle or gush?
C - Color - Was it clear or green/brown? This is a sign of meconium (which is the baby's stool) and might mean the baby needs to be suctioned to clear out the meconium by medical staff at the time of birth.
O - Odor - Amniotic fluid has a musky odor; however a foul odor could indicate an infection is present.
You should call your care provider to alert her of the above information. It will be helpful to know your Group B Strep status as well when you call your provider since that information will play a role in how quickly you will need to get to your place of birth and whether or not you need antibiotics.
If you are given the option to remain home for awhile after your water breaks, be careful to not introduce anything vaginally so as to reduce your chance of infection. This would include having intercourse or using tampons. Check with your provider to see if it would still be okay to use a tub after your water has broken.
What to do if Contractions do not Start after Your Water Breaks
If your water breaks and your contractions do not start, the likely protocol would be for your provider to start pitocin to augment your labor. You could also request to try natural options such as walking, nipple stimulation or pressure points or combinations of those things to help progress labor prior to starting pitocin.
An important thing to remember is that if you and your baby are being monitored and you are protected with antibiotics if you have tested positive to Group B Strep, you can always ask for more time to labor after your water breaks. There should never be any hurry to start pitocin unless there is an indicated risk to your or your baby.
