Water breaking in pregnancy

Spontaneous rupture of membranes is the medical term for when a pregnant woman’s water breaks naturally (spontaneously). This typically happens before or during labour. If labour doesn’t begin soon after water breaking—as may happen in some cases—the doctor may have to induce labour. This is done to avoid the risk of complications like infections for the mom and baby.

Two things happen when water breaks properly:

• Intense uterine contractions put pressure on the amniotic sac—made up of the chorion (the outer layer) and amnion (the inner layer) membranes. The sac breaks or ruptures. This rupture may occur anywhere on the sac.
• The same uterine contractions put pressure on the mucus plug that keeps the cervix closed during gestation to prevent infections. Once this plug (a sort of stopper) comes out, the amniotic fluid can flow out more easily.

Sometimes, pregnant women leak a small amount of amniotic fluid but the flow stops soon after. You should talk to your doctor if this happens, to know what to do next.

In some cases, the water doesn’t break at all—this could be because of weak uterine contractions during pregnancy. Doctors can perform a small procedure known as amniotomy in these cases, to artificially cause the membranes to rupture and the water to break. To do this, the doctor will use a plastic hook and gently guide it up the cervix, to nick the amniotic sac.

However, this procedure may not be performed in pregnant women diagnosed with placenta previa (in which the placenta covers part or all of the cervix) or breech baby (the baby’s feet—instead of the head—are towards the cervix). Your doctor will be able to diagnose a breech baby in the last scheduled pregnancy ultrasound, a couple of weeks before the due date. Placenta previa is also diagnosed through ultrasound during pregnancy—it may be detected as early as the second trimester.

A full-term pregnancy of about 40 weeks is what all expecting parents want. Ideally, a pregnant woman’s water would break around the 40-week mark. But as things stand, it is possible for the water to break prematurely, after labour begins or not at all. Read on for more:

• If the water breaks early: Sometimes, the membranes of the amniotic sac rupture before the 37th week of pregnancy. Known as prelabour or premature rupture of membranes (PROM), this kind of water breaking is a complication of pregnancy in the third trimester.
  If this happens, your doctor may put you on antibiotics to fight off infections now that the protective mucus plug is dislodged from your cervix. The baby may even have to be delivered before the full term of 40 weeks if this happens.
  If this is diagnosed early enough, doctors can deliver the baby safely. Though, depending on how many months the baby spent in the womb, he or she may have to spend some time in the NICU.
• If the water breaks between the 37th week and 40th week of pregnancy: You are right on time. Water breaking is a signal that labour has begun. Time your contractions, if you haven’t started doing it already. Go to the hospital when your contractions are rhythmic and intense. Remember, the first phase of labour can last from a few minutes to 14 hours (up to 20 in first-time pregnancies). So try and stay calm, and don’t rush.
• If the water doesn’t break even after labour begins: In this scenario, the doctor may advise an amniotomy to break the water and induce or speed up the labour.
• If water breaks 24 hours prior to delivery: Prolonged rupture of membranes occurs when water breaks about 24 hours prior to delivery. This is a complication that can expose the foetus to infections and distress due to cord compression, cord prolapse or even placental abruption (in which the placenta becomes completely detached from the uterus). Prolonged rupture of membranes is also a risk factor for foetal deformation syndrome and pulmonary hypoplasia (incomplete development of lungs in the baby).

Usually, water breaking is not a significant event in a Cesarean section or C-section delivery. However, if your water breaks before the surgery date, you should get to the hospital as early as possible.

First, it helps to know what amniotic fluid looks and smells like. Amniotic fluid is typically clear (there’s nothing floating in it) and yellow in colour—this is because amniotic fluid also contains the baby’s pee. Amniotic fluid doesn’t smell bad, unless there is a problem—if your amniotic fluid is green and smelly, it could indicate that your baby has pooped dark-coloured meconium inside the womb. Doctors consider this an emergency because it could lead to meconium aspiration if the baby ingests this meconium with amniotic fluid (which babies routinely swallow). This, in turn, could affect the baby’s lungs.

Second, it helps to know what to expect. Some women experience a “pop” before their water breaks. Others notice a mucus-like white discharge before the clear yellow fluid starts to flow. Almost all women notice an increase in the flow when they stand up from a sitting position—this is another telltale sign that you haven’t just peed. (Read more: Frequent urination during pregnancy)

Third, if you experience rhythmic contractions that grow in intensity as time passes along with the fluid discharge, it’s probably time to get your go-back and head to the hospital.