Breaking The Waters: Hospital Procedures Explained

Water breaking is a well-known milestone in pregnancy and part of the labour process. It occurs when the amniotic sac, a bag of fluid that cushions and protects the baby in the uterus, ruptures. This can happen naturally or be induced by a doctor through a procedure called amniotomy. When the water breaks, clear fluid flows out of the cervix and vagina, followed by continuous leaking. While it is often a sign that labour will soon follow, in most cases, labour begins with contractions, and then the water breaks. In rare cases, a baby can be born while still inside the amniotic sac, known as an en caul delivery.

When to go to the hospital

Your water breaking is often a sign that labour will soon follow, though this is not always the case. In most instances, labour begins with contractions, and then the water breaks. However, in some cases, the water breaks first and is followed by labour pains within a few hours.

If your water breaks, you should contact your OB-GYN or healthcare provider. If you are less than 37 weeks pregnant, or GBS Group B Streptococcus positive, they may instruct you to go to the hospital. If your amniotic fluid is foul-smelling, stained with lots of blood, or has a greenish or dark tint, you should go to the hospital as these are signs that your baby could be in distress.

If your water breaks and you are not experiencing contractions, you should still go to the hospital to be checked for meconium. If you are GBS positive, you should go to the hospital within 12 hours of your water breaking. Otherwise, you can wait up to 24 hours.

If you are experiencing contractions, you should go to the hospital when they are consistently occurring every 3 to 5 minutes for an hour or more and you are unable to walk or talk through them. If this is not your first baby, you should wait until your contractions are 5 to 7 minutes apart for a full hour.

What to expect

Water breaking is one of the most famous pregnancy milestones and is usually a sign that labour is imminent. It occurs when the amniotic sac, which is a bag of fluid that cushions and protects the baby in the uterus, ruptures. This is also known as the rupturing of the membranes.

For a vaginal delivery, your water must break. However, it doesn't need to break before a Caesarean delivery. In rare cases, a baby can be born while still inside the amniotic sac, which is called an "en caul" delivery.

If your water breaks before labour begins and it occurs before 37 weeks of pregnancy, it's called premature rupture of membranes (PROM). PROM is the cause of a third of all preterm deliveries. If you experience PROM, you should go to the hospital.

If your water breaks, you may feel a strong and sudden gush of fluid from your vagina, or you may feel a trickle. It feels a little different for everyone. The fluid may rush down your legs, or it may just trickle into your underwear. It doesn't hurt when your water breaks, so you shouldn't feel any pain.

If you are uncertain for more than a couple of hours about whether your water has broken, you should get checked out at your OB's office or the hospital. There are several ways to determine if it's amniotic fluid, including the fern test, the nitrazine test, and visualisation with a speculum.

If your water breaks and you haven't yet gone into labour, you will likely go into labour within 24 hours. If labour doesn't start naturally, your healthcare provider may offer to induce labour.

How to identify amniotic fluid

Amniotic fluid is a clear, yellow fluid that surrounds the amniotic sac. It is vital for healthy fetal development. It is mostly water in the early stages of pregnancy, but its chemical makeup changes over time. It is important to be able to identify amniotic fluid as it can indicate that labour is about to begin.

Amniotic fluid is mostly clear or light yellow, although it can be tinged brown or red. It is odourless. If it has a foul smell, this could be a sign of infection or that meconium has entered the fluid, which can cause serious breathing problems for the baby. If the fluid is stained with lots of blood, or has a greenish or dark tint, this could be a sign that the baby is in distress.

Amniotic fluid will continue to leak, whereas urine can be held in. Amniotic fluid cannot be stopped or controlled in the same way as urine.

It can be hard to tell the difference between leaking urine and amniotic fluid, especially during contractions. Inspecting your underwear for colour and smell can help determine the difference. Urine is usually dark yellow and has a distinct odour.

If you believe your water has broken, contact your healthcare provider to determine your next steps.

What happens after

After your water is broken at the hospital, there are a few things to keep in mind and some precautions to take to ensure the health and safety of both you and your baby. Here is a detailed overview of what happens after your water is broken:

Immediate Actions:

Firstly, it is essential to contact your OB-GYN or healthcare provider. They will provide specific instructions and guidance based on your unique circumstances. If you experience a water break before 37 weeks, it is considered premature rupture of membranes (PROM), and your healthcare provider may try to delay labor to allow your baby more time to develop.

Monitoring Contractions:

In most cases, labor begins within a few hours after your water breaks. However, if contractions do not start naturally within 24 hours, your healthcare provider may induce labor with Pitocin or other methods. It is important to monitor the intensity and frequency of contractions, as they typically intensify after the water breaks.

Hospital Stay:

Depending on your specific situation and the hospital's protocols, you may be admitted to the hospital immediately after your water breaks or advised to wait for a certain period. During your hospital stay, healthcare professionals will closely monitor you and your baby, checking for any potential complications or concerns.

Infection Prevention:

After your water breaks, the baby is at an increased risk of infection. Your healthcare providers may administer antibiotics intravenously to prevent any potential infections from affecting you or your baby. It is important to avoid activities that could introduce bacteria into the uterus, such as intercourse.

Fluid Observation:

Pay close attention to the condition of the amniotic fluid. If it exhibits any unusual characteristics, such as a foul smell, significant amounts of blood, or a greenish or dark tint, it could indicate that your baby is in distress. In such cases, immediate medical attention is crucial.

Delivery Timeline:

In most cases, your healthcare provider will aim for delivery within 24 to 48 hours of your water breaking. However, this timeline may vary depending on your specific circumstances and the baby's well-being.

Remember, every pregnancy is unique, and the specific protocols and procedures may vary based on your healthcare provider's recommendations and your individual needs. Always follow the advice and instructions provided by your healthcare team to ensure the best possible outcome for you and your baby.

What is an amniotomy

During pregnancy, the baby is cushioned and protected by a bag full of amniotic fluid called the amniotic sac. When the amniotic sac ruptures, clear amniotic fluid flows out of the cervix and vagina, and this is called "water breaking".

Amniotomy, also known as artificial rupture of membranes (AROM) or colloquially as "breaking the water", is a procedure where a healthcare provider intentionally breaks a pregnant woman's amniotic sac to induce labour contractions. This is done by inserting a thin, plastic tool called an "amnihook" through the vagina to scratch or tear a hole in the amniotic sac. This allows the amniotic fluid to escape, and the procedure may result in a gush or trickle of fluid from the vagina.

Amniotomy is performed to speed up labour by releasing hormones that cause stronger contractions. Without the amniotic fluid, the baby can move deeper into the pelvis, increasing pressure on the cervix and causing further dilation. Additionally, it allows for more direct monitoring of the baby's distress and detection of meconium levels, helping healthcare providers determine the kind of medical support the baby needs at delivery.

There are risks and complications associated with amniotomy, including umbilical cord prolapse, where the umbilical cord drops through the vagina before the baby. It is important to discuss any concerns about the procedure with a healthcare provider.

Frequently asked questions