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My Water Broke, What Now?

The great thing about having your water break is that it for sure means your having a baby soon, no more am I in labor, am I not in labor contractions. It is a definitive, YES, it's baby time, what a relief.

In reality, your water breaking before labor has begun is clinically known as premature/prelabor rupture of Membrane (PROM) only happens in about 8% of pregnancies after 37 weeks gestation according to the National Center for Biotechnology Information. When it is before 37 weeks it is called Preterm Prelabor Rupture of Membranes (PPROM) and occurs in 1-2% of pregnancies according to the same study. If you are before 37 weeks, then the safest course of action is to head to your local hospital to the Labor & Delivery unit.

So if you are beyond 37 weeks and thing your water broke, then here are some tips and things to be aware of.

Many times I have clients call or text asking or questioning if their water has broken, but they are not sure. Unless it is a strong gush of fluid, there is no missing what that is (I speak from experience) it can be hard to tell if your water has broken. I typically suggest going to the bathroom, empty your bladder and wipe really well, then put on a clean pad and go lay down for 30 minutes. When you stand up after 30 minutes, if your water has indeed broken, the pad should then be wet from the fluid build up and you will have your answer.

Once you have determined that in fact your water did break, it is important to note a few things.

Color of amniotic fluid is typically clear or has a light yellowish tint. If it has flecks or appears to be brown or green that means it has Meconium in it (the baby pooped). Your provider will need to know this so that a little more attention can be paid to the babies breathing once they have been born. Typically a Nurse Practitioner will be in the room to evaluate the baby after delivery when meconium is present.

Odor, there typically is no odor or a slight sickly sweet odor to amniotic fluid, if there is any strong odor once your water has broken, it is indicative of infection and you should head in the hospital quickly.

Amount, this allows the providers to understand if your water has really broken. This is typically asked over the phone or when you first get to triage.

Time, what time did the rupture occur. It is recommended that labor have begun progressing by 24 hours of rupture. Once your water is broken, it is easier for infection to enter your uterus, there will be fewer vaginal exams. It used to be said that baby needed to be delivered by 24 hours, but in recent years they have begun to extend "the Clock" allowing a person more time to have a vaginal delivery.

If your water has broken, it is advised that you no longer take baths, use tampons or have sex because all of these activities could introduce foreign bacteria. When my water broke PROM with my 3rd child I wore a newborn diaper in my underwear to the hospital because I kept leaking through pads. It was quite comical and absolutely normal, until delivery your water will continue to leak.

You should call your provider and let them know what is going on, most times they will tell you to come in to L&D, it is up to you if you want to go right away. Most people will have their labors begin with 12 hours of rupture. At the hospital, they may try to induce labor more quickly with the use of pitocin, you can advocate for more hours to try and start contractions on your own.

Some things that you can do to encourage contractions are walking, squats, lift/tuck positions, cat/cow, the Miles Circuit, 3 Sisters positions and breast pumping/nipple stimulation.

When you are ready to go to the hospital in active labor, if contractions have not begun within a normal amount of time or if you develop a fever, you should expect them to do some tests to confirm if your water did indeed rupture. These test are: pH Test, it involves testing the pH of a sample of vaginal fluid. Normal vaginal pH is between 4.5 and 6.0. Amniotic fluid has a higher pH of 7.1 to 7.3. Therefore, if the membranes have ruptured, the pH of the sample of vaginal fluid will be higher than normal. A Nitrazine test, this involves putting a drop of fluid obtained from the Vagina onto paper strips containing Nitrazine dye. The strips change color depending on the pH of the fluid. This strips will turn blue if the pH is greater than 6.0 A blue strip means it's more likely the membranes have ruptured. This test, however, can produce false positives. If blood gets in the sample or if there is an infection present, the pH of the vaginal fluid may be higher than normal. Semen also has a higher pH, so recent vaginal intercourse can produce a false reading.

Ferning, if your water is broke, the fluid mixed together with estrogen will create a "fern-like" pattern under a microscope due to salt crystallization. A few drops will be placed on a microscope slide and observed under the microscope by a doctor or midwife.

If all of these tests are still inconclusive then a AmniSure Rom test can determine it, but this test can take 2-3 hours to return from the lab.

I know this was a lot of information, but it is good things to know if your water breaks before the onset of labor.

I always recommend calling your medical team and want to reiterate that I am not a doctor or a midwife. All of the information that I shared is evidence based, but always speak with your doctor or midwife.

Have any of you had your water break at awkward times? My third broke in my sleep (which is common) and in my last delivery it broke while I was in active labor while my husband was kneeling in front of me while I was sitting on a birth ball. I looked up and said, "Oh my water broke" he smiled and said "I know, I am kneeling in it, good to know it is not urine". We had a good laugh.

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