Note: I am going to drop a lot of bolded names of elements about amniotic fluid. Not cuz I want to impress you with my vast knowledge (LOL) but because I want you to become familiar with these terms so that when you hear them, you aren’t wondering what they mean. The more you know, the more you know!! I am always learning, too!

Did i just pee myself or was that my water?

Sometimes, it’s hard to know! There could be a big gush like in the movies or maybe just a trickle. When it does break, it will have a different smell from urine - some folks think amniotic fluid smells a bit like bleach or has a sweet smell to it. It is usually clear, pale in color but may have bits of white vernix in it or bits of streaked blood or strands of mucous. That is all normal.

It is not normal to have green streaks or particles or to be green in color or look like pea soup. That can mean that they baby has had a bowel movement (called meconium) and you need to let your care provider know about that. If you are at home, take a picture of the toilet water or your pad in case your provider would like to see that (no kidding!)

Sometimes, you may wonder if your water broke but you are actually experiencing an increase in watery vaginal discharge. That can happen, too. If you are concerned, always call your provider. (Don’t worry about “bothering them”. That is part of their job.) They can check and see if it is urine, discharge, or your water and put you at ease.

I think my water just broke!

When that happens during your labor, it is called SROM meaning Spontaneous Rupture of Membranes - meaning it was not purposefully broken by a care provider. Perhaps you heard your nurse telling your care provider that you “schrommed at 8am and the water was clear” or something like that and you were wondering what the heck that meant! Well, now you know!

Sometimes, your water breaks before labor starts and that’s called Premature Rupture of Membranes (PROM). When this happens between 37 weeks and full term it is called "Term PROM" (TPROM) and happens in about 8-10% of pregnancies (Dayal 2020). If it happens before 37 weeks, it is called "Preterm PROM" (PPROM). Sometimes, your care provider will break the bag of waters for you around 4cm of cervical dilation to “help” labor or to get stronger contractions. We call that AROM or Artificial Rupture of Membranes.

What is your “bag of waters”?

Your “bag” is made up of 2 Chorioamniotic membranes: the Chorion and the Amnion.

The Chorion is the bag closest to the placenta and the Amnion is the bag closest to the baby. Inside the Amnionic sac, is a warm, clear, slightly yellowish fluid that is your “water”. By the time you are in labor, this fluid is mainly made up of your baby’s urine which protects and cushions your baby and the umbilical cord, and allows for fetal movement. It also helps regulate your baby’s temperature and is important for your baby’s GI tract, lung development. Your baby swallows and “breathes in the amniotic fluid all through their development. Many times, in the first hours or day after baby is born, they spit up amniotic fluid and this is very common.

Did you know that your amniotic fluid is generally about one degree (Fahrenheit) warmer than your body temperature? Many moms report that they were surprised at how “hot” the water felt when it hit their skin. This is also why your care provider is concerned if you get a fever. Your baby is usually about one degree warmer than you are!

The amount of fluid changes throughout your pregnancy and is measured by ultrasound. Around 28 weeks of pregnancy, there is about 800 mls of fluid, and at 40 weeks, there is about 600mls. That’s why when your water releases, it feel like a lot!!

During an ultrasound, you may have heard the term AFI and wondered what that meant. AFI stands for Amniotic Fluid Index and when it’s measured it can be used as an indication of your baby’s well-being. They don’t actually measure the amount of fluid, but they measure the space that they can see in the ultrasound. They add the different area measurements up to get an AFI. Too much fluid in the amniotic sac is called PolyHydramnios and that is when more than 24cm of fluid is measured. Too little fluid is called Oliohydramnios and that is when less than 5cm of fluid is measured. So normal fluid levels are between 5 and 24cm.

A cool fact: Did you know that your amniotic fluid is exchanged every 3 hours? Your baby swallows and “inhales” the fluid and then pees it out. Yup, kind of gross, kind of cool.

What happens next?

Let your care provider know that your water has broken or released. They will ask you questions about color, odor, when it released, are you feeling your baby move, etc. Some will ask you to come right in to the place of birth or to their office and other providers will tell you to stay home.

Expectant Management - is when you wait for labor to start on its own. 75% of patients will be in labor by 24 hours on their own without being induced. So patience is often a good plan.
Active Management is when labor is induced by your care provider. There may be a medical reason for induction or this may be your provider’s policy. ( This is a great conversation to have at some of your first OB appointments, by the way!) Interesting to note that it takes an average of 17 -23 hours to deliver depending on what type of induction occurs

Is “breaking” your water a problem?

Not necessarily. The concern for how long your water is "broken" is about infection and how your baby is responding. If you are GBS negative, the risk of Chorioamnitis and neonatal infection is relatively low, even after 24 hours of your water breaking. One key thing is to keep the number of vaginal exams to a limit after PROM to reduce the risk of infection especially if you are GBS positive. (Seward et al. 1997) If you are GBS positive, then your provider will speak to you about receiving 2 doses of antibiotics prior to baby being born. But this is something to discuss with your care provider and make an informed decision on.

What can you do after your water breaks?

If you choose to stay home:

Rest now! You’ll be so grateful for the rest later when you are in active labor.
Stay hydrated and eat. You need to fuel your body just as you would when getting ready to exercise. Once you are in active labor, you will likely not feel like eating much more than bites of food here and there.
Keep your bladder empty every few hours
After resting and eating, you could try nipple stimulation (which release oxytocin) with a breast pump or manually with your hand to attempt to “naturally” kick in labor.
Be patient

If you choose to go to the birth venue:

Do all of the above things that is within your care plan
Limit vaginal exams to reduce your risk of infection
Be patient

Most of all:

Trust your care provider because you chose them.
Remember that you are in charge of your body and your baby
Your care provider should discuss all plans with you.
Trust your intuition.
Be Patient!

Sources:

Prelabor Rupture of Membranes: ACOG Practice Bulletin, Number 217. (2020). Obstetrics and gynecology, 135(3), e80–e97. https://doi.org/10.1097/AOG.0000000000003700

Dayal S, Hong PL. Premature Rupture Of Membranes. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532888/

Hannah, M. E., Ohlsson, A., Farine, D., Hewson, S. A., Hodnett, E. D., Myhr, T. L., Wang, E. E., Weston, J. A., & Willan, A. R. (1996). Induction of labor compared with expectant management for prelabor rupture of the membranes at term. TERMPROM Study Group. The New England journal of medicine, 334(16), 1005–1010. https://doi.org/10.1056/NEJM199604183341601

Pintucci, A., Meregalli, V., Colombo, P., & Fiorilli, A. (2014). Premature rupture of membranes at term in low risk women: how long should we wait in the "latent phase"?. Journal of perinatal medicine, 42(2), 189–196. https://doi.org/10.1515/jpm-2013-0017

Sae-Lin, P., & Wanitpongpan, P. (2019). Incidence and risk factors of preterm premature rupture of membranes in singleton pregnancies at Siriraj Hospital. The journal of obstetrics and gynaecology research, 45(3), 573–577. https://doi.org/10.1111/jog.13886

Shalev, E., Peleg, D., Eliyahu, S., & Nahum, Z. (1995). Comparison of 12- and 72-hour expectant management of premature rupture of membranes in term pregnancies. Obstetrics and gynecology, 85(5 Pt 1), 766–768. https://doi.org/10.1016/0029-7844(95)00031-l

Seaward, P. G., Hannah, M. E., Myhr, T. L., Farine, D., Ohlsson, A., Wang, E. E., Haque, K., Weston, J. A., Hewson, S. A., Ohel, G., & Hodnett, E. D. (1997). International Multicentre Term Prelabor Rupture of Membranes Study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. American journal of obstetrics and gynecology, 177(5), 1024–1029. https://doi.org/10.1016/s0002-9378(97)70007-3

Underwood, M., Gilbert, W. & Sherman, M. Amniotic Fluid: Not Just Fetal Urine Anymore. J Perinatol 25, 341–348 (2005). https://doi.org/10.1038/sj.jp.7211290

U.S. National Library of Medicine. Amniotic fluid: MedlinePlus Medical Encyclopedia. MedlinePlus. https://medlineplus.gov/ency/article/002220.htm.

Yasmina, A., & Barakat, A. (2017). Rupture prématurée des membranes à terme: facteurs pronostiques et conséquences néonatales [Prelabour rupture of membranes (PROM) at term: prognostic factors and neonatal consequences]. The Pan African medical journal, 26, 68. https://doi.org/10.11604/pamj.2017.26.68.11568

My water broke! Now what?