What to expect when your waters break

In popular culture, ‘waters breaking’ is always the first sign of labour, and it happens very suddenly and usually in public. Here, we talk about what it’s really like.

What are my ‘waters’?

Your baby develops inside a bag of fluid called the amniotic sac. When your baby is ready to be born, the sac breaks and the fluid comes out through your vagina. This is your waters breaking.

Your waters may break before you go to hospital (if that’s where you plan to give birth) but they are more likely to break during labour. Sometimes, your midwife may break your waters for you to induce or speed up your labour. This is known as artificial rupture of membranes (ARM).

There’s no need to worry about your waters breaking. But get medical advice straight away if your waters break and you are less than 37 weeks pregnant. This is because you could be at risk of premature labour.

Find out more about your waters breaking early.  

What does it feel like when my waters break?

Your waters breaking can feel like a mild popping sensation, followed by a trickle or gush of fluid that you can’t stop, unlike when you wee. You may not have any sensation of the actual ‘breaking’, and then the only sign that your waters have broken is the trickle of fluid.

This is what women told us how it felt for them:

"It felt like I might have wet myself and it definitely wasn’t a gush like it happens in films. In fact, I wasn’t even sure my waters had broken. I put it out of my mind until I started having contractions later on that evening. I called the midwives and they called me in to be checked over."

Katherine

"My waters were broken for me to move things along. ‘Breaking waters’ sounds kind of brutal and I was scared and put it off for a while but actually it felt like nothing at all – no pain and not much sensation." 

Deirdre

"Both times they went while in the birthing pool, and both times just before they were born. There was a pop and the pressure I'd been feeling suddenly went, it was like the relief of releasing a full bladder, with a slightly warm sensation as if I'd peed in the water." 

Laura

How do I know if my waters have broken?

If you experience the following, your waters may have broken:

• a popping sensation followed by a gush or trickle of fluid
• an unusual amount of dampness in your underwear that doesn’t smell like urine
• uncontrollable leaking of small or large amounts of fluid from the vagina that doesn’t smell like urine.

Does it hurt when my waters break?

No, it shouldn’t hurt when your waters break or when they are broken for you. The amniotic sac, which is the part that ‘breaks’ doesn’t have pain receptors, which are the things that cause you to feel pain.

"My waters didn’t break of their own accord so I had them broken for me while in hospital. I didn’t feel a thing. It might be that the pain was masked by the pain of labour (which was pretty intense at that point) or it might be that it is in fact a surprisingly painless process – probably the latter." 

Danae

My waters broke, what do I do now?

Put a sanitary pad (not a tampon) in your pants, if you can. Amniotic fluid is clear and a pale straw colour. Sometimes it's difficult to tell the difference between amniotic fluid from wee. The water may be a little bloodstained to begin with.

Once the waters have broken, your baby is at risk of infection and your midwife or hospital/birth centre is likely to ask you to come into hospital to be checked.

Tell your maternity unit immediately if:

• the waters are smelly or coloured
• you're losing blood.

This could mean you and your baby need urgent attention.

If your waters break before you go into labour

Sometimes your waters may break before you go into labour. Most women go into labour on their own within 24 hours. If this doesn’t happen your midwife will offer to induce labour and you’ll be advised to give birth in hospital, if you’re not there already.

This is because your waters breaking before labour starts increases your baby’s risk of infection.

While you’re waiting to be induced (or if you choose not to be induced), your midwife will ask you to take your temperature every 4 hours while you’re awake. This will help you find out if you’re developing a temperature.

Contact your midwife if:

• you develop a high temperature (around 37.5 degrees Celsius)
• you notice any change in the colour or smell of your vaginal discharge
• you feel your baby's movements have changed or they are moving less. You should continue to feel your baby move right up to the time you go into labour and during labour. Find out more about your baby's movements.

Having a shower or bath won’t increase the risk of infection, but sex might, so avoid this after your waters break.

Your midwife should check your baby's heartbeat every 24 hours during this time.

How do midwives check if my waters have broken?

If you or your midwife think your waters might have broken but aren’t sure, you should be offered an internal examination.

With your permission (consent), your midwife or doctor will insert a small plastic instrument called a speculum into your vagina, so they can see the neck of the womb. You may be asked to cough to encourage the waters to pass through your cervix from your womb, if this cannot be seen easily.

You won’t have this examination if it is obvious that your waters have already broken.

“My waters broke differently with all of my children.  The first time felt like the movie-style gush. During my second labour my waters broke before my contractions started, and it was just a little ‘pop’ and a trickle. I was monitored daily and went into labour naturally 2 days later. During my third labour my waters broke in the birthing pool and it was a big ‘pop’. In my last labour my waters broke while I was pushing and my son pretty much surfed out on them!”

Sarah 

Why would my midwife break my waters?

If your labour is going very slowly, your midwife or doctor may suggest breaking your waters (also known as artificial rupture of the membranes) if they haven’t broken already. This can help to make your labour shorter.

Having your waters broken doesn't hurt your baby, but there are some risks as with any intervention.

Having your waters broken may make your contractions stronger and more painful. It may be worth talking to your midwife about pain relief before your waters are broken.

How are my waters broken artificially?

Sometimes, your midwife may break your waters for you to induce or speed up your labour. This is known as artificial rupture of membranes (ARM).

Your midwife or doctor will make a small break in the membranes around your baby. They’ll either use a long thin probe (known as an amnihook) or a medical glove with a pricked end on one of the fingers (an amnicot). This will feel a bit like an internal examination and won’t hurt your baby.

Find out more about the stages of labour, including delays.

Induction of labor or induction of labor

The purpose of this informational material is to familiarize the patient with the induction of labor procedure and to provide information on how and why it is performed.

In most cases, labor begins between the 37th and 42nd weeks of pregnancy. Such births are called spontaneous. If drugs or medical devices are used before the onset of spontaneous labor, then the terms "stimulated" or "induced" labor are used in this case. nine0003

Labor should be induced when further pregnancy is for some reason unsafe for the mother or baby and it is not possible to wait for spontaneous labor to begin.

The purpose of stimulation is to start labor by stimulating uterine contractions.

When inducing labor, the patient must be in the hospital so that both mother and baby can be closely monitored.

Labor induction methods

The choice of labor induction method depends on the maturity of the cervix of the patient, which is assessed using the Bishop scale (when viewed through the vagina, the position of the cervix, the degree of its dilatation, consistency, length, and the position of the presenting part of the fetus in the pelvic area are assessed). Also important is the medical history (medical history) of the patient, for example, a past caesarean section or operations on the uterus.

The following methods are used to induce (stimulate) labor:

• Oral misoprostol is a drug that is a synthetic analogue of prostaglandins found in the body. It prepares the body for childbirth, under its action the cervix becomes softer and begins to open.
• Balloon Catheter - A small tube is placed in the cervix and the balloon attached to the end is filled with fluid to apply mechanical pressure to the cervix. When using this method, the cervix becomes softer and begins to open. The balloon catheter is kept inside until it spontaneously exits or until the next gynecological examination. nine0022
• Amniotomy or opening of the fetal bladder - in this case, during a gynecological examination, when the cervix has already dilated sufficiently, the fetal bladder is artificially opened. When the amniotic fluid breaks, spontaneous uterine contractions will begin, or intravenous medication may be used to stimulate them.
• Intravenously injected synthetic oxytocin - acts similarly to the hormone of the same name produced in the body. The drug is given by intravenous infusion when the cervix has already dilated (to support uterine contractions). The dose of the drug can be increased as needed to achieve regular uterine contractions. nine0022

When is it necessary to induce labor?

Labor induction is recommended when the benefits outweigh the risks.

Induction of labor may be indicated in the following cases:

• The patient has a comorbid condition complicating pregnancy (eg, high blood pressure, diabetes mellitus, preeclampsia, or some other condition).
• The duration of pregnancy is already exceeding the norm - the probability of intrauterine death of the fetus increases after the 42nd week of pregnancy. nine0022
• Fetal problems, eg, problems with fetal development, abnormal amount of amniotic fluid, changes in fetal condition, various fetal disorders.
• If the amniotic fluid has broken and uterine contractions have not started within the next 24 hours, there is an increased risk of inflammation in both the mother and the fetus. This indication does not apply in case of preterm labor, when preparation of the baby's lungs with a special medicine is necessary before delivery. nine0022
• Intrauterine fetal death.

What are the risks associated with labor induction?

Labor induction is not usually associated with significant complications.

Occasionally, after receiving misoprostol, a patient may develop fever, chills, vomiting, diarrhea, and too frequent uterine contractions (tachysystole). In case of too frequent contractions to relax the uterus, the patient is injected intravenously relaxing muscles uterus medicine. It is not safe to use misoprostol if you have had a previous caesarean section as there is a risk of rupture of the uterine scar.

The use of a balloon catheter increases the risk of inflammation inside the uterus.

When using oxytocin, the patient may rarely experience a decrease in blood pressure, tachycardia (rapid heartbeat), hyponatremia (lack of sodium in the blood), which may result in headache, loss of appetite, nausea, vomiting, abdominal pain, depression strength and sleepiness. nine0003

Induction of labor, compared with spontaneous labor, increases the risk of prolonged labor, the need for instrumentation

(use of vacuum or forceps), postpartum hemorrhage, uterine rupture, the onset of too frequent uterine contractions and the associated deterioration of the fetus, prolapse umbilical cord, as well as premature detachment of the placenta.

If induction of labor is not successful

The time frame for induction of labor varies from patient to patient, on average labor begins within 24-72 hours. Sometimes more than one method is required. nine0003

The methods used do not always work equally quickly and in the same way on different patients. If the cervix does not dilate as a result of induction of labor, your doctor will tell you about your next options (which may include inducing labor later, using a different method, or delivering by caesarean section).

ITK833

This informational material was approved by the Women's Clinic on 01/01/2022.

What will help in childbirth - articles from the specialists of the clinic "Mother and Child"

Vovk Lyudmila Anatolyevna

Reproductologist, Obstetrician-gynecologist

Lapino-1 Clinical Hospital "Mother and Child"

We walk and dance

If earlier in the maternity hospital, with the onset of labor, a woman was put to bed, now obstetricians, on the contrary, recommend that the expectant mother move . For example, you can just walk: the rhythm of steps soothes, and gravity helps the neck to open faster. You need to walk as fast as it is convenient, without sprinting up the stairs, it’s better to just “cut circles” along the corridor or ward, from time to time (during the aggravation of the fight) resting on something. The gait does not matter - you can roll over like a duck, rotate your hips, walk with your legs wide apart. It is worth trying and dancing, even if you think that you do not know how. For example, you can swing your hips back and forth, describe circles and figure eights with your fifth point, sway in a knee-elbow position. The main thing is to move smoothly and slowly, without sudden movements. nine0003

Showering and bathing

For many people, water is a great way to relieve fatigue and tension, and it also helps with painful contractions. You can just stand in the shower, or you can lie down in the bath. Warm water will warm the muscles of the back and abdomen, they will relax, and the birth canal will relax - as a result, the pain may decrease. Well, if it does not decrease, then in any case, the water will relieve stress and at least for a while distract from the pain. So if there is a shower or jacuzzi bath in the delivery room, do not be shy and try this method of pain relief for contractions. The only thing is that the water should not be too hot, even if it seems that heat helps to better endure contractions. nine0003

Swinging on the ball

Until recently, fitball (rubber inflatable ball) in the rodblock was something outlandish, and today is found in many maternity hospitals. And if you find a fitball in your rodblock, be sure to use it. You can sit on the ball astride and swing, rotate the pelvis, spring, roll from side to side. You can also kneel down, lean on the ball with your hands and chest and sway back and forth. All these movements on the ball will relax the muscles, increase the mobility of the pelvic bones, improve the opening of the neck, and reduce the pain of contractions. And while the woman is sitting on the ball, her partner (usually her husband) can massage her neck area for additional relaxation. nine0003

To be more comfortable, the ball should be soft, slightly deflated, and large, with a diameter of at least 75 cm.

We hang on a rope or wall bar

When the contractions become very strong and painful, you can take poses in which the stomach is in a “suspended” state. Some advanced maternity hospitals have wall bars and ropes attached to the ceiling for this. During contraction, you can hang on them, as a result, the weight of the uterus will put less pressure on large blood vessels, and this will improve uteroplacental blood flow. In addition, in the “suspended” position, the load from the spine will be removed, which will also reduce pain. nine0003

Do not hang on a rope or a wall only if there is a desire to push, and the cervix has not yet opened and the efforts must be restrained.

Lying comfortably

If during childbirth a woman wants not to move, but, on the contrary, to lie down, then, of course, she can lie down. In modern maternity hospitals, instead of traditional ones, there are transforming beds: you can change their height, lower or raise the headboard or foot end, adjust the tilt level, push or push some part of the bed. There are also handrails in transforming beds (to use them to rest or even hang on them), and leg supports, and retractable pillows, and special backs - in general, everything in order to fit the bed under you and take it with it comfortable position. Moreover, this can be done without any physical effort - using the remote control. nine0003

We use everything we have

In any road block, even if it is minimally equipped, you can still find something useful. For example, if during a fight you want to take a position with a support, you can lean forward and rest against something that turns up under your arm - a table, a headboard, a window sill. The main thing is that the support must be very stable. You can also get on all fours in the “cat pose” and focus on your hands, and to make it more convenient, put a pillow and a folded blanket under your chest. If you want to hang on something (and there is no rope or wall) and your husband will be nearby, you can use postures that allow you to transfer body weight to him: for example, hang on your husband’s neck. In general, it is worth showing imagination and adapting any item in the rodblock to your needs. nine0003

And don't be afraid to look stupid during childbirth. No one in the delivery room cares about how you move or lie down as long as it helps you get through your contractions, so calmly find your comfortable position.

Giving birth in an uncomfortable position is both difficult and inefficient.

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