Dr. Lewis Lipscomb

Water breaking is one of the most famous pregnancy milestones. Everyone knows it’s part of the labor process. But what does it mean, exactly? And is it obvious enough that every pregnant woman will know when it happens? (Not necessarily.)

We asked Dr. Lewis Lipscomb, with Novant Health Triad Obstetrics & Gynecology in Winston-Salem, a few burning questions about the iconic – but sometimes subtle – occurrence.

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Does a pregnant woman's water always break?

Yes. Her water must break or be broken.

The only time that doesn’t happen is when a baby is born inside the amniotic sac, which is something like a water balloon. That’s called an “en caul” delivery, and it’s extremely rare.

What exactly does it mean for water to break?

Water breaking is actually the rupturing of your amniotic membrane. It happens when the membrane surrounding the baby spontaneously ruptures or is ruptured by the doctor in an amniotomy, which is one of the most common procedures we do in obstetrics.

Why would a doctor need to break a woman’s water?

We perform an amniotomy when labor is stalled or in order to speed up labor.

How does a doctor break a woman’s water?

During a cervical exam, we use an instrument with a little “burr” at the tip of it. I place the burr up against the membrane covering the amniotic sac. It’s like popping a water balloon.

The procedure is very much like getting your cervix checked. Some women worry it might be painful, but it does not cause any more discomfort than a cervical exam does.

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Apparently, women don't always know their water has broken. They may think they’re leaking urine, right?

The symptoms can be very subtle; it can be hard to ascertain if something significant has happened. But it is very important to know if your water is broken or not. If you are uncertain for more than a couple of hours, you should get checked out at your OB’s office or the hospital.

We have several ways to determine if it’s amniotic fluid. We can put a sample of the fluid on a slide and examine it under a microscope. That’s called the fern test. There’s a nitrazine test, which is a measurement of the pH of the amniotic fluid. A nitrazine paper changes color when it comes in contact with amniotic fluid. And we can use a speculum to visualize the upper vagina and see if there’s any liquid pooling.

I tell my patients that if they’re leaking and are uncertain if it’s urine or amniotic fluid, to:

  • Empty your bladder.
  • Lie down flat on your side.
  • Then, stand up and walk around for a couple of minutes.
  • If you notice fluid leaking, call your doctor. You can be reasonably sure it’s not urine because you just emptied your bladder.

If there's any doubt whatsoever, call your doctor’s office and speak to the nurse or provider on call. Or, proceed to the labor and delivery triage at the hospital and get evaluated. This is not an emergency. It's not anything to panic about, but it should be addressed within a few hours if you're uncertain.

Besides getting evaluated, is there anything else a woman needs to know or do after her water breaks?

She should avoid placing anything – including tampons – in the vagina and should not have sex. This is important because if the amnionic membrane is broken, then the barrier which protects the baby from infection is no longer providing protection.

What does it feel like when water breaks?

It can feel like water dripping – or gushing – down your legs.

Does it ever happen that a woman's water breaks, and she’s not aware of it?

That could happen, although she will eventually become aware of it.

Sometimes, a woman may come in for a routine ultrasound, and we’ll notice there’s not much fluid in the sac. A doctor may ask: “Have you noticed increased moisture in your underwear?” And she might say, “Now that you mention it, maybe.”

That can be a risky situation for the baby.

If you experience pain, bleeding, any leaking of fluid from the vagina, or frequent contractions when you’re pre-term, or if the baby's not moving, we want to be there for you. So, let us know if any of those things happen.

Can water break early? Can it break before the baby is ready to come?

Yes. And if that happens, it doesn't necessarily mean that the baby needs to be born.

If a woman's water breaks and the baby is preterm – less than 37 weeks – she should be admitted to the hospital. But again, that can be evaluated in the office before she goes to the hospital.

It could be preterm, premature rupture of the membrane (PPROM), which happens in only about 8% to 10% of pregnancies and needs to be attended to in the hospital.

How long after your water breaks do you have to deliver?

If the mom is term or near-term, we generally proceed with induction of labor. If she’s preterm, we carefully weigh the risks to mom and baby, discuss this with the patient and make recommendations about the best course of action. Sometimes we can delay delivery while closely monitoring mom and baby for signs of complications.

There's not really a time limit on labor based on water breaking, but somebody whose water has been broken for an extended time and hasn’t delivered is at risk of developing a bleeding complication called a placental abruption, a condition in which the placenta separates – partially or completely – from the uterine wall before birth. If this happens, the baby is at risk of not getting enough oxygen and nutrients in the womb. Of course, because the protective membrane is compromised, infection is a risk that we need to take steps to prevent or detect. If there is infection present, delivery will be necessary.

In the early stages of labor, as your cervix opens, a woman may notice a pink or slightly bloody vaginal discharge, which is the mucus plug releasing. Could a woman mistake that for her water breaking?

Probably not. When the mucus plug breaks, there’s some substance to that discharge. I’m sorry to be indelicate, but it’ll look like a glob of snot. But when your water breaks, it’s very watery – a liquid – you’ll feel.

If a woman notices her mucus plug has passed, is that a sign her water will be breaking soon?

Not necessarily. There can be a lot of excitement with passage of the mucus plug – a woman might feel like something must be happening; labor must be coming. But it’s not predictive of a baby coming in the next X number of hours or days. It's not insignificant, but it just doesn't herald anything. Sometimes the mucus plug will be dislodged following a cervix examination that was performed at a prenatal care visit.