When a person’s “water breaks” during pregnancy, the risk of infection increases. Doctors may recommend inducing labor if it does not begin naturally within 24 hours of water breaking.
The longer the time between water breaking and delivery, the higher the risk of infection. Seeking medical attention sooner rather than later is advisable.
This article outlines what a person should do if they think their water has broken, when to contact a doctor, possible options regarding labor and delivery, and more.
When a person experiences water breaking, it means their amniotic sac has ruptured. The amniotic sac contains amniotic fluids that protect the fetus during pregnancy.
The most obvious sign a person’s water has broken is when fluid begins leaking from their vagina.
It is difficult to predict how much amniotic fluid they will lose. For example, some people experience a gush of fluids, while others experience a steady stream or trickle until the baby is born.
After their waters break, many people need to wear a sanitary pad until they get to the hospital.
Some people may confuse amniotic fluids with leaking urine or increased vaginal discharge, as both are common during pregnancy. Differences include the following characteristics:
- Urine will typically be yellow and smell like ammonia.
- Vaginal discharge may be milky-white with the consistency of thin mucous.
- Amniotic fluid is generally clear or pale yellow and odorless or sweet-smelling.
What to do if a person’s water has broken
After a person’s water breaks, it is best to follow any instructions an OB-GYN may have provided in the months leading up to birth.
Amniotic fluid helps protect the pregnant person and fetus from infection. Once the waters break and that protective barrier is gone, ways to prevent infection include:
- using liners or pads to absorb amniotic fluid, not tampons
- being careful to wipe front to back after using the bathroom
- avoiding sex
Typically, a pregnant person who tested positive for a group B Streptococcus (GBS) infection will need to go to the hospital immediately following their water breaking. There, healthcare workers can help prevent GBS developing in the baby.
Many pregnant people go into labor within 12 hours of their water breaking. However, 1 in 10 will not go into labor on their own after a day or so.
A person may consider contacting their doctor if they do not experience any signs of labor within several hours of their water breaking.
The time a pregnant person can safely go between their water breaking and giving birth varies from case to case. However, waiting too long, especially without medical supervision,
The American College of Obstetricians and Gynecologists (ACOG) recommends waiting no longer than 24 hours before inducing labor. However, it is important to note that this recommendation is for OB-GYNs who are closely monitoring a pregnant person.
For many pregnant people, the membranes rupture right before or during labor.
When they break before then, but after 37 weeks of gestation, doctors call this “term prelabor” or “premature rupture of the membranes (PROM).” The ACOG recommends inducing labor at this point.
When waters break before 37 weeks, doctors call this “preterm premature rupture of the membranes (PPROM).” In that case, the doctor will measure the risks against the benefits when determining whether to induce labor or allow time for expectant management, which we describe below.
Once the doctor confirms a pregnant person’s water has broken, they will consider the following and develop a plan of action:
- how early the waters broke
- the pregnant person’s current health, including signs of infection
- the fetus’s current health, including signs of distress
- the fetus’s position or presentation
- risk factors, such as GBS
Typically, either labor induction or a short window of expectant management follows.
An OB-GYN may use a combination of medications and devices to induce labor. These include:
- Medications: Drugs for inducing labor include prostaglandins and oxytocin. Prostaglandins are hormone-like substances that a pregnant person may take orally or insert into their vagina to “ripen” or thin out their cervix. Oxytocin, or the “love hormone,” can kickstart contractions. Doctors administer oxytocin intravenously.
- Devices: These may include laminaria, thin rods the doctor inserts into the cervix, and catheters with balloons that inflate and help open the cervix.
As with labor that starts on its own, induced labor can last anywhere from a few hours to a few days.
Sometimes, expectant management is an option before induction.
Expectant management, which doctors may also call “watchful waiting,” involves waiting to see if labor starts on its own.
The ACOG recommends labor induction for people who experience PROM after 37 weeks and plan on vaginal delivery. However, they also provide guidelines on offering expectant management for 12–24 hours for people experiencing low risk pregnancies.
During this time, doctors will monitor vitals and counsel the pregnant person on progress and potential next steps.
It is best for a person to contact their OB-GYN if their waters break and:
- they are only 37 weeks pregnant, or fewer
- they have had a cesarean delivery before and plan to have another cesarean birth this time
- they have GBS or do not know whether they have it
- they have a history of fast labor
- the fetus is not in the head-down position
- the fetus is high in their pelvis
Furthermore, they may want to go directly to the hospital if:
- the amniotic fluid is brown or green, which may indicate meconium aspiration syndrome
- they experience only a small, one-time gush of fluid, which may indicate that the fetus’s head moved and stopped the leak after their membrane ruptured, increasing the risk of infection
- they feel or see something in their vaginal opening
Although rare, prolapse of the umbilical cord can occur, meaning it sweeps into the cervix or vagina along with the amniotic fluid. A prolapsed umbilical cord can cause birth asphyxia.
Any intense pain or bleeding also warrants a trip to the hospital.
According to a
The article states that gestational age plays a major role in the outlook for the fetus. For example, PPROM that occurs from 20 weeks and 0–7 days of gestation to 25 weeks and 6–7 days, while less common than PROM, is even more critical.
As researchers point out in a recent
It is dangerous to wait too long between the membranes rupturing and delivery. Without an amniotic sac, the pregnant person and the fetus have less protection against dangerous infections.
A healthcare team will consider the pregnant person’s current health, the gestational age of the fetus, and other factors when recommending the next steps after water breaks.
It is common for doctors to induce labor to shorten the period between the water breaking and delivery.