You know the scene in all the movies. A very pregnant woman flawlessly dressed with perfect hair and makeup walks into the room. She smiles, not a care in the world. And then, without any warning, you hear the characteristic splash! A rush of clean, clear water has flooded her expensive shoes right in the middle of the street, restaurant or church. Then, as if on cue, her contraction pains start immediately and she is in full-blown labor by the time the car screeches to a stop in front of the hospital.
Don’t get your hopes up, ladies, as this isn’t usually the case. In fact, fewer than 15 percent of women go into labor with their water breaking first. Typically there are many other symptoms that happen prior to that.
Your baby is surrounded by amniotic fluid. He/she is cocooned in a warm water balloon of fluid that is safely confined in your uterus. There is a thick membrane that holds the amniotic fluid inside the uterus. When your “water breaks” it is actually the membrane that ruptures causing the release of fluid out of your uterus though the cervix. This is known as rupture of membranes (ROM). This can happen as a slow trickle or a large gush. It can happen during contractions or with no pain involved. It can even happen early in the pregnancy when the baby is very premature. Very early rupture of membranes can lead to many complications and makes your pregnancy a high risk one, so it is important to tell your provider as soon as possible if you think that your water has broken.
Amniotic fluid isn’t the only thing that can cause that funny leaky feeling in pregnancy. Almost every woman develops a change in vaginal discharge in pregnancy. This increased discharge can be clear, pink or slightly bloody. This can happen several days before labor begins or at the onset of labor. Some women will notice thicker discharge that reminds them of mucous from the nose. This is often called your mucous plug or “show”; it is mucous that has accumulated normally at the cervix during pregnancy. When the cervix begins to dilate, the plug is pushed into the vagina. This can happen all at once, or in small amounts over the course of weeks. Unfortunately it does not predict how soon after you will go into labor.
Some women are prone to vaginal infections that can act very similarly to leaking fluid. Pregnant women can get yeast or bacterial infections any time in pregnancy. These often cause an increase in discharge but are usually accompanied by other symptoms such as burning, irritation or odor. If there is concern for an infection you must have this evaluated by your provider.
Also, let’s not forget the bladder. Many pregnant women find they leak urine. The heavy uterus and baby lay right on your bladder, which contributes to having to urinate all the time in pregnancy. But it can also lead to leaking small amounts of urine out of your bladder with certain activities or position changes. This can be very confusing to most women as they don’t typically leak urine. Frequent urination and leaking urine can also be a sign of a bladder infection and should be discussed with your provider.
If you think your water has broken you should call your provider. You will be asked questions about when it happened and if you are still leaking fluid. Many times you will be asked to come in to the birthing center to be evaluated. Your provider may do tests and examinations that can confirm if the fluid that you are leaking is in fact amniotic fluid. Amniotic fluid has a specific pH level and will turn special pH paper a distinctive color. The fluid may also be collected and looked at on a slide under a microscope because amniotic fluid dries to form a special pattern that cannot be seen without magnification. There are other special tests that can be used to confirm it is amniotic fluid, but those tests must be collected by a nurse or physician and evaluated in the laboratory. If it is amniotic fluid you will be admitted to the hospital right away even if you are not having contraction pains yet.
When the bag of water is broken there is no longer a barrier between the baby and the outside world; bacteria can travel up into the uterus and could cause an infection. Once you have ruptured membranes it is important to monitor you and the baby. You may also need assistance in getting your labor started if there is concern about preventing an infection.
Don’t wait for that dramatic Hollywood gush of fluid. If you think your water has broken be sure to call as soon as you can.