POP GOES YOUR AMNIOTIC SAC: AKA WATER BREAKING 101
We all know water can’t really “break,” so when we talk about “water breaking” in labor, what the heck is going on?!
IT'S ALL ABOUT THAT SAC:
The amniotic sac is a thin, two-layered membrane that lines the uterus and protects the growing fetus and its surrounding amniotic fluid from the outside elements.
It’s super strong given how thin it is, but it can only stretch so far and eventually, it pops! The good news is that because the amniotic sac has no nerve endings, no amount of tearing, popping, or breaking causes any pain to the pregnant person or fetus. While no one has pinpointed the exact reason why labor begins, we do know that your water breaking isn’t what causes labor to start.
Contrary to what Hollywood may have led you to believe, only about 10-20% of pregnant people(1) will have their water break before contractions begin and it’s not necessarily the reason to rush to the hospital (we’ll get into when it actually might be time to scoot). For most people, the water breaking doesn’t happen until later in labor, and in rare cases, it never breaks at all!
THE FOUR WAYS YOUR WATER CAN BREAK
The entertainment industry has painted a v. dramatic picture of the whole water breaking ordeal. While a gush can certainly happen while giving that big presentation or at your best friend’s wedding, it tends to be a bit more subtle than that.
1. The Slow Drip AKA Did I Pee Myself?
If the sac doesn’t tear at the bottom near the cervix (either in between the two layers of the sac, or higher up in the uterus), you’ll likely experience a slow leak of fluid instead of a gush. Small trickles of fluid will come out of your vagina and if contractions haven’t started yet, you may be unsure if it’s increased discharge, fluid, or if maybe you just peed yourself (#cool).
2. The Gush
The cinematic gush happens more often during labor when the cervix has begun to dilate and the amniotic sac is left more exposed. The sac is then able to create a bulge outward into the vagina, referred to as a “forebag.” This, plus the pressure from the baby’s head, leads to a more enthusiastic pop—like a water balloon! A lot of people will feel that contractions get stronger after their water breaks in this manner, but otherwise labor just keeps plugging along. It doesn’t mean a whole lot about your labor, but it’s an exciting moment!
3. W/ a Lil Help from a Friend:
It is also possible to artificially rupture the membranes. This is when a doctor or midwife uses a special tool to purposefully break the amniotic sac, usually with the hope of helping labor progress along. Research is still out(2) on whether or not this actually shortens the length of labor, and it should be done only with explicit consent from the pregnant or laboring person.
(Note from editor: Sadly, in hospitals, consent is not always explicitly asked for. If this is important to you, let your practitioner know you want to be involved in the water breaking convo prior to them doing any cervical exams in labor.)
While artificially rupturing the membranes can cause an increase in the intensity of labor, studies also show that it can lead to an increased risk for intrauterine infection and cesarean birth.(3) It continues to be a super commonly used intervention in labor despite most scholarly research recommending against it.(4)
4. Sometimes, it doesn’t break at all!
In rare cases, babies can be born with the full sac intact. This is called being born “en caul” and is considered an auspicious sign in many cultures. Apparently, you need to be born this way to be the next Dalai Lama.(5) Cool!
SO WHAT DO I DO IF MY WATER BREAKS?
Check the color and the odor. It should be clear or pink-tinged. Not brown, green, or murky. Baby should be moving and grooving as usual. If it is brown, green, or murky, don’t freak out, but do call your practitioner. This can just be a sign that baby has pooped in utero, which can signal some stress on their end and is worth investigating.
WHEN MY WATER BREAKS DOES THAT MEAN I RUSH TO MY BIRTH PLACE?
Here’s the thing—anytime the sac breaks, the uterine environment is no longer protected from the rest of the world, allowing the introduction of bacteria and possible infection to the fluid around the fetus. This sounds scary, but the good news is that statistically speaking, as long as nothing enters the vagina (a penis, fingers, a speculum, sterile gloved hands), waiting for labor to begin at home is an evidence- based option.(6)
Important to note: if you are one of the 25% of people who tests positive for group beta strep (a normal member of vaginal flora) at 36 weeks, the evidence does show a dramatic benefit in receiving antibiotic treatment once your water breaks.(7) Again, here’s where a phone call to your midwife or doctor would be important.
THIS IS IMPORTANT!
OBs and midwives vary widely in their protocols when the water breaks before contractions begin. Some may insist on immediate admission to the hospital to begin labor induction, while others will trust the evidence and counsel their patients to stay in touch and wait for labor to start on its own.
Remember, you are the boss of your body. Have a chat with your care provider around their specific protocols, it’ll help to know what to expect and how to communicate your needs if your water does break before contractions begin. If their protocol doesn’t feel right to you, remember that it is completely valid, reasonable, and within your rights to ask questions, seek second opinions, or even switch providers at any point in pregnancy. Here’s where having a doula can be hugely useful in talking through this and navigating toward your best options.
By: Yael Borensztein, RN, IBCLC and birth doula in NYC. You can find her bopping around the city supporting new families, online at bornknowing.co, or on instagram @born.knowing.
(1,6,7) Dekker, Rebecca. “Evidence on: Induction When Your Water Breaks at Term.” Evidence Based Birth®, 14 Dec. 2018, evidencebasedbirth.com/evidence-inducing-labor-water-breaks-term/.
(2) Dekker, Rebecca. “Evidence on: Failure to Progress.” Evidence Based Birth®, 14 Nov. 2018, evidencebasedbirth.com/friedmans-curve-and-failure-to-progress-a-leading-cause-of-unplanned-c-sections/.
(3) Cline, Matthew K., and James M. Nicholson. “Artificial Rupture of Membranes.” NeuroImage, Academic Press, 2008, www.sciencedirect.com/topics/medicine-and-dentistry/artificial-rupture-of-membranes.
(4) Saadia, Zaheera. “Rates and Indicators for Amniotomy During Labor - a Descriptive Cross Sectional Study Between Primigravidas and Gravida 2 and Above.” Medical Archives, vol. 68, no. 2, 2014, p. 110., doi:10.5455/medarh.2014.68.110-112.
(5) “The Order Of The Ancient Way.” Intellectual Property and Plagairism, www.caulbearer.org/cb_whysospecial.php.