Your water can break without you being dilated. The protective fluid surrounding the baby can escape at any time, even hours or days before labor contractions begin to open the cervix. This situation requires immediate contact with your healthcare provider to ensure a safe transition for both you and the baby. A premature rupture of the membranes carries specific considerations that medical professionals need to address promptly.
The Two Components of Labor: Dilation and Membrane Rupture
Labor involves two separate physiological events: the progressive opening of the cervix (dilation) and the rupture of the amniotic sac. Cervical dilation is the widening of the lower uterus, measured from zero to ten centimeters, necessary for the baby to pass through the birth canal. The cervix must also undergo effacement, which is the thinning and softening of the tissue.
The amniotic sac is the fluid-filled membrane containing amniotic fluid, which cushions and protects the developing fetus. The rupture of this membrane, known as the water breaking, releases the fluid and removes the sterile barrier between the baby and the outside world. Although contractions ideally cause the sac to break during active labor, these two processes are not always synchronized. The membrane can rupture before the cervix has begun to change significantly.
Prelabor Rupture of Membranes (PROM)
The medical term for when the amniotic sac ruptures before the onset of regular labor contractions is Prelabor Rupture of Membranes, or PROM. This phenomenon occurs in a small percentage of full-term pregnancies. If this rupture occurs before 37 weeks of gestation, it is classified as Preterm Prelabor Rupture of Membranes, or PPROM.
Risk Factors for PROM
Factors that weaken the amniotic sac predispose a person to PROM. Infections of the reproductive tract, such as bacterial vaginosis, are commonly associated with membrane weakening. Other recognized risk factors include a previous PROM event or having a short cervical length. Conditions that cause excessive stretching of the uterus, such as carrying multiple fetuses or having polyhydramnios (excess amniotic fluid), also contribute. Lifestyle choices like cigarette smoking or the use of illicit drugs during pregnancy are linked to an increased risk.
Urgent Next Steps: What to Do When Your Water Breaks
If you suspect your water has broken, contact your healthcare provider or go to the hospital immediately. Note the time the fluid leak began, as the duration of the rupture is an important factor in medical decisions. You should also assess the characteristics of the fluid using a clean pad or liner.
Normal amniotic fluid is typically clear or pale yellow and may have a slightly sweet scent. If the fluid appears green, brown, or has a foul odor, communicate this information immediately. A greenish or brownish tint is often caused by meconium (the baby’s first stool), signaling a need for closer fetal monitoring. A strong, unpleasant odor may suggest an infection is present within the uterus.
While preparing for the hospital, avoid inserting anything into the vagina, including tampons, and refrain from bathing or sexual intercourse. The loss of the amniotic sac’s sterile environment heightens the risk of bacteria ascending into the uterus. Use a sanitary pad to absorb the fluid and maintain hygiene to reduce the possibility of introducing infection.
Medical Management and Associated Risks
Confirming Rupture
Upon arrival, providers will confirm the diagnosis of membrane rupture, often using a sterile speculum examination. They may use a ferning test (examining dried fluid for a characteristic pattern) or a pH test, as amniotic fluid is more alkaline than normal vaginal secretions. Digital vaginal examinations are generally avoided unless delivery is imminent, as this practice increases the risk of infection.
Term Rupture Management
The two primary concerns following membrane rupture are the risk of intrauterine infection (chorioamnionitis) and the management of prematurity. If the rupture occurs at or near term (37 weeks or later), delivery is generally recommended to minimize the risk of infection. Labor is often induced if it does not begin spontaneously within a short period.
Preterm Rupture (PPROM) Management
For PPROM (rupture before 37 weeks), management balances the risk of prematurity against the risk of infection. Providers may choose expectant management, involving close monitoring to delay delivery and give the fetus more time to develop. During this latency period, broad-spectrum antibiotics are typically administered to prolong the pregnancy and reduce infection risk. Corticosteroids may also be given to accelerate the maturity of the baby’s lungs.