Breaking the waters
Your baby is enclosed inside a bag made of two very thin membranes (like very thin skin). This bag contains a water-like fluid called ‘amniotic fluid’, which the baby is floating in.
Many women will experience their ‘waters’ (amniotic fluid) breaking naturally in labour during contractions. Other women find that the waters break naturally without any contractions. After 37 weeks of pregnancy this is normal, but it is important to let your healthcare provider know that your waters have broken naturally. A small percentage of women get to the stage of pushing out their baby with the bag of membranes still intact!
However, when you are in labour, your midwife or doctor may discuss with you the option of ‘breaking the waters’ (artificial rupture of the membranes) rather than waiting for this to happen naturally. This means that, during a vaginal examination, the midwife or doctor will open the bag of water that surrounds your baby and the waters will start to leak out. You may or may not experience contractions after the waters are broken.
As with every decision, it is one that you will discuss with your healthcare provider after your questions have been answered. Here are some of the reasons why this may be suggested to you:
- To try to induce your labour (to start labour off with or without other methods)
- To attempt to speed up your labour if it has slowed down
- If there are some concerns with your baby’s heart rate
- If you have an epidural
In 2013, a review of studies involving 5583 women showed that breaking the waters may not increase the progress of your labour (Smyth et al 2013). Another review of studies, including 5390 women, found that caesarean section rates were slightly lower in the group of women that had ‘active management of labour’ (Brown et al 2013) - this includes having your waters broken by a midwife or doctor as well as other methods such as using a ‘drip’ of artificial oxytocin (syntocinon) into your arm.
However, the review also showed that ‘active management of labour’ could possibly lead to more invasive monitoring, more interventions and a more medicalised birth in which women have less control and less satisfaction. It is important that your pregnancy, labour and birth is individually assessed and that you and your healthcare professional agree on the right actions for you.
In order to break your waters, your midwife or doctor will examine your cervix by doing a vaginal examination (a bit like having a cervical smear done). You usually lie down for this examination. Some women find having the waters being broken slightly uncomfortable and use breathing techniques to help them relax. If you feel you would like or need something more to help you relax, ask your midwife or doctor if you may have some Entonox (‘gas and air’ or ‘laughing gas’).
Your cervix will need to be slightly open for your midwife or doctor to be able to break the waters, otherwise it is not possible to do so. Once your waters have been broken, the waters will keep leaking until you birth your baby. The amount of water can vary; most women find that with each contraction they have or when changing their position, a little more fluid will drain out, so you may want to wear 2 sanitary pads.
The midwife or doctor will assess the colour of the waters after they have been broken. It is important that you also look at the colour of the waters each time you change your pad, as the colour can change. Your waters can be clear, pinkish, blood stained or meconium (green) stained. Meconium-stained waters mean that your baby has passed their first bowel motion, which is sometimes a sign that they are getting a little distressed.
It is helpful to show your pad to your midwife or doctor, if you have any concerns about the colour of the waters that are leaking. The midwife or doctor may suggest using the CTG machine to monitor the baby’s heartbeat electronically for a while, if the waters are blood-stained or have meconium in them.