Water discharge (PROM & PPROM)

When your water breaks, it means that the membranes have ruptured, allowing amniotic fluid to flow out through the vagina. There can be larger or smaller amounts. In movies, water breaking often happens with a huge SPLASH, and the woman is standing or lying in a pool of water. This is how can It may seem like a good idea, but in the real world, water breaking is much more often a trickle than a splash. There may even be so little amniotic fluid that you are unsure whether your water has broken - more on that later.

When will you get your water removed?

Water breaking is a sign that you are about to give birth (usually within the next 24 hours). Water breaking can either occur as the first step towards birth - that is, without contractions. In medical terms, it is called PROM (Prelabour Rupture Of Membranes). Approximately 10% of Danish births start with water breaking.

Water breaking most often occurs during labor caused by contractions. In a few cases, the baby is born in victory shirt. This means that the membranes are intact and the baby is still wrapped in amniotic fluid and membranes after birth. This is both rare and beautiful. In this case, the midwife, your partner or you puncture the membranes, the amniotic fluid flows out and the baby is helped out of the membranes.

If your water breaks without labor before week 37+0 of pregnancy, it is called premature rupture of membranes, or PPROM (Premature Prelabour Rupture Of Membranes). Depending on how early in the pregnancy your water breaks, you will be admitted with medical help to delay labor as long as possible.

What to do when there is a water leak?

If your water breaks, or you are in doubt whether your water breaks, you should contact the maternity ward at the birthing centre you are attending. Firstly, it is important that the maternity ward knows that a woman is walking around with her water breaking and will later need a midwife and a delivery room - unless you are giving birth at home. Secondly, it is important to know when your water broke, i.e. when the membranes broke. After this, there is a small risk of bacteria crawling up to the baby and potentially causing an infection, which you want to avoid.

When you call, the midwife will therefore ask when your water broke (colloquial jargon for when the membranes break). She will also ask about the color of the amniotic fluid and whether it smells. All of this information helps to show whether everything is okay.

If there is any doubt as to whether your water has broken, the midwife will ask you to put a pad in your panties, walk around for an hour or two and then check the pad. If there is still any doubt as to whether your water has broken, you will be invited to come in for a check-up at the maternity ward.

How do you know if your water has broken?

Some women feel a small pop and then warm fluid between their legs. Others wake up in a small pool in bed and may be unsure whether they have wet the bed. Still others experience just a few drops in their panties and may also think it is pee or discharge.

The characteristic of water leakage is that it cannot be controlled in the same way that you can control/stop the stream when you urinate. Amniotic fluid flows/drips without you being able to “cut off the stream”. Another characteristic of water leakage is that it continues and continues until the baby is born, as amniotic fluid is produced until the baby is born. You may experience small splashes when you get up from the sofa or turn over in bed. This is completely normal.

Color and odor of amniotic fluid

Amniotic fluid is clear and has whitish flakes consisting of amniotic fat and skin cells from the baby.

The amniotic fluid may also be pink. In this case, there is a little blood in the water. Most of the time, the blood will come from the small blood vessels in the cervix that can burst when the cervix softens and opens, this is also called bleeding . This is normal. If there is any sign of blood in your amniotic fluid, it should be checked by a midwife to take good care of both you and your baby. Wear a pad in your panties so that the midwife has something to assess when you come in for a check-up.

Amniotic fluid can also have different shades of green. From light neon green all the way to almost moss green. Green amniotic fluid is a sign that the baby has dirt in the amniotic fluid. This only happens if the baby is stressed right before or during the birth. Stress in the baby can be caused by several things and requires a midwife to keep an extra eye on the baby and you. If your amniotic fluid is green, you should call the maternity ward, who will ask you to come in. You should expect to stay in the hospital, so bring your maternity bag etc.

Most women don't think that amniotic fluid smells. We midwives have a slightly different opinion 🙂 We often describe the smell as fishy. And yes, we smell the amniotic fluid. Because if it smells like fish or brackish water, it can be a sign of infection or amniotic fluid poisoning, and then professional action must be taken to take good care of you.

When will labor start?

In some women, contractions start as if a switch was pressed shortly after the water breaks. In the vast majority, a few hours pass before the contractions begin and gradually increase in strength, duration and number. And then there are some who have their water break without subsequently having contractions of their own accord. In this group, contractions are helped along with birth-preparation pills, Angusta or a vasostimulating drip depending on what the internal examination shows, vaginal examination shows. If a uterine stimulating drip is started, for some it will run throughout the entire birth, for others it can be turned off at some point because the body itself takes over uterine production.

Of course, fertility pills and vasostimulating drops will not be started without your consent! It is your body and your child, so be true to yourself and ask all the questions you may have.

If everything is normal with you and baby, then you can make an agreement with the birth center that you will wait for labor and/or work on the initial contractions at home, just as if the labor had started with contractions. An individual agreement will always be made about when the delivery will take place and you will check in with each other again regarding a status of how things are going.

Why is it important to know when your water breaks?

When your water breaks, there is a hole in the membranes, potentially allowing bacteria to travel up to the baby in the womb and cause an infection. We want to avoid this. We strive to have the baby born within 24 hours of your water breaking, as this minimizes the risk of infection in both baby and mother, and reduces the use of antibiotics, which can affect both your and your baby's intestinal flora.

18 hours after the water breaks, it is recommended to give the mother IV antibiotics to prevent infection. And then give preventive antibiotics every 4 hours until the baby is born. You will be monitored for any signs of infection, including by taking your temperature at regular intervals.

If your water has broken for more than 24 hours, it is recommended that you be admitted to the mother-child ward for 2 days to observe any signs of infection in the baby after birth.

A Danish study has shown that approximately 70% of women with PROM (when labor begins with water breaking) go into labor and give birth within 24 hours. 95% of women go into labor spontaneous birth, that is, she will have her own contractions and give birth within 72 hours.

If it's not water leakage, what is it?

If they confirm that your water has broken at the birthing center, many pregnant women naturally ask: If it's not your water breaking, what is it?

First, pregnant women have much more discharge than non-pregnant women. In the latter part of pregnancy, it can become more watery and thus feel like water breaking.

Partly it could be the mucus plug, which can have several consistencies, including quite thin. Read more about the mucus plug here

And not least so can It could be that you've had to pee a few drops because baby is jumping on your bladder. If it's pee, it's yellowish and smells like pee.

And last but not least, it happens every now and then that the outermost membrane breaks. Between the two membranes there is a little water, which can then come out through the vagina. There is not enough for it to continue to leak or to slosh around like when the water breaks. If the outermost membrane breaks, it is called pre-watered that has passed. The baby is still well protected in the inner, intact amniotic membrane.

Dear, I hope you learned more about the what, how and why of water drainage. If not, please reach out to me.

Most affectionately

Siff Stephenson, HeartMidwife