When will the birth take place after the waters break?

As your due date approaches, you may start to worry about breaking your water while in the car, on the sofa, or while shopping.

What exactly does “water breaking” mean?

The baby is surrounded by amniotic fluid contained within an amniotic sac. When does this sack break? It usually happens just before or during labor. If it ruptures before contractions begin, it is called  premature rupture of membranes (PROM).

Premature rupture occurs in only 8 to 10 percent of pregnancies . So, in most pregnancies, your water will break after contractions begin .

What happens to the baby after the waters break?

Amniotic fluid contains hormones, nutrients, and antibodies. It also represents a protective cushion for the baby, a cushion that begins to form about 12 days after conception.

How long a child can survive once their waters have broken depends on a number of factors, it is not possible to give an unequivocal answer

In cases where the waters were to break in a condition of prematurity, babies could survive well for weeks with proper monitoring and treatment, obviously in hospitalization. In cases where the baby is at least
37 weeks old , current research suggests it may be safe to wait 48 hours (and sometimes longer) for labor to start on its own. Usually, however, the wait is around 24 hours at most . Monitoring
is essential : waiting for the onset of labor must be constantly monitored.

For this reason it is important that the woman goes to the hospital immediately once her water breaks or if she suspects that the amniotic sac has ruptured.

Why might my waters break before labor?

Possible risk factors include:

  • natural sac weakening caused by contractions
  • uterine infection
  • chlamydia, gonorrhea and other sexually transmitted infections
  • previous preterm birth
  • cigarette smoke
  • insufficient prenatal care

Signs of amniotic sac rupture:

  • feeling of wetness in the vagina or underwear
  • constant loss of fluids, in small or large quantities
  • intermittent leaks or gushes of liquid, in small or large quantities
  • you see a clear or light yellow fluid that is odorless (urine typically has some odor)

If in doubt, call your midwife or gynecologist or the hospital where you are going to give birth. They may suggest that you go to the hospital to have a specific test done to understand if it is amniotic fluid.

Once the breaking of the water has been confirmed, further evaluations will be made by the gynecologist:

Based on the overall situation, it will be decided whether to induce labor immediately or wait a bit to see if it will start on its own.

Labor typically begins naturally within 24 hours for most women.

What if labor doesn’t start after the membranes rupture?

Recall again that after the membranes rupture and fluid loss, the baby receives nutrients and oxygen from the placenta through the umbilical cord.  The main concern with early rupture of membranes is infections for both mother and baby.

Although  more and more research shows that longer periods of time may be safe, induction is usually started within 24 hours of rupture of membranes.

If there are no risk factors, doctors may also decide to wait and see if labor starts on its own. However, this expectation requires careful monitoring, including the mother’s blood values ​​to check for infections.

If she is positive for group B strep, she will be given antibiotics after the membranes are ruptured to protect the child from infection.

In a 2015 study looking at 100 women with premature rupture of membranes, 28% of deliveries ended in a cesarean delivery. Reasons for this surgery include failed inductions and fetal distress.

Is there a risk of newborn death if you wait too long?

Premature rupture of membranes accounts for 0.8% of neonatal deaths . The main cause is bacterial infection that ascends the vaginal canal and reaches the uterus. Obviously, the longer it takes for the baby to be delivered, the more opportunities there are for possible infections.

Interestingly, a 2017  Cochrane review  did not find a huge difference in the risk of stillbirth in women who were induced after their membranes ruptured versus those who waited for contractions and spontaneous labor to start.

In conclusion

Unfortunately, there is almost nothing that can be done to prevent premature rupture of the membranes. However, some research shows a link with smoking , so if you are looking for other reasons to quit smoking , you certainly have another very important one here.

Also monitor pregnancy losses, some infections can cause preterm birth.

In any case, if you have questions or doubts or are worried about any symptoms, call your doctor, it is always better to have one more call than one less.

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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