When Does the Bag of Waters Break?

Introduction

The bag of waters - or amniotic sac - is a bag or "membrane filled with fluid that surrounds your baby in your uterus during pregnancy." The bag of waters is very important to your baby's health. The fluid protects your baby and gives your baby room to move around. The bag itself protects your baby from infections that may get into your vagina.

Usually the bag of waters breaks just before you go into labor or during the early part of labor. It happens most often when you are in bed sleeping. You may wake up and think you have wet the bed. Sometimes women feel or even hear a small "pop" when the bag breaks. Sometimes there is a gush of fluid from the vagina that makes your underwear wet; or maybe just a trickle that makes you feel damp. Sometimes the bag does not break until the baby is being born. In about 1 in every 10 women, the bag of waters breaks several hours before labor starts. Although rare, the bag of waters can break days before labor starts.

If your bag of waters breaks more than 3 weeks before your due date, your health care provider may try to stop labor if the baby would be too premature. Because the bag of waters protects against infection, you will be checked to make sure there is no infection in your uterus.

If your bag of waters breaks within 3 weeks of your due date, your health care provider will recommend either waiting to let your labor start on its own or inducing your labor right away. You can discuss the pros and cons of each of these options with your health care provider. If you have a bacteria, such as Group B Strep in your vagina, your health care provider may want to give you antibiotics or get your labor started (induction). The longer the bag of waters is broken before birth, the more chance there is that infection will get to the baby.

The section below gives instructions on what to do if your bag of waters breaks. If you think your bag of waters has broken, your health care provider might check in your vagina with a sterile speculum to find out for sure. Except for that one examination, it is very important that nothing is put in your vagina. Every time you have a vaginal examination after the bag of waters is broken, your risk of getting an infection gets higher. You can help protect yourself and your baby by asking your care providers to only do vaginal examinations when absolutely necessary.

Your health care provider can do a simple test using a sterile speculum to see inside your vagina. A sample of the fluid in the vagina will be collected and placed on special paper that turns very dark blue if it touches amniotic fluid.

Labor contractions can start any time from right away to many hours or a few days after your water breaks. If you think your bag of waters has broken, call your health care provider.

Call your health care provider right away if

Your due date is more than 3 weeks away from today The water is green, or yellow, or brown, or has a bad smell You have a history of genital herpes, whether or not you have any herpes sores right now You have a history of Group B strep infection ("GBS positive") You don't know if you have GBS or not Your baby is not in the head-down position, or you've been told it is very high in your pelvis You have had a very quick labor in the past, or feel rectal pressure now You are worried or discouraged.

Call your health care provider within a few hours if

Your due date is within the next 3 weeks and You are not in labor and The fluid is clear, pink, or has white flecks in it and Your baby is in the head-down position

Some health care providers will want you to come in to the office to confirm that the bag of waters has broken and listen to the baby's heartbeat as soon as you notice that the bag of waters has broken. Others will suggest you stay home for several hours to wait for labor to start. The bottom of this form can be used to write down what you and your provider agree should be done.

Most women will go into labor within 48 hours. If you are waiting for labor to start and your bag of waters has broken

Put on a clean pad Do not put anything in your vagina Drink plenty of liquids - a cup of water or juice each hour you are awake Get some rest Take a shower or bath If there is any change in your baby's movements, call your health care provider right away Check your temperature with a thermometer every 4 hours - call right away if your temperature goes above 99.6

Other instructions:	_________________
Health care provider phone number:	______________
Hospital phone number:	_____________

This page may be reproduced for noncommercial use by health care professionals to share with clients. Any other reproduction is subject to JMWH approval. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JMWH suggests that you consult your health care provider.

J Midwifery Womens Health. 2004;49(5) © 2004 Elsevier Science, Inc.