When you are pregnant and your water breaks (membranes rupture), you may have a sudden gush of fluid running down your legs but often, you will just have a trickle or slow leak, or your underwear will feel wet. When you just have a leak, it may be hard to tell the source of the fluid. Knowing the difference between the possible sources can sometimes help you decide. If you are uncertain, go to the hospital for an evaluation.
Sources of Fluids
The three sources of fluid that might leak when you are pregnant have some properties that might help you determine the source. The differences between amniotic fluid (your water), urine, and vaginal discharge might provide some clues but in the end, it may be impossible for you to be certain.
Amniotic Fluid Leaking
If it is amniotic fluid, it may have some of the following properties.
- Is colorless and odorless or has a sweetish smell
- Does not smell like urine
- Can have bloody flecks
- Can have some whitish flecks of mucus
If you continue to leak over time, chances are this is amniotic fluid. If you empty your bladder and you are still leaking, you may, indeed, be leaking your water.
You may leak rather than gush because there is just a pinhole in the amniotic sac or because your baby's head is low in your pelvis and therefore sealing your cervix.
If you are leaking urine, you may notice it has the following properties:
- Is usually clear yellowish or darker
- Can have an odor of ammonium or a distinct smell of urine
Bladder leak is more common as you advance in the second and third trimesters, and your baby presses on your bladder.
You may also experience vaginal discharge, which may have the following properties:
- Can be whitish or yellowish
- Will generally look thicker than amniotic fluid or urine
- May or may not have an odor, but does not smell like urine
What to Do
Because it might be difficult for you to decide if your water is leaking, if you suspect that it is, do the following:
- Note the time you think your water broke because this is important to the timing of your delivery.
- You can put a sanitary pad on to look at the fluid and smell it.
- Assess the quantity of the amniotic fluid you are leaking - a moderate to large quantity will soak through a pad in less than 10 to 20 minutes.
- Put nothing in your vagina that could introduce infection; this also means no intercourse.
- Err on the side of caution. Call your doctor or go to the hospital whether you are contracting or not.
Confirmation of Membrane Rupture
At the hospital, you will get a sterile vaginal exam for the following confirmation:
- The doctor will check for a pool of fluid in the vagina.
- The doctor may take some fluid from the vagina for a Nitrazine test if unsure. Amniotic fluid is alkaline, and the test will be positive if water broke.
- The doctor may also do a fern test by drying a drop of the fluid on a slide and looking it under the microscope if unsure.
Risk Factors For Leaking Your Water
There are various causes and risk factors for your water breaking during pregnancy. Preterm (less than 37 weeks) risk factors include:
- Preterm labor, which is labor before 37 weeks
- Infection or inflammation in the fetal membranes (chorioamnionitis)
- Other infections, such as in the vagina, cervix, bladder, or kidneys
- Polyhydramnios - too much fluid in the amniotic sac
- Twins or other multiple pregnancies, or a large baby
- Having had a procedure during early pregnancy, such as an amniocentesis, a cervical stitch (cerclage) placed to prevent preterm delivery, or a previous cone biopsy of the cervix
Term risk factors include the preterm risk factors, as well as onset of pre-labor or false labor (Braxton Hicks) contractions.
Things to Consider
At different stages of your pregnancy, there are various considerations if you are outside the hospital:
- If you go into active labor, you could proceed quickly to an unattended delivery with risk to you and your baby.
- If your water breaks at term (37 weeks or more) and you are not in active labor, your doctor will likely induce labor within 24 hours to decrease the risk of infection in you and your baby.
- If your water breaks before term (less than 37 weeks), your doctor may wait to buy more time in the hospital to give your baby's lungs more time to develop.
These are important things to consider and serve as reasons for you to consult with your doctor or midwife or go to the hospital if you suspect your fluid leak is your amniotic fluid.
When to Be Immediately Concerned
If you think you water is leaking it is more immediately concerning if you also have the following:
- Your pregnancy is still preterm (less than 37 weeks), and you are at risk for delivering a preterm baby, at home especially if you are less than 28 weeks
- You are having regular contractions close together and appear to be in advanced labor.
- The leaking was preceded by or is now accompanied by decreased fetal movement.
- You have a fever and abdominal pain that suggest you might have a uterine infection, which puts your baby at risk for infection, stillbirth, or death soon after delivery.
- Your fluid leak is followed by moderate to heavy vaginal bleeding.
- There is what appears to be umbilical cord or a fetal body part, such as a hand or a foot, at or outside the entrance of you vagina after a gush of fluid.
Call doctor immediately or call an ambulance urgently to be transported to the hospital.
It is not always easy to tell if your water broke if you are just leaking fluid rather than a gush of your water. You can examine the fluid to try to confirm, but if you are uncertain, don't delay going to the hospital to be evaluated. This is especially important if you are in active labor or your baby is premature.