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The patient came in, a slightly embarrassed look on her face. "I'm not sure, but I had a little dampness down there," she said hesitantly. I bustled around her chart and set her up in a room, certain this would be a routine check-up.

Why it might happen and what to know

But of course, it didn't end up being a routine check-up. (Maybe the fact that I'm writing this story gave that away, huh?) 

What started with a patient who was hesitant to be seen ended up with an emergency transfer to a larger hospital that specialized in high-risk pregnancies — her water had broken and unfortunately, she was only 32 weeks along into her pregnancy.

When your water breaks too soon

"It may not necessarily mean the woman is in labor."

Premature Preterm Rupture of Membranes (PPROM) is the official name for when a woman's water breaks too early in her pregnancy, generally before 37 weeks when she is considered "full-term" and the baby can be safely delivered. Because it happens so early, it may not necessarily mean the woman is in labor. Premature rupture of membranes occurs in approximately two out of every 100 pregnant women. The condition is especially dangerous in women who are still early in their pregnancies as it can lead to infection, put the baby at risk and if delivery is imminent, the baby may have severe respiratory and developmental problems.

Why it happens

A woman's water may break prematurely for a variety of reasons, some known and sometimes for seemingly unknown reasons. Some of the medical factors that may cause premature rupture include:

  • Infection
  • STDs, such as chlamydia
  • History of preterm labor
  • Preterm labor
  • Lack of prenatal care
  • Trauma or injury

How you can tell if your water has broken

"Your water can break too early and it's not always a huge gush of fluid."

Ah, and there's the rub — it can extremely difficult to tell if your water has actually broken, especially, if like the patient I saw, you are too early in your pregnancy to really be expecting your water to break. Many women, during the later weeks of pregnancy, often mistake normal increased discharge as the cervix prepares for labor as their water breaking, while others actually experience leaking of urine from the increased pressure of the baby as it descends.

But what's most important for you to remember is that your water can break too early and it's not always a huge gush of fluid that is obvious. Sometimes, it may be a small leak or just fluid that you notice in your underwear, especially when you stand up. My water actually broke a week early with my first daughter and it was just a tiny leak. I noticed dampness on my underwear when I woke up in the morning and like any first-time mother, I immediately was worried, but also embarrassed to call my midwife. What if I was just gross and sweaty? What if I had peed my pants? Can you say mortifying?

And, if your water does break or leak a little bit, in some cases, the bag of water will actually "seal" itself back up, making it even harder for you to tell if it really is broken. Imagine a big water balloon and small pinprick leak — it may just be a little and it may seal itself back up right away.

What you need to know

First of all, don't be embarrassed. Your doctor and the entire labor and delivery team is there to help you have a healthy pregnancy and baby, so really, don't worry about feeling foolish if you can't tell if your water has broken.

If you suspect your water may be leaking or wonder if it has broken, you can try calling your doctor to be seen, but in general, the best thing to do is to head to the hospital to be evaluated in the birthing unit. The nurses and staff there can check you to make sure you aren't in active labor and do testing to see if your water has actually broken.

There are two different types of tests, one that looks for amniotic fluid under a microscope and one that uses pH testing that will determine if your water has actually broken. And if it's still unclear or your doctor wants to rule out any other problems, an ultrasound to monitor fluid levels can also be ordered.

Bottom line?

When in doubt, check it out.

More on premature labor

Learn how to prevent and identify preterm labor
How to recognize preterm labor
Preterm birth: Questions to ask your doctor

Tags: water breaking


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