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Should I let them break my waters?
- thesmartdoula
- Jun 10
- 8 min read
What are 'your waters'?
Let's start with a brief anatomy lesson!
Your baby is surrounded by amniotic fluid, which is primarily composed of water but also contains electrolytes, proteins, carbohydrates, hormones, immunoglobulins, and fats.
Initially, all the fluid comes from you, but after 20 weeks, your baby starts swallowing and cycling it through its body, producing urine and then swallowing it again!
The amount of amniotic fluid or 'waters' increases as your baby grows.
The waters are contained within the amniotic sac, which has two layers, the amnion and chorion.
All of this beautiful anatomy is contained within your uterus (or womb!) when you are pregnant, with your cervix and mucus plug sealing it off from the outside world through your vaginal canal.
In pregnancy, the amniotic sac provides a barrier for harmful infection.
The fluid within the sac provides cushioning for the baby, regulates temperature, provides it with buoyancy to aid movement, and separates the umbilical cord from the baby, preventing compression, which could cut off the baby's oxygen supply.
The fluid also supports the development of organ systems within the baby, like the lungs and the gastrointestinal tract.
Will my waters break in labour?
The media will have us believe that usually your labour will START with your waters breaking, usually in a big gush at the supermarket.
But the truth is that less than 10% of waters break before labour starts, and that is because most of the time, your waters and the amniotic sac still have a role to play during labour.
For most people, their waters break during labour, usually once contractions are established. Your waters may break during the pushing stage, and a very small number of people have an en caul birth (1 in 80,000) where the sac doesn't break until the baby has already been born.
Studies show that the amniotic sac goes through similar changes to the cervix toward the end of pregnancy, becoming 'weaker' and allowing for membrane rupture.
The rupture itself is usually caused by the pressure of the contractions and the baby's head.
There is some evidence that diet can affect the strength of your amniotic sac!
Holistic Midwifery; A Comprehensive Textbook for Midwives in Homebirth Practice, Volume I notes that “Vitamin C, along with its associated nutrients, the bioflavinoids, helps to strengthen all bodily membranes. It will make the amniotic sac strong, elastic and resilient, thus minimizing the possibility of early rupture of the membranes. The mineral zinc is also important for tissue integrity and adequate amounts assist in maintaining intact membranes as well”
Whilst other sources state beta carotene and collagen/protein are important.
If your waters break in very early labour, it is unlikely that all the fluid has been released. Often, the baby's head forms a seal, trapping some water behind it! You may have heard of a forewater leak and 'hind waters'; this is what this refers to.
Why are your waters important during labour?
First and foremost, in labour, your cervix is opening, so there is now a pathway to the outside world! Your amniotic sac maintains an effective barrier between the outside world and your baby, preventing infection.
As your uterus contracts, the amniotic sac is squeezed downwards and puts even pressure on your cervix, aiding dilation.
The fluid in your amniotic sac provides some cushioning to your baby from the strong uterine contractions.
The sac and fluid cushions the umbilical cord and prevents it from passing through your cervix, which is a very serious complication (cord prolapse).
The fluid provides your baby with buoyancy, helping them more easily complete the movements they are required to do to enter and move through your pelvis. It's much easier to move in a swimming pool, right?
Of course, there are different physiological variations of labour, and for some people, their waters may well have broken before labour starts or in early labour. Usually, there is some fluid left that provides some of the benefits above.
What is an amniotomy?
An amniotony or Artificial Rupture of Membranes (AROM) is where during a vaginal exam a midwife or Dr finds the opening of your cervix and passes through a 'crochet like hook' called an amniohook.
They then use this hook to pierce the amniotic sac and release the waters.
What are the risks of having your waters broken?
The risks you will see in the literature are:
Intrapartum chorioamnionitis (an infection of the placenta and amniotic fluid).
Cord prolapse.
However, there are many more risks associated and I will tackle them one by one below:
Interuption to physiology - To have your waters broken, you need to be on your bed, on your back, the procedure is painful for many, all these things interrupt your physiological hormone cascade and can work to make contractions feel more painful, or even cause a 'pause'.
Pain - Having someone carry out this procedure during labour is painful, they often are required to stay inside your vaginal canal and cervix throughout contractions, this can be painful.
Damage to your baby - Often babies are born with scratches caused by the amniohook (mine way!).
Damage to you - A sharp hook in your vaginal canal and against your cervix has the potential to do damage, my midwfe cut my cervix.
Fetal distress - With the cushioning removed from around the baby, they are now more exposed to the contractions, which can cause changes in heart rate patterns. There is also less cushioning for the umbilical cord, meaning it is more easily compressed, causing distress. On another level, they may have just been jabbed with a hook, causing them to react.
Suboptimal fetal positioning - With their buoyancy removed, your baby may now be wedged in a suboptimal position, which can cause cervical dilation to stall, more painful contractions and fetal distress. It is very hard to correct a misalignment without any water.
More painful contractions - With the cushioning from the waters gone, your baby will now be pressing against your cervix, maybe in a suboptimal position, which can make your contractions more painful and harder to deal with. An NCT survey found that two-thirds of women found contractions after having their waters broken to be harder to cope with and required more analgesia.
Long-term side effects of a more painful and harder to cope with labour are documented in evidence, these include less confidence in your ability to mother and a delayed onset of maternal affection.
Once your waters are broken, you are on a 'clock' counting down to 24 hours, at which point you will be labelled high risk and changes to your care will be suggested.
Why would they suggest breaking my waters?
Usually, this is for four reasons:
To assess your waters.
Once they break your water, they can assess its colour. They will be looking for things like meconium, which CAN be an indicator of fetal distress, but also can be a normal physiological feature of a mature baby. It is important in this situation that the whole clinical picture is taken note of, and you are given full information to make an informed decision about your continuing care. https://midwifethinking.com/2015/01/14/the-curse-of-meconium-stained-liquor/
To attach a fetal scalp electrode (FSE). This is a form of continuous monitoring which is attached to the baby (a thin wire) under their scalp, in order to do this, your waters have to be broken. Agai,n this can cause a cascade of intervention, and you should have already looked into the evidence on continuous fetal monitoring before labour. https://birthsmalltalk.com/blog/
To 'accelerate' labour.
As part of an induction
Will breaking your waters speed up labour?
To tackle this question, I first need you to rewind and remind yourself that in physiology,y labour isnt linear.
The medical model of assessing progress via cervical exams is not evidence-based! You can read my other blog on that!
So you first need to consider where the need to 'speed up' your labour is coming from?
Physiological labour sometimes has cervical dilatation pauses and even breaks in contractions.
However, this is often pathologised in the medical model, and AROM is one of the first things that will be offered if you are diagnosed with a 'delay'.
The NICE guidelines state:
Interventions in the first stage
1.8.33
Do not routinely perform amniotomy in normally progressing labour.
However, their definition of a 'normally' progressing labour is based on a non-evidence-based medical model!
The NICE guidelines state:
If a delay in the established first stage of labour is suspected, discuss the findings (and the options available with the woman, and support her decision. [2007, amended 2023]
1.8.38 Offer all women with delay in the established first stage of labour support and effective pain relief. [2007]
1.8.39 Advise all women with suspected delay in the established first stage of labour to have a vaginal examination 2 hours later, and diagnose delay if progress is less than 1 cm. [2007]
1.8.40 If a delay in the established first stage of labour is diagnosed, consider amniotomy for all women with intact membranes, after explanation of the procedure and advice that it will shorten labour by about an hour and may increase the strength and pain of contractions. [2007, amended 2023]
Ask yourself if all the risks we looked at above are worth a potential one-hour reduction?
However, if we look into a Cochrane review, we see that the evidence supporting this claim of a 1-hour reduction is extremely mixed.
"The review of studies assessed the use of amniotomy in all labours that started spontaneously. There were 15 studies identified, involving 5583 women, none of which assessed whether amniotomy increased women's pain in labour. The evidence showed no shortening of the length of first stage of labour and a possible increase in caesarean section. Routine amniotomy is not recommended as part of standard labour management and care"
Another variation of this is when you are told that your baby's waters are bulging and may be preventing descent, so they offer to break them to get them out of the way. This is not evidence-based or backed by physiology.
Isnt having my waters broken better than a chemical induction?
If your cervix is open enough to allow your waters to be broken, hospitals will skip the cervical dilation step and go straight to breaking your waters.
In theory, this can induce labour on its own, and I have seen it do this, and people go on to have a relatively undisturbed birth.
There isn't a lot of data on how successful AROM alone can be in inducing labour.
The problem is that once your waters have broken you are on their clock, you can choose to wait for aslong as you like, or to go home BUT there will be significant pressure to continue the induction with oxytocin, so if you are considering this as a route to avoid this, you need to be aware that it may well lead to it!
Once you do start your induction with broken waters, you don't have the waters to assist you.
What else can I do if my labour has 'stalled'?
If you instinctively feel that your labour has stalled and you need assistance, there is evidence to show that simple positional changes can be extremely effective.
You can learn about birth biomechanics during your pregnancy. The Serenity Doula) has some great courses. https://www.theserenitydoula.co.uk/birth-preparation
You can also choose to work with a Doula (or Virtual Doula) like me who can help you identify and rectify positional problems using biomechanics.
When should I ask them to break my waters?
This decision is ultimately upto you, you can make an informed decision when you have all the information.
If your waters are bulging though your vaginal canal, you may feel alot of pressure, and you may want your midwife to break them for you to relieve this. At this point, the baby is probably very close behind, so it's unlikely to affect things!
The below is another great summary of the evidemce behind this topic:
Who am I?
I am Charlotte, a Virtual Doula, providing bespoke evidence-based pregnancy support to families who want an empowering birth.
With 10 years + of clinical research experience, a biomedical science degree, and two hospital births under my belt, I use my knowledge to provide pregnancy support to help you make informed decisions about your pregnancy, birth, and postpartum.
I provide pregnancy support for all types of births, including hospital births, helping you to navigate NHS guidelines and have an empowering, positive birth.
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