Your water breaks and the clock starts ticking.  At least, that's what happens to many moms – during home births, during hospital births, and during birth center births.  Water breaking generally means care providers will start counting down to a mandatory cesarean.  It's understandable that you want to know how to have a bag of waters that's going to stay strong until late in labor!

What is PROM?

First, lets look at the definition of “premature rupture of membranes” (or PROM).  It's also sometimes called “pre-labor rupture of membranes.”  This means the water breaks before labor – generally an hour or more before.

“Prolonged rupture of membranes” indicates that the water has been broken for a long period of time (most hospitals use 12 hours as a measure) – this is a benchmark because of worry of infection, and in many hospitals is an automatic cesarean (even if no signs of infection are present).

The term “PPROM” means preterm, premature rupture of membranes – in other words, your water breaks before 37 weeks gestation.

Once a PROM, Always a PROM?

If your waters released before labor began in a previous pregnancy, does that mean it's going to happen in another pregnancy?  Many moms worry about this, especially if they felt they were trying to “beat the clock” in a previous labor.  So is it inevitable that your waters will break?

No.

Sometimes we don't know why waters break before labor begins.  It happens spontaneously in about 10% of pregnancies (some women consent to having their water broken by a doctor or midwife to try and start or speed labor) – so some women have it happen as a simple variation of normal.  If that's you, keep reading because I have advice for you, too.

But you can take steps during pregnancy to reduce the chance that your waters will release before labor or early in labor.  Releasing late in labor gives both you and your baby the benefit of a “cushion” provided by the water as your baby navigates through your pelvis and into the birth canal.

Most women will have their water break during transition or just before pushing, though a few special babies are born with membranes intact.  Being born with these membranes, the amnion on and chorion, intact as the bag of waters, is often called being born “in the caul.”  It's not dangerous – it simply means the bag needs to be opened as soon as baby is born.

The bottom line is, you can build a strong bag of waters:

Building a Strong Bag of Waters

The “bag of waters” is the amniotic sac – as I noted above, it's made of two membranes called the amnion and chorion.  If you were to feel these, they feel like wet cellophane, but they are incredibly strong.  They hold the amniotic fluid and the baby throughout pregnancy, along with an assortment of floating particles such as flecks of verix (the creamy, protective covering on your baby's skin in the womb), skin cells, urine, etc.  Your body filters this fluid constantly.

Just like many things you do in pregnancy can make a positive impact on the development of the placenta and your baby, good choices can increase the health of amniotic sac.  It's part of the same baby/placenta system 🙂  Here are some practical suggestions for creating a healthy baby and a strong bag of waters:

Nutrition Foundations

Your nutrition is important for many, many reasons during pregnancy.  In fact, I could write volumes on it and teach for hours (in fact, I have taught for hours on it, and will cover practical nutrition, special diets, etc. again in my live, six-week online class on pregnancy health starting next week!)

Right now you're focused on building a strong bag of waters, and nutrition is important to that, too.  My waters released as I was pushing my third baby out and my midwife joked that “it was all those eggs you ate during pregnancy.” Now that was probably only part of it, but my religious devotion to eating two eggs a day throughout my pregnancy was an indication of how seriously I took eating well for my baby.  I was just a mom who wanted a healthy baby – and my water had broken “early” before labor with my second baby.  I gave birth about 9 hours later, but I still didn't want that to happen again.  I do feel those nutritional choices made a difference.

You can also be conscientious about your prenatal nutrition.

Your body supports many things via nutrition:

• Growing your baby
• Growing and supporting the placenta
• The developing bag of waters
• Replacing the amniotic fluid repeatedly
• Filtering your baby's wastes
• Filtering your wastes
• Maintaining your body
• Expanding your blood supply by 50-60%
• Many physical, physiological, and metabolic changes for your pregnant body

In fact, the list of changes in your body during pregnancy is staggering.  It's awe-inspiring to think that your body knows how to handle such a complex task as growing a baby, and it's practically miraculous to think of all the changes your body goes through just to support the growing baby in the womb and while breastfeeding (maybe I'll write an article on that!)

To fully support all of this, you need good nutrition.  Adequate protein, calories, and sodium (salting to taste) are especially important because they directly support your increasing blood supply.  Your blood supply brings nutrients to your baby and carries away waste products.  These key nutrients also keep the amniotic fluid levels where they're supposed to be and circulate in fresh fluid while circulating out the old – also important to baby and baby's support systems.

Plenty of vegetables and some fruits give you vitamins and minerals vital to your baby's growth.  Iron-rich foods (especially red meats and organ meats) lend high bio-available iron to your blood supply and the placenta for baby's circulation.

There's evidence that certain vitamins, such as Vitamin C and Vitamin E can help the bag of waters stay stronger and protect from infection.  Food-based sources of these vitamins are the safest and most effective way to maximize them.  Zinc, beneficial for preventing many infections, may also contribute to a strong bag of waters.

In addition, particular foods have been traditionally felt to contribute to a strong bag of waters: eggs, leafy greens, and dates are some midwives encourage.

Dates have actually been clinically studied in pregnant women, and moms who eat dates regularly during late pregnancy have less chances of their waters releasing early, dilate faster and more smoothly, and almost no labor augmentation (drugs to artificially stimulate labor).  Almost all moms in the date-eating group went into labor spontaneously, too – in other words, they didn't need an induction¹.  So stock up on dates!

Vaginal Health

The discussion of vaginal health is almost taboo in the modern world, where jokes are made about “smells” and the only concern seems to be masking those.  But if something seems off, it needs to be taken care of!  And even if it doesn't, you can proactively boost your vaginal health.

This is important because having plenty of “good bacteria” (healthy flora or microbiota) in the vagina/birth canal greatly decreases the risk of infection.  As I'll discuss further below, sometimes germs can cause water to break before labor begins, so it makes sense to minimize those chances.

I've detailed the benefits of healthy flora for you and your baby in a recent podcast:  How to Give Baby Healthy Gut Flora. It also gives practical strategies on how to do this.  My recent article How to Prevent Group B Strep also details this subject thoroughly, so take a look at that.  Both links will open in a new tab for your convenience.

Decline (AKA Forbid) All Vaginal Exams

Vaginal exams are all the rage from early pregnancy through labor and birth.

You should decline ALL vaginal exams.

That means even the ones early in pregnancy.  Decline vaginal exams and decline an early pap smear.  Evidence does not support pap smears in pregnancy – it's better to schedule it when your baby is about six months old because pregnancy hormones, even early on, can skew results and cause false worry.

Plus exams, even done with a sterile glove or sterile speculum, introduce outside germs to the vagina.  It even moves germs that lie on the perineum and in the labial folds from the outside to inside of the vagina/birth canal – where they don't belong.  Germs are good at being air-born, so don't trust sterile gloves or instruments.  This area is an intimate and private area for a reason – keep it to yourself (and perhaps your lover 😉 )

Vaginal exams give no good information during pregnancy or labor. They can't predict when labor will begin or how fast it will progress.  Some moms do want an exam for encouragement in a long labor – that's up to you.  But decline “routine” vaginal exams.

Stay With Your Own Germs

I hinted at this above, but you want to be with your own, familiar germs and environment.  Your body is used to the “critters” in your own environment – be they good or bad.  Chances are you've developed immunity/resistance or have specific “good bacteria” on board to combat common “bad bacteria” you come in contact with.

Minimize the amount of time you're in a place that may have a lot of unfamiliar germs – especially hospitals and doctor's offices (and public restrooms).  Keep hands away from the birth canal.  And enhance your environment by enhancing vaginal and gut flora, as we discussed above.

This is also important if your waters do release before labor begins, or early in labor.  Here's more information on that:

Proactive Monitoring

What if your water does break “early” and infection is raised as a concern?

If there's evidence of infection right away (fever, chills, etc. – flu-like symptoms), chances are the water broke because of the infection.  It already existed and was not caused by the bag of waters breaking.  This is a situation where you want to be in the hospital and you want to get baby out quickly so that both you and your baby can overcome the infection.  Good nutrition, avoiding germs, good vaginal health, etc. can all make a huge impact on completely preventing this situation.  But if it does present, get help right away.

If there wasn't infection present, however, then proactive monitoring has been shown to be safe and effective.  This means you, your midwife, your nurse, etc. monitor you regularly for signs of infection.  You also decline vaginal exams or other invasive procedures that could introduce germs into the birth canal (decline even if they say they'll use sterile gloves).

To proactively monitor, you should watch carefully for signs of infection:

• Take your temperature regularly (every hour)
• Notice baby movement – is there baby movement?
• Is the uterus sore to the touch?
• Is your pulse rate increasing?
• Chills, flu-like symptoms

Any of these signs are an indication to immediately go to the hospital or immediately page your nurse if you're already at the hospital.   Your nurse or midwife can and should monitor baby's heart tones frequently.  If you're staying at home and your midwife or nurse is on the way, let them listen to baby's heart rate over the phone – a handheld Doppler can allow them to listen for 10 minutes or longer at regular intervals.

If none of these signs are present, good hygiene generally prevents infection:

• Keep on clean panties or go without
• No sex
• No tampons (use a clean cloth diaper to catch fluid flow)
• NO Exams – NOTHING Up There
• No public bathrooms
• Stay home with your own germs and proactively monitor

And of course, listen to your own intuition.  If you feel you should go in for monitoring, then do so.

Communicating with Baby

Talk to your baby throughout pregnancy, and picture how labor will begin.  Think about your ideal birthing, and imagine when your waters will release.  Just before baby's birth is a very typical pattern in undisturbed birth and is a nice point in labor to visualize.

This serves two purposes – firstly I believe it really is a way to communicate with baby, though I have no studies to back that up.  But it also helps you to relax and relieve stress.  It helps you to feel more prepared.  Thinking about your baby and daydreaming about a wonderful birth, nursing him or her, etc. really does boost oxytocin levels and other “feel-good” hormones in your body.  These hormones are beneficial to you because they reduce stress (which can cause your waters to release too early) and they support healthy pregnancy and smooth birth.

Honoring and respecting this journey and its important – and, of course, enjoying the thoughts of a good birth and a healthy baby relieve stress and benefit all systems – yours and your baby's.

You can make a difference in your health, your baby's health, your bag of waters, and labor and birth.  Enjoy taking practical steps and increasing your confidence!

Remember, my upcoming live, online class on healthy pregnancy is about to begin.  It's packed full of high-quality information on how you can enjoy your pregnancy and make a difference in your baby's health.  Go ahead and click here for full details!