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Expert Q&A:
Can you explain what happens when your water breaks?

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Margaret Freda
Answered by Margaret Freda Ed.D., R.N., C.H.E.S., F.A.A.N.
"I've been a professional nurse working with pregnant women and parenting families since 1966," says Margaret Comerford Freda. "Pregnant women and parents need to know as much as possible about their own health and that of their children."

Margaret Comerford Freda, Ed.D., R.N., C.H.E.S., F.A.A.N., is a Professor in the Department of Obstetrics &; Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, and also serves as Director of Patient Education Programs for that department. Since 1993, Dr. Freda has been the Consultant for Nursing at the National March of Dimes Birth Defects Foundation and the Chair of the National March of Dimes Nurse Advisory Council. In addition, Dr. Freda serves as the editor of MCN, The American Journal of Maternal Child Nursing.

Dr. Freda received her Master's Degree in Nursing from New York University and her doctorate in Health Education from Columbia University. She has worked in women's health for her entire professional career. Dr. Freda has published 50 research articles in professional journals, and is a frequently invited speaker at nursing and medical conferences. She has written two books: Perinatal Patient Education, published by Lippincott Williams &; Wilkins, and Miscarriage After Infertility, published by Fairview Press, written with her daughter Carrie Semelsberger, who is also a nurse.

Dr. Freda has received several noteworthy awards, such as the Distinguished Professional Service Award and the First National Award for Excellence in Nursing Research from the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), the Woman of Distinction Award and the Maternal Child Nurse of the Year Award from the March of Dimes, the Patient Care Award for Excellence in Patient Education from the American Academy of Family Physicians, the Research Recognition Award from Molloy College, and several Outstanding Research Paper awards at national conferences. She serves on the Scientific Advisory Council for the March of Dimes, and was selected to serve on the Select Panel of the Centers for Disease Control to advise on prenatal health. Dr. Freda has developed patient education booklets and videotapes that are now distributed nationally.

Dr. Freda has been married for four decades. She has two daughters, two sons-in-law, three grandsons, and a granddaughter.
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Question


What happens exactly when your water breaks? Silly question, I know, but when you're new at this, there are a lot of questions.

Answer


It's not a silly question at all! Your "water" is actually amniotic fluid, which surrounds the fetus as a protection. It's like a big balloon in which the baby is floating. The "bag of waters" has a membrane around it that is resistant to breaking, and that's why when your water breaks the provider will say that your "membranes ruptured." No one knows why labor begins, but one way that labor starts is when your water breaks spontaneously, and labor begins shortly afterward. This happens about 30 percent of the time, according to Dr. Susan Warhus's book Countdown to Baby. If your water breaks after 37 weeks of pregnancy, it is considered normal. You can feel a big gush of fluid running out of you (this happened to me in a furniture store with my first pregnancy), or you might feel just a little wet. If you think your water has broken, you should always call your provider, for the amniotic sac is the baby's protection, and after your water has broken you need to take precautions to keep the baby safe from infection. In 70 percent of cases, however, your water doesn't actually break until you are in active labor. Often if you're in the hospital in labor, your provider will manually "rupture the membranes" (by using a sort of hook during a vaginal exam) in order to speed up your labor.

If your water breaks before 37 weeks of pregnancy, you have what is called "preterm premature rupture of membranes" (PPROM). That's a bigger problem, for we don't like babies to be born before 37 weeks. This premature rupture is many times due to an infection in the uterus, and it is essential to contact your provider immediately if this happens.

 

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