Breaking Water to Induce Labor?

What is an amniotomy?

Pregnant mom walking in labor at the hospital
Photo © Blend Images/Getty Images

You may have heard that there are many methods of inducing labor. One of the ones that people often talk about is an amniotomy or breaking the water to induce labor. The amniotic sac lines the uterus and houses the amniotic fluid, baby, and placenta. It provides a barrier to infection for your baby during pregnancy. It is made up of the amnion and the chorion. So how does breaking water to induce labor work?

Breaking the bag of water, also known as an amniotomy, is one way to attempt to induce labor. (Though it is infrequently done alone and frequently done with Pitocin.) During a vaginal exam, your doctor or midwife will insert an amnihook (a large crochet hook looking device with a small sharp end), and snag the amniotic membranes. By creating this tear in the bag, the amniotic fluid will begin to leak out.

The actual breaking of the bag of waters shouldn't be any more painful than any other vaginal exam. It may unleash a lot of fluid, so it is usually done while sitting on special towels to collect the fluid which can be removed. Typically you will continue to leak fluid in small amounts for the remainder of your labor.

"What surprised me most was the fluid that kept leaking," says Ava. "I guess I knew it would happen, but just sort of forgot. A nice nurse helped me with some mesh panties and the largest pad I've ever seen.

It was all good."

After your water is broken you may notice that you begin to have contractions or you may feel like your baby has dropped further in your pelvis. If you were having contractions before your water was broken, this is called augmenting labor. If this is the case, then you may feel an increase the intensity of the contractions or you may feel no difference at all.

Risks Associated with Breaking the Water Include:

  • fetal distress
  • failure of labor to start
  • increase in fetal malposition
  • increase in pain sensation with labor

There are repeatedly more calls for research on the best method of induction of labor when labor needs to start prior to the onset of spontaneous labor. If the cervix is not ripe or favorable, it is usually advantageous to use some method to force it to be more favorable to induction. 

Questions to Ask Before Breaking the Water

Some of the things you will want to know before agreeing to having your water broken include:

  • Will this change my birth plan?
  • Will I be allowed to walk?
  • Will I need extra monitoring?
  • What signs of problems will you be looking for and how?
  • Will my labor be on a clock?
  • Are there other interventions that may be needed because of this?
  • What are my alternatives?
  • Do I have time to make this decision?

Breaking the Water in Labor

When the water is broken by your doctor or midwife in labor, this is called an augmentation of labor. This is typically done to try to speed up the labor process. While it does not always speed up the process, it can provide, in some cases, a slight reduction in the need for a cesarean birth, but not without some tradeoffs.


Basically only you and your health care provider can decide what works best for you and your situation. It can be worth the added risks to start labor before spontaneous labor begins. This is done by taking into account your entire medical history, the pregnancy needs, and the state of your cervix.


Approaches to limit intervention during labor and birth. Committee Opinion No. 687. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e20–8. 

Bricker L, Luckas M. Amniotomy alone for induction of labour. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD002862. DOI: 10.1002/14651858.CD002862

Howarth G, Botha DJ. Amniotomy plus intravenous oxytocin for induction of labour. Cochrane Database of Systematic Reviews 2001, Issue 3. Art. No.: CD003250. DOI: 10.1002/14651858.CD003250

Smyth RMD, Markham C, Dowswell T. Amniotomy for shortening spontaneous labour. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD006167. DOI: 10.1002/14651858.CD006167.pub4

Thomas J, Kelly AJ, Kavanagh J. Oestrogens alone or with amniotomy for cervical ripening or induction of labour. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003393. DOI: 10.1002/14651858.CD003393

Wei S, Wo B, Qi H, Xu H, Luo Z, Roy C, Fraser WD. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006794. DOI: 10.1002/14651858.CD006794.pub4

Continue Reading