On TV, you know that someone’s about to give birth because their water breaks with a dramatic pop, often in a humorous fashion (they’re about to go on stage, or it goes all over their on their friend’s brand-new Christian Louboutin sandals). But if you’re delivering via cesarean section, whether scheduled or not, you might wonder what happens to the amniotic fluid. Do they break your water for a C-section? TV won’t show you — it hasn’t really gotten the memo that a C-section is a very common way to have a baby.
Do they break your water for a C-section?
“Most routinely, yes, we AROM (artificial rupture of membranes) right before delivering the baby in most Cesarean deliveries — even if they’ve already broken their water, sometimes there’s still a sac,” Dr. Zuri Hemphill-Bryant, an Atlanta-area OB-GYN, tells Romper. Your doctor will likely use something called an Allis clamp to break the amniotic sac.” In a typical C-section, this rupture of the membranes happens after they’ve made the incision and right before your doctor starts maneuvering to get your baby out of the incision.
What’s being broken is actually the amniotic sac, filled with sterile fluid that surrounds the fetus. And yes, it is sterile, though after 20 weeks, the prominent substance in amniotic fluid is your baby’s urine (weird, right?). So, if your water breaks when you’re not yet in the hospital, your experience with cleaning up your baby’s pee may start before they’ve even made their entrance into the world.
If your C-section isn’t scheduled but occurs after you’ve been laboring, your water may already be broken: Hemphill-Bryant notes that “if the patient is in labor and trying have a vaginal delivery, then we may have already broken their water to help with the labor process. If for whatever reason, we decide they need a C-section (and it doesn’t have to be emergent) then their water is still already broken.” In other words, your water only gets broken once: if it’s already happened, whether on its own or because your doctor helped it along during the labor process, it doesn’t need to happen again.
In some rare situations, however, the baby might be delivered in his or her amniotic sac, which is called an “en caul” delivery. “I have found it to be helpful to deliver en caul when delivering very premature babies. When I’ve had to deliver babies at early gestations (especially multiples) I try to deliver en caul because it can help with extraction,” Hemphill-Bryant explains.
What about a scheduled C-section?
If your C-section is scheduled, it’s likely that your water will be broken right before they extract the baby — Hemphill-Bryant explains that rupturing the membranes is “not something we’d do purposefully before going to the operating room.” If you’re not laboring before your C-section, it’s likely that your amniotic sac will be fully intact, and thus will need to be completely ruptured prior to the extraction, assuming your doctor isn’t trying for an en caul delivery.
What happens to the amniotic fluid during a C-section?
Kimberly Hensel, a former labor and delivery nurse in the Seattle area, tells Romper that in her experience in the operating room for a C-section, she’s seen the doctor cut through each layer and then just nick the amniotic sac and reach in to deliver the head. The amniotic fluid is then suctioned out by a tech — though even with the suction, there can be some dripping or spattering of the amniotic fluid. After the baby is removed, the doctor will remove the placenta, irrigate the area with a saline solution, and suction that fluid out as well. A dramatic explosion of water isn’t common in a vaginal delivery or a C-section, though she has seen it happen: One baby was almost out when his amniotic sac broke with his mom’s last push, which caused “quite the explosion of amniotic fluid.”
Over 30% of babies are born via C-section, and most of those babies will have their amniotic sacs ruptured during the surgery. It may not make for a dramatic TV moment, but at least this way your clothes, shoes, and car stay safe and dry.
Zuri Hempill-Bryant, M.D., OB-GYN based in Atlanta, GA
Kimberly Hensel, RN, registered nurse at Northwest Hospital