WHAT TO DO WHEN YOUR WATERS BREAK?
Countless myths surround waters breaking. Movie and TV dramas would have us believe that it always heralds the onset of full-on-labour; a huge splash followed by a mad dash to the hospital. Then there's the myth that if your waters break in the supermarket you'll get a year's free shopping.
It's very unlikely that your waters will break at the shops, and if they do it'll probably be a trickle rather than a gush. So how will you know what to do if it happens to you?
The liquid that appears when your waters break is the amniotic fluid that surrounds and protects baby while she grows inside you. The fluid cushions your baby and keeps the temperature in your uterus constant.
Amniotic fluid is contained within the amniotic sac or membranes. It begins to collect around your baby at around week four of pregnancy and the amount increases as your baby develops. It's made up of around 99 percent water as well as a mixture of fetal cells, microorganisms and waste products. The fetal cells contain genetic information about your baby, which is why the amniocentesis test takes a sample of amniotic fluid to determine whether baby has any chromosomal abnormalities.
During the first two trimesters (weeks 0-12 and 13-28) your baby's skin isn't waterproof yet, so amniotic fluid is absorbed into her body. At around 14 weeks of pregnancy, your baby's kidneys begin to work and she starts to swallow amniotic fluid. This swallowing action is thought to help mature her lungs. She then excretes the fluid back into the amniotic sac.
Amniotic fluid never gets stale, as it's constantly being absorbed across the amniotic sac back into your circulation and replaced by your baby's urine. The total amount of amniotic fluid your uterus increases from 600ml at 22 weeks to one litre at 34 to 36 weeks.
At the start of labour, you'll have a show (the mucus plug sealing the cervix comes away), your waters will break and contractions begin. These three things can happen in any order. "Waters breaking" literally means that the membranes containing amniotic fluid rupture and the fluid leaks out. The usually happens when your cervix begins to dilate, so very often it's a signal that labour has started.
If lots of fluid leaks out, you'll probably be sure your waters are breaking, but if there's only a small amount you may think you're leaking urine. A sanitary towel can tell you whether or not it's urine. If not, you can assume your waters are breaking. Your caregiver can also check to see if they've broken. Another tip is to smell it. If it is "sweet" then it could be your waters.
The fluid should be clear or a light straw colour and smell a little like almonds. If a dark green liquid is present in the waters, this probably means it contains traces of meconium (baby's first bowel movement), which she normally passes in the first days after birth. Passing meconium during labour may indicate that baby's in distress, so contact your caregiver at once.
Amniotic fluid contains prostaglandis, hormones that help your uterus contract. When your waters break, your baby's head moves down further into your pelvis and presses on your cervix. This causes a hormone, oxytocin, to be released, which helps establish contractions. This chain of events means that around seven out of 10 women whose waters break before they have contraction will go into labour during the next 24 hours. Nine out of 10 women go into labour within 48 hours of their waters breaking.
Once your waters have broken and you've told your caregiver, she'll probably want to see you to make sure everything is normal with you, baby and baby's position. If all's well, you'll probably be advised to go home and relax until contractions kick in, and to stay in touch as things develop.
If you think your waters have broken, but aren't sure, your midwife can examine you with an instrument similar to the one used when you have a cervical smear test, to see if any amniotic fluid is collecting in front of your cervix (neck of the uterus). If there's no fluid, it's unlikely that your waters have broken yet. Otherwise, there are various stages of labour that you could be in.
If you're not having contractions, or if they're irregular and coming at varying intervals (each longer than 10 minutes), your caregiver will probably advise you to stay home until you're in established labour. If you feel at any stage that you can't cope, call your caregiver again, or go to hospital.
If your contractions still aren't coming regularly around 24 hours after your waters have broken, you may be induced, as there's a risk of infection.
If you're having regular contraction (every 10 minutes or more frequently) and your cervix is steadily dilating but your waters haven't yet broken, your caregiver might suggest that you stay at home and wait for them to break naturally or have them artificially ruptured.
If you're having regular contractions, your waters have broken and an examination shows your cervix is dilating, and then baby's finally on the way and you're about to become a mom.