Membranes rupturing / waters breaking, no contractions
What if? Looking after yourself with broken waters
The bag of membranes, or sac of waters (known as the 'amniotic fluid') can rupture or break at any point in the labour process. This can be from prelabour, up until the actual birth. Breaking the waters is definitely a sign of prelabour, and one that your caregiver should know about.
Did you know?
There are two ways broken waters can present:
A slow trickle, or leak
A big gush
A slow trickle, or leak. The sac can have a small opening in it, so that the amniotic fluid only trickles out slowly over several days. The water can dribble away intermittently with movement from you or your baby (or with a contraction). The water can also come away as a slow leak if your baby's head is very engaged. This is because the baby's head is sitting snugly over the opening of the cervix, letting only small amounts of fluid drain away at any one time.
Many women who have a slow, fluid leak find it quite difficult to know whether the fluid coming away is either urine or the amniotic fluid. One way to tell is to be aware that amniotic fluid will generally continue to drain away, even after you have emptied your bladder. If you do notice water coming away, go to the toilet and empty your bladder, then put on a pad and see if any more comes away over the next couple of hours.
If in doubt, sometimes the smell of the fluid can also help you know. Amniotic fluid does not smell acidic, like urine. The smell is somewhat odourless, or has an almond-like aroma (some people liken the alkaline odour of amniotic fluid to the smell of male semen. This can make it more difficult to tell if you have just had intercourse).
A few women will experience what is called a 'hind water leak'. This is where a small hole opens in the sac, usually up behind the baby's head, closer to the baby's body. Hind water leaks can continue as a slow dribble or leak, or can stop after a short while. The fluid can stop coming away because the two layers of membrane (in the sac) are able to 'slip' back over each other, to reseal the hole. This is why some woman will notice a dribble of fluid, and then getting nothing more for several days until the fore-waters (or the part of the sac in front of the baby's head) break with a gush.
Image 3-15 shows the bag of waters in front of the baby's head intact, the arrow indicating the place where hole in the sac may be.
NOTE: If you think your waters have broken contact your caregiver for advice. Keep any pads or under wear and take them with you for your caregiver to look at.
If there is some doubt as to whether your waters have broken, your caregiver may use one of the following methods to try and determine if they definitely have.
They can:
Place a speculum into the vagina (the instrument used to take a pap test) to see if the water 'pools' or collects on the speculum. Sometimes the caregiver will take a swab test (sterile cotton bud) to send to the pathologist to check for infection.
Use an 'amnicator'. This is a long, orange coloured cotton bud that changes in colour to navy blue if it comes in contact with alkaline fluid, such as amniotic fluid (like a pH indicator).
Sometimes neither of these methods are conclusive and even the most experienced caregivers can find it difficult to know if the waters have definitely broken. In this case, it is often just a 'wait and see' approach, observing if any more comes away over the next few hours / days. Most women can go home to 'wait and see', unless the baby is premature.
A big gush of fluid. Some women's waters will break suddenly with a large gush. This is more common if the baby's head is not fully engaged and resting snugly on the mother's cervix (for example with second (or more) time mothers, breech babies, posterior babies or twins).
The connotation of a 'gush of waters' makes some women a little nervous about going out. It can conjure up visions of "a mop and bucket needed in aisle 8" of the local supermarket. In reality, this rarely happens, but it may be handy to carry around a large sanitary pad and a change of underwear in the last couple of weeks of the pregnancy!
Image 3-16 shows the waters in front of the baby's head before breaking.
Image 3-06 shows the waters now ruptured after a big gush of fluid.
NOTE: If you think your membranes have ruptured and your baby is not due (before 37 weeks). Contact your hospital or caregiver immediately, regardless of whether you are having contractions or not, as your baby is regarded as being premature.
OR
If the membranes rupture, and you notice a discolouration of yellow, green or brown in the fluid, it is necessary to contact the hospital or your caregiver straight away. The discolouration is probably meconium, (the substance in your baby's intestines that is passed as the first bowel movement), which is sometimes passed before the birth, staining the amniotic fluid.
Depending on the thickness of the meconium (a very faint discolouration may not be of concern, compared to a 'pea soup' consistency which is more serious), it may indicate that your baby could be distressed, or has been stressed at some time previously. Keep any tissues, underwear or sanitary pads with the fluid on them to show your caregiver. You can read more in meconium stained amniotic fluid.