From watching all the stuff on the telly and in the cinema these days, you couldn’t be blamed for thinking that labour always starts with breaking of the waters but in reality, your labour is far more likely to start with contractions.
Even those who find their waters break (or ROM – rupture of membranes) as the first sign of labour, they usually break overnight, or as they get up out of bed, noticing a leak when they wake up. Some women pop on a waterproof mattress cover for protection just in case.
If you suspect your waters have broken, then pop a pad on (never use tampons) and call your midwife or hospital who will ask a few questions to help distinguish what has happened. Sometimes it may be a bladder leak and you mustn't feel embarrassed if this is the case, as it’s quite common in the last stage of pregnancy.
If you're a bit worried about your waters breaking in public, it’s really not very likely.
It would be daft to confine yourself to indoors just because you are close to your due date – getting out of the house and distracting yourself is very good for you! Itsnot a bad idea to put towels down on your carseat as you approach your due date, as waters seeping into your carseat can smell a little.
Some signs that your waters that have broken are:
 Having no control over the flow
A panty liner is inadequate to absorb the fluid
The pad is wet more than once, and
It doesn’t smell like urine
Some women describe their waters smelling a bit like ‘semen’, so if you do notice a smell, mention this to the midwife. Your waters should be clear or may have a pink tinge to them. If they are green, brown or any other colour you should get checked out by your doctor or midwife.
When waters do break, some women hear a pop sound, some don’t. Some have a gush and others have a trickle – it’s different for everyone. Waters often break just before the second stage (the pushing stage) of labour, when you are nearly fully dilated, due to the pressure of your baby coming down.
The Amniotic Sac & Waters
The amniotic sac surrounds your baby, protecting it from infection. When your baby engages, the amniotic fluid will be above and below your baby’s head. The forewaters are like a cushion for your baby, located between the baby’s head and the cervix. The hindwaters are above the head (assuming your baby is head down!), surrounding the baby’s body.
If your waters break and there is only a small gush or trickle, this could be because it’s only the forewaters that have escaped, with the hindwaters still above the baby – the head engaged in the pelvis can block the flow of the hindwaters which will eventually release (you may get little trickles or gushes with each contraction) as labour progresses or as your baby is born. You could also get a hindwater leak, which may even reseal and stop leaking!
The fact that waters have broken at the start of labour doesn’t mean labour will come on hard and fast and your partner needn’t race home, as the thing you need are the contractions for labour to be happening.
Waters Breaking and Contractions
When your waters break, contractions may or may not start right away. Some women will initially start to feel period pain, which gets stronger and progresses to strong contractions. Some women will wait hours after the waters breaking before they get any contractions, some will wait days and some will not have any contractions at all, and end up being induced. This may happen if the baby is in a bad position (i.e. posterior) but does not mean your body has failed or does not know how to birth. Most importantly, this does not mean it will happen next time, so don’t think that it’s your body’s fault – malposition can be just bad luck!
Waters Breaking and Infection
Once the waters have broken, the seal around your baby is no longer there to prevent bacteria reaching your baby. This is the reason why internal vaginal examinations are best avoided once your waters have broken. You are at higher risk of infection if your waters are artificially ruptured by your doctor or midwife (AROM – artificial rupture of membranes) as they are reaching in your vagina, up to your cervix where the baby’s head is, to break the waters or to examine you etc.
However if your waters rupture spontaneously without help then you have less risk of infection since there is a downwards flow of fluid and for bacteria to reach your baby, it would have to migrate up against the current of waters. An example of this is having an internal scalp monitor clipped onto the baby’s head to measure the heartrate. This means that a foreign object is being placed directly on your baby, so there is a chance for bacteria to go with it.
If your waters are broken artifically to start labour, you will most likely be told that you need to be started on antibiotics immediately or within 4 or so hours to prevent infection depending on the hospital policy. This is usually done by injection or possibly a drip, but it’s best to avoid the need for it in the first place if there is no medical problem. Antibiotics not only kill the bad bacteria in your body, but the good bacteria too as they can’t tell the difference. It can throw yours and your baby’s gut bacteria out of balance and is not ideal. So it’s best to let the waters to break on their own unless there is a medical emergency.
Speeding Up / Inducing Labour By Artificial Rupture of Membranes
Some doctors or midwives will recommend breaking your waters to speed up your labour if it is slow or has stalled. If your waters are broken before 4cms, there is the possibility it may slow your labour down, or even do nothing. This means that you’ll on the antibiotics anyway, as well as a syntocinon drip, which is a sythetic version of the labour hormone, by i/v drip, restricting you to the bed as you’ll also need to be monitored. This may start or speed up your labour but it also may not – and failed inductions mean caesarean sections. If the labour does not start or speed up with the drip, the next port of call is a caesarean section – which carries its own set of risks.
If labour hasn’t started after the rupture of membranes and you have the syntocinon drip which does work, you are at a high risk of needing further pain relief, especially an epidural, as well as a caesarean section should your baby go into distress from the syntocinon. You may not feel your intense contractions from the drip but your baby does. So you can see, something so simple can result in complications very quickly.
If you do need to be induced for a medical reason, rupturing your membranes is a better option than syntocinon, however you may also need to argue your case to have your waters broken without other interventions. Many doctors will want waters broken and the drip started straight away, as they’d rather not wait and see. On the other hand some are happy to rupture your membranes first, and see what happens.
Even then, some may have an unrealistic time limit of an hour or two or even four hours for your body to be labouring. Hopefully your body is ready to labour and labour does get started fairly soon, but you have to remember that labour is a complex system of hormones and it does need time for those hormones to circulate and be in sync with mother and baby, especially when your own body hasn’t initiated labour. .
What All This Means…
If your water breaks, remain calm, know that this is the start of a long process that could last minutes, hours, even days before contractions begin. Get rest, as you have a long way to go, and let your labour unfold how it’s meant to. Hopefully long before this you have found out what your midwife's/hospital’s policy is for how long they ‘recommend’ a woman can go with broken waters. If you and baby are healthy, you can negotiate for more time. If you need to, you can negotiate with things like coming in for monitoring, and if you are happy to, you can agree to antibiotics and also self monitoring of your temperature, reporting any changes right away.
Unless there are any signs of problems, and there probably aren’t, you are unfortunately in a medical system where you are treated as if you have a problem unless proven otherwise – which is fine for those that have a problem but not the majority who do not, who cop all the ‘just in case’ interventions and treatment.
January 2009
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