Your waters have broken: Let a sanitary towel be your friend

In this post we look at how you look after yourself and your baby when your waters break before labour starts.

What is amniotic fluid?

Protective water around your baby inside the membrane sac. After 20 weeks it is mostly produced by the babies kidneys – Yes its wee. It’s straw coloured with flex of vernex which is your babies skin.

It provides a protective, cushioning environment for your baby to grow.

What happens when your waters break?

90% of the time your waters break during labour. The other 10% of the time they will break with no contractions or surges as I like to call them.

Waters can break in two places – Hind and Fore. With a hind leak the membrane leaks from behind the babies head. This can feel like a trickle or like you’ve just peed your knickers by accident but the peeing continues to intermittently trickle.

A hind leak is the water breaking under pressure. Think of a splash like the one’s we see in movies or the great clip at the end of this post.

What to look out for when your waters break?

Waters should be a clear straw colour
Wear a sanitary pad to make sure that the colour stays the same and there is no unusual odour. So look at it and give it a sniff.

If your waters are dark greenish, brown or have any dark slimy bits in it you need to go and get hooked up to a monitor to make sure your babies heart rate is stable and take your vital signs to ensure everything is ok. Meconium is the name of your babies first pooh. The colour may reflect that your babies bowels have emptied. They may have just been full but it should be checked to see if they are under pressure and need to come out.

When your waters break during labour things will normally progress as usual.

What to do if your waters break and there are no signs of labour?

So as a doula for the women I am looking after I would always try to follow your natural rhythms – a wait and see approach if you like.

This differs considerably from hospital policy which I will go into later.

How do you care for yourself if your waters break before labour?

Firstly your vagina is self cleaning. It cleans from the top down. Do not put anything up there. We want to reduce the risk of any infection by keeping clean. Wiping towards the back and no prodding! This includes your care givers fingers.
Take your temperature. Elevated temperatures are the best indication of infection. You will need a thermometer for your baby as they have temperatures frequently. Look out for flu like symptoms.
Supplements to boost your immunity. Vitamin C – I would take 1000mg per day, 3 times. Echineacha and garlic are also recommended.
Be self aware. Keep doing your kick count while watching your babies movement and activities. Observe and record it to make sure there are no sudden changes.
Take showers until labour starts then bath all you like. As I said, the vagina is self cleaning and water proof.
Observe any fluid by using pads.
Trust the process of birth and relax. Do your breathing and relaxation exercises.
Promote oxytocin with nipple and clitoral stimulation.

The good news it that 70% will go into labour within 24 hours, about 90% will go into labour within 48 hours.

Keep that wait and see approach, watching and observing how you and your baby feel.

If at any time you feel unsure, go to the hospital and get checked out. The main risk associated with premature rupture of membranes is an infection. If you feel unwell, your temperature rises or you are worried about your babies movements, you need to get checked by your caregiver.

What happens in hospital if my waters break and I have not gone into labour within 24 hours?

Hospital policy around this has changed over the 13 years I have been working with women. At home births we would follow WHO guidelines and more often than not wait 72 hours.

We are now in the situation where hospital policy is: After 24 hours labour is induced and routine IV antibiotics are given. In some places this 24 hours has reduced to 18, 10 and in some places ZERO.

Think about it. If your waters break before 34 weeks the policy is to monitor mother and baby waiting for the baby to develop. But at full term the policy changes to induction. Why?

Let’s be honest here. Induction is not an easy path to follow. It’s not a natural birth. It is a hard, hard ride. Induction methods have many associated risks. These risks will mean that you require further monitoring and intervention. Another point that people fail to mention is that it’s often painful. The intensity can become sharp and unmanageable very quickly leading to the use of painkillers and epidurals. More intervention. Leading to more and more cesareans.

So why not just wait another day or two?

And the routine antibiotics? These are given as a routine to reduce infection risk. This is something I strongly disagree with as a routine – a just in case policy with no evidence to support it.

Chocrane review

This review included four randomised controlled studies involving 2639 pregnant women at 36 or more weeks’ gestation. The evidence shows that routine antibiotics for term PROM did not reduce the risk of infection for pregnant women or their babies when compared to the control group which received a placebo or no antibiotics.

Antibiotic Resistance

A study in 2011 found that antibiotics given in labour increased the incidence of antibiotic resistance when treating late-onset serious bacterial infections in infants (Ashkenazi-Hoffnung et al. 2011). I think more research needs to be carried out considering the number of women/babies given antibiotics in labour.

And what else ?

It wipes out your and your babies gut flora. There’s a lot of study on how important it is to maintain a healthy gut microbiome. Depletion of the microbiome is now being scrutinised by our scientific community and early studies indicate a link between allergies, auto immune disease, asthma and obesity.

So why give routine antibiotics due to waters breaking before labour?

Its risk management rather than evidence based. Please don’t accept this policy if you feel it is not for you. You do have a choice here.

And what to do if you are advised to be induced if labour has not yet started?

Ask if you baby is doing well?
Ask if you are doing well?
If everything is ok…
Politely say you will wait and see.
You will probably then hear what might happen – not a kind tactic to use.
Remember it’s your choice. Your decision.

If they trust you to go home with a new baby – they should trust you to go home with a thermometer!

Go home. Observe your vital signs. Tweek your nipples. Get your partner to get sassy with you!

Follow the recommendations I gave you earlier. If you feel unsure at any stage just go back in to be monitored.

Stay in hospital and wait and see if feel more comfortable. It will be harder to relax and get into the dance of labour. Just put a note on the door if someone is going to tweak your nipples. It’s only polite!

Here’s a little something that made me laugh!