‘Breaking the waters’ - what an odd phrase! Can water ‘break’? In what other situation is water described in the plural? Are we even talking about H2O? So many questions…
When I ask expectant parents what they think the first sign of labour might be, someone usually suggests the ‘waters breaking’ but did you know that is only the first sign in 10% of labours? Unless you’re in a tv show or movie of course - in which case it always happens unexpectedly and in an inconvenient location! And that Hollywood gush? Nah, it’s more likely to be a bit of a trickle, as a baby’s head engaged in the pelvis forms quite a good plug.
If your waters (as the amniotic fluid is known) do release before any other signs of labour - what should you do?! Obviously in the movies you’d rush straight to hospital as your baby is likely to arrive in the next few minutes… but in real life it usually takes a fair while longer than that. Remember that the hormone oxytocin is what’s going to get those surges going and the best place to create oxytocin is where you feel most comfortable - probably at home rather than in a car or on a plastic chair in a hospital waiting room.
You might not be 100% sure that it is amniotic fluid that’s been released… that baby’s head deep in the pelvis is going to put quite a lot of pressure on your bladder too!! So what should you do if your knickers are damp and you’re not entirely sure why?! One solution is to go to hospital for a check. That’s likely to be offered if you call to talk to a midwife. Once there, they’ll ask you to empty your bladder and lie down for 20-30 minutes, after which they’ll take a look into your vagina using a speculum to see if fluid is pooling there. That’s because, whether the waters have gone with a gush or a trickle, they will continue to leak until your baby is born. There’s about a litre of amniotic fluid around your baby at any given time but it’s not the same litre of fluid for the whole pregnancy: it’s constantly being refreshed and replaced, and that process continues until it’s no longer needed. So there’s no concern about the waters ‘going’ and leaving the baby in a dry environment.
If you don’t want to go into hospital and have an internal examination - which of course increases the risk of infection, especially if the amniotic sac has ruptured - then you don’t have to, and there’s a simple test you can do at home. Firstly, empty your bladder. Put a pad on and stay upright, not lying down, for 20-30 minutes - after that time the pad will be damp if your waters are trickling… and if you give it a sniff, amniotic fluid smells a lot like semen. If the pad is dry, I’m afraid you probably did just pee yourself a bit - forgivable at this stage of pregnancy! If it is your waters, try to relax and await events - for most people labour is likely to become established within the next 24 hours.
There are a couple of situations when it would be sensible to talk to midwives if your waters have gone, even if you’re not in labour yet: check the colour. Amniotic fluid is usually clear, pinkish or pale yellow. There might be some blood, which is the ‘show’ or mucus plug coming away with the fluid - that’s fine, and a good sign that the cervix is softening and opening. But a lot of blood, like a period, that’s not stringy or mucussy like the ‘show’ could be a cause for concern. Also if the fluid is brown or greenish it might be stained with meconium, the tar-like substance that lines the baby’s gut in utero and is the first poo they produce. If they’ve started pooing inside, it might be a sign of distress - or it could be a sign that they’re 40-odd weeks and ready to start pooing! A midwife can listen in to the baby’s heartbeat and see how happy they are. Midwives are also very good at checking the amniotic fluid and telling if it’s ‘old’ meconium which might be less of a cause for concern or ‘fresh’ meconium - so save those pads!
If however you’re in the 90% of people who don’t experience a ‘spontaneous rupture of the membranes’ (SRM) as the first sign of labour, when does it occur? It’s most likely to happen as the baby moves down into the pelvis, creating pressure on the amniotic sac and it’s often accompanied by the transition from the first to second (pushing) stage of labour. A midwife might offer to break the waters using an ‘amniohook’ device: this is called ‘artificial rupture of the membranes’ (ARM) and is done to speed up labour or check the colour of the fluid. You can, of course, decline this intervention.
Sometimes the waters don’t break until the baby is born - I’ve witnessed this a few times in undisturbed home births - it’s called an ‘en caul’ birth, sometimes known as a mermaid birth and is seen in birth mythology as a sign of great good luck - those babies born ‘en caul’ will never drown at sea, and sailors used to take dried amniotic sacs onto their boats as protection against drowning - which I think is wonderful!