How Can I Know If My Water Broke?Dave Smith
I remember a particularly uncomfortable encounter in my training, in which a very pregnant woman arrived at the hospital in wet formal clothes. Several other members of her family and the wedding party had followed her with enthusiasm to the hospital, thinking that the family would experience a wedding and childbirth the same night. After a thorough examination, I realized that his water was not broken. Then I had to delicately explain to the patient and her extended family that she had just urinated.
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While a woman’s water rupture always seems obvious on television, in real life, it can sometimes be difficult to tell if the water broke, urinated or just lost the mucous plug.
As the baby grows inside the uterus, it floats in the amniotic fluid, which is a clear fluid: the consistency of water. Think of the baby growing in a giant water balloon, where “water” is amniotic fluid and “membranes” are the balloon. Many women imagine childbirth starting with a stream of cascading amniotic fluid, but only in 8% of jobs will the water break before contractions begin. And when the water breaks, it is not always dramatic: sometimes the water balloon does not explode completely and a “slow leak” occurs. Image by making a hole in a balloon with a pin and water dripping continuously until it is empty. Without fluid flow, just a confusing drip that can be difficult to distinguish from vaginal discharge or urine.
One would think it would be quite obvious if a water balloon broke in his pants, but many things are happening in that region during the last months of pregnancy that can make the situation confusing. Your bladder is attached to the front of your uterus, so that as the uterus grows, the position of the bladder is distorted. The baby’s head also pushes the bladder when it begins to fall into the birth canal. In addition, the pelvic muscles that help you control your urine often weaken during pregnancy; So most women have more trouble controlling their urine in the second and third trimesters. This combination leads to a large amount of urinary incontinence during pregnancy, especially in the last weeks of pregnancy, when the baby begins to hit the bladder.
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Many pregnant women have significantly more vaginal discharge towards the end of pregnancy, often so much that they need to use a pad, and this flow can create enough moisture to be confused with amniotic fluid. In the last weeks of pregnancy, as the cervix begins to dilate, it will also begin to secrete mucosa. Sometimes this comes out in a large portion that is often known as a mucous plug, other times it will come out in small amounts at regular intervals. Vaginal discharge and mucosa are typically white or yellow, and although they can sometimes be heavy, they are generally not transparent and have continuous leaks such as amniotic fluid.
When my patients call me to tell me they have a small amount of leaks and are not sure if their water has broken, I tell them to completely empty the bladder and completely dry the external genitalia. After everything is dry, I have them sitting on a fresh towel for half an hour. If your water has broken, the liquid will usually continue to leave leaving the new towel at least a little wet. If the towel is completely dry for 30 minutes, then the leak is more likely to be urine or secretion. If you want to be a little more scientific at home, you can try to test the mysterious liquid with pH paper (the amniotic fluid will turn it blue, while the vaginal discharge will turn it yellow). But this can be complicated because urine and amniotic fluid have a similar pH. There is also an over-the-counter test in the form of a special pant protector that has been shown to diagnose broken membranes with accuracy approximately 95% of the time.
If you have questions about whether your water could break, you should contact your supplier and be evaluated. The longer the water breaks, the greater the chance that bacteria will enter the uterus and possibly cause infection in the baby, especially if the membranes have been broken for several days. Your provider will often perform a test in which they collect fluid from the vagina using a speculum. The test involves looking at your cervix to see if fluid comes out and if it is thick as mucous or more like water / amniotic fluid. Then, they test the pH of the liquid and observe the liquid on a slide under the microscope. The amniotic fluid has a high salt content (once I splashed on my face and accidentally discovered that it tastes like coconut water. I can no longer drink coconut water), and when it dries, the liquid looks like the branches of a fern. Alternatively, your doctor can perform a test in which a swab is placed in the vagina and then sent to the hospital laboratory for analysis, usually getting results within an hour. Both options are approximately 95% accurate. The level of amniotic fluid can also be verified by ultrasound, but if it is a small and early leak, the fluid will sometimes look normal.
What happens if you are in 5% where the test is wrong? Most of the time, once the water breaks, the delivery will begin within 24 hours, but occasionally it will not, and this may increase the risk of infection for the baby and the mother. If you have a continuous discharge of water, then follow up with your supplier. If it is a small leak, sometimes the tests are initially inaccurate.