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Water flows first. Too long anhydrous period without contractions: the effect on the fetus and the consequences. Lack of discharge of water during labor pains

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Some women who have not given birth may not know what it is - "the waters have moved away." The amniotic fluid leaves after rupture of the membranes, so an anhydrous period begins, which lasts until the moment the baby is born. At this time, the woman is under stress, tension and may be frightened. She listens to herself and asks questions when the contractions will begin and how many hours she will have to give birth if the waters have receded.

First of all, the expectant mother needs to calm down and slowly get ready for the hospital. The rupture of amniotic fluid is one of the normal stages.

How long does it take to start labor after the water has passed

The question of how many hours the labor will begin, if the waters have already departed, is quite natural. Normally, rupture of the fetal bladder occurs just during childbirth. In the first, the bubble acts as a shock absorber, protecting the child from injury. Its insertion promotes the opening of the cervix. But there comes a moment when he is already superfluous and prevents the child from passing through the narrow birth canal. Then the bubble bursts and water flows out.

If the waters of a pregnant woman have departed, they will begin at any time (if they have not already begun), after how many hours or minutes this will happen, no one will say for sure. The first contractions are weak and painless, with large intervals. Intensive normally can begin both after 2 hours and after 6. often proceed faster, therefore, the contractions begin earlier.

When the waters leave

Normally, this occurs at the end of the first period of labor, when the cervix is ​​dilated by about 6 cm, before intense contractions.

Another development of events is possible:

  • If the waters have departed before the normal dilatation of the cervix, but in the presence of contractions and labor, this is considered an early effusion.
  • It is also possible a situation in which the water may already move away, but there are no contractions. E If this happened before the onset of labor, it is a premature outpouring.

What will happen if contractions have begun, and the water has not departed, how will this affect childbirth? There is nothing terrible in this. You need to see a gynecologist. If this is the beginning of labor, if necessary, the bladder will be pierced in the maternity hospital. If it is, it will be left intact, but the obstetrician must differentiate these conditions.

How does this happen

How to understand that the waters have moved away? This usually happens after the first contractions appear and after. They can pour out profusely, in amounts ranging from 200 ml to 1 liter. The woman has a feeling of urinary incontinence, while she cannot stop the flow of flowing fluid by contraction of the muscles of the sphincter of the bladder. Water can drain in 2 or even 3 stages. Some women may have a “pop” sensation when the membranes rupture before the water drains away.

Could it be that the waters receded, and there were no fights? This happens with the premature discharge of amniotic fluid through microcracks of the membranes. A woman may mistake them for urinary incontinence or an increased abundance of vaginal secretions, since the water can come out poorly, literally drop by drop.

How to understand that the waters have moved away?

A woman will not miss the abundant outpouring of waters. However, it is not uncommon for the waters to recede while the woman was sleeping at home. In a dream, she may not feel it. If after waking up on a wet sheet there is no smell and color of urine, and even more so if there is a mucous plug, this speaks in favor of water. A plug is a clot of mucus that forms in the cervix during pregnancy.

You can skip the moment of pouring out when the woman is taking a bath or shower. In this case, the presence of a mucous plug in the bath may indicate that the water has left without contractions.

In such situations, a woman often doubts and asks questions: did the waters recede and when did it happen, and if the waters really did recede, then what to do? There can be only one answer - to urgently go to the gynecologist.

When to be alert

Premature discharge of water is common and poses a great threat to both the baby and the woman.

Therefore, you need to be on your guard at all times, especially:

  • with an increase in incontinence;
  • when vaginal discharge becomes more abundant and watery;
  • when the discharge becomes more abundant with a change in body position;
  • when there is an unpleasant odor of vaginal discharge;
  • when the belly decreases in size;
  • when down;
  • with soreness of the abdomen.

What are the normal waters?

In the normal course of pregnancy in a healthy woman, amniotic waters are light, transparent, colorless and odorless. The volume of water by the end of pregnancy ranges from 600 ml to 1500 ml. A deviation from these figures up or down is considered low water or.

In the presence of pathology, water can change:

  • with oxygen starvation of the fetus, they have a greenish tint;
  • with the threat of miscarriage and premature placental abruption, they may have a brown or brown color;
  • with a bacterial infection, the waters will be cloudy, yellow-green, with an unpleasant odor.

Why does the water drain?

This happens when the volume of the fetal bladder under external pressure from contractions decreases - as a result, the internal pressure of the amniotic fluid on its walls increases, and they burst.

However, rupture of membranes can occur long before the birth process. One of the reasons is an infectious melting of the walls of the fetal bladder. Where it is thin, microcracks are formed. Trauma is also one of the obvious causes of bladder rupture.

Factors contributing to premature or early outpouring of water:

  • narrow pelvis of a pregnant woman;
  • violation of the condition of the woman's cervix - rigidity, cicatricial changes after abortion or previous childbirth;
  • abnormal position of the fetus and;
  • polyhydramnios;
  • exacerbation of a chronic bacterial infection in the vagina and uterus;
  • the presence of serious chronic diseases of the mother - diabetes mellitus, lupus erythematosus and others.

If there are no contractions

If the mother's water has already departed, she naturally wonders how much the child can do without this water. Ideally, the anhydrous period lasts 4 to 6 hours and ends with the birth of the baby. When it exceeds 6 hours, it is already considered long-term, but this is not yet a pathology. The danger arises, this period lasts over 72 hours.

Inexperienced expectant mothers sometimes ask the gynecologist what to do when the waters have departed, for example, 12 hours ago, and there are no contractions. But why wait so long? Immediately after the outpouring of water, you need to go to the hospital. Within a day, doctors can begin to stimulate labor activity or proceed to.

The discharge of water is an important sign of the onset of the generic process. The premature onset of the process is often subtle and gradual, but it can provoke a spontaneous abortion or cause serious complications of pregnancy. If a woman noticed that her water was leaking, she should urgently seek professional help from an obstetrician-gynecologist.

Useful video about the end of pregnancy and the beginning of labor

  • We go to the hospital
  • Difference from pushing

    • When a woman enters the last weeks of pregnancy, along with the preparation of the child's dowry and the collection of things in the hospital, she involuntarily thinks about how everything will really be.

    The main question is where will the birth start? From the discharge of water or from the appearance of characteristic labor pains? In this article we will try to answer this difficult question.


    How does it work?

    And it happens in different ways. Children are not alike, pregnancies cannot be identical, and any obstetrician-gynecologist will confirm this. Carrying a child is a purely individual process, with its own difficulties and nuances. Childbirth also begins differently for everyone. The most preferable, from the point of view of doctors, is the sequence in which regular true contractions begin first.

    They should not be confused with training ones. Unlike false contractions, true contractions cannot be removed by changing the position of the body or taking the No-shpy pill, a warm shower will not help, and there will be no sense in the horizontal position of the body. True contractions, if they have begun, proceed with the simultaneous smoothing and opening of the cervix, which has been tightly closed throughout the pregnancy.


    This process is not controlled by the will of a woman, cannot be reversible, and therefore true contractions are constantly growing, intensifying, becoming longer, and the intervals between them are shorter.

    As soon as the contraction is repeated every 10-15 minutes, you need to go to the hospital. It is not worth waiting for the waters to recede.

    If childbirth proceeds correctly, according to the classic pattern described in all textbooks on obstetrics, then the waters leave without the intervention of doctors when the contractions become quite frequent and strong. The pressure of the walls of the uterus at the moment of tension (at the peak of the contraction) provokes a violation of the integrity of the fetal bladder, as a result of which the water is poured out, the baby begins to move forward along the birth canal. Attempts start.



    In general terms, ideal childbirth has the following sequence:

    • the cervix becomes smoother, it is compared with the body of the uterus, disclosure begins;
    • smooth muscle fibers become shorter with each subsequent contraction;
    • the walls of the uterus become denser;
    • the external pharynx opens, the opening increases with each contraction;
    • pressure on the bubble increases;
    • under the pressure of the fetal head and the amniotic sac itself, the internal pharynx opens;
    • there is an outpouring of water and attempts begin - the uterus "pushes" the baby out.



    The attempts end with the birth of the child, then the placenta leaves within 20-45 minutes. On this, the correct textbook childbirth ends to the great joy of all participants in this process.

    Like anything perfect, classic childbirth is rare.

    There are many variants of the norm, and therefore the sequence may be different. We answered the question of whether contractions can begin without leaving the waters, but not completely. Very rarely, the waters leave at the very last moment, and the child is born in the amniotic membrane, in which he passed through the birth canal.

    In this case, they say that the baby was "born in a shirt." Popular rumor and omens attribute to such people incredible luck and great luck throughout their lives.

    The waters are gone, but there are no fights

    This variant of childbirth is considered dysfunctional. But everything will depend on how ready the woman's body was for the upcoming birth and how quickly the contractile activity of the uterus begins.

    If contractions begin to develop immediately after the water leaves, they are strong enough, the neck opens at an optimal pace, then the forecasts are more favorable. If labor is weak, painful, the cervix opens slowly or does not open, then an urgent emergency caesarean section is considered the best solution.



    A long stay of a baby in an anhydrous environment (more than 8-12 hours) can lead to acute hypoxia, to the death of a child, to irreversible consequences for his health, resulting from post-hypoxic disorders in the work of the brain. A 48-hour waterless period is considered critical (fatal), although everything is ambiguous here, and miracles happen.

    Situations when water first recedes do not tolerate even a minute delay.

    The woman needs to be taken to the hospital of the obstetric institution as soon as possible, where doctors will be able to assess the condition of the child, record his cardiac activity, physical activity, assess the degree of cervical maturation and make a quick and correct decision - to stimulate labor or deliver the patient surgically.


    The main danger of the anhydrous period lies in the possibility of infection of the fetus. The point is that the waters are sterile. If they move away, the baby is deprived of protection. Without amniotic fluid and mucous plugs, bacteria and viruses can penetrate directly to the baby, and he is clearly not ready to meet them yet.

    Inflammatory or viral diseases that a woman suffered during pregnancy, the presence of isthmic-cervical insufficiency, polyhydramnios, pregnancy with twins or triplets, thin fetal membranes (for idiopathic reasons that cannot be established is not possible to establish) usually lead to the outpouring of water before contractions. Also, early outpouring of water before labor is fraught with falling on the stomach, on the ass, on the back in late pregnancy.



    Simultaneous process

    Sometimes the contractions begin almost simultaneously with the discharge of the amniotic fluid. In this case, hospitalization must also be urgent. Staying at home and waiting for the contractions to pick up the necessary frequency and frequency, which was talked about so much in the courses for expectant mothers, is dangerous.

    The risks are the same as in the case of premature effusion. First, the baby may experience acute hypoxia, intrauterine infection often occurs, especially if some infections remain untreated by the woman herself.


    A situation in which the contractions began almost at the same time as the water departed, is dangerous for the development of rapid, rapid labor, which, in turn, are dangerous with birth trauma, premature placental abruption, massive bleeding and other serious complications for the child and mother.

    There are contractions, there is no outpouring

    In some situations, when the fetal membranes in which the baby is located are too dense, the intervention of doctors is required. When there is no longer time to wait and on the approach of an attempt, the cervix is ​​fully opened, the whole fetal sac is punctured, a so-called amniotomy is performed.

    A long hook is used to puncture the bladder and make sure that the water does not pour out too intensively. The rapid outpouring of water can lead to the loss of the umbilical cord loops, the prolapse of the arms or legs of the fetus into the genital tract.



    Throughout the entire period of bearing a child, he is in the fetal bladder filled with amniotic fluid. This is his natural environment, which ensures harmonious development and growth, and also protects him from possible negative influences from the outside world. But before childbirth or already in their process, the integrity of the fetal bladder is violated, which is accompanied by the discharge of amniotic fluid.

    Normally, this means that childbirth has already begun, and the baby will be born in the next 10-12 hours or earlier. But in each individual case, the water can drain in different ways, not always in a timely manner and sometimes "wrong", which confuses the expectant mother. It can be difficult to determine whether water is leaking or leaking. Meanwhile, the difference is very big!

    Some conditions require urgent medical attention. In addition, it is impossible to stay at home after the discharge of amniotic fluid. Therefore, every pregnant woman should know how water flows before childbirth and what needs to be done in such a situation.

    Let's make a reservation right away that the waters do not always leave with the onset of labor. If this happens before it begins, then doctors talk about premature or prenatal rupture of amniotic fluid. Their early discharge occurs already with the onset of contractions, but still with insufficient opening of the cervix. If the waters are poured out when the cervix is ​​sufficiently softened and open (at least 4 cm), then such an outpouring is considered timely and the most favorable in terms of the course of labor. However, it also often happens that the fetal bladder does not burst in due time - and then doctors pierce it manually by mechanical means.

    How water leaves in pregnant women depends on the place of rupture of the fetal bladder, the location of the fetus in the uterus, the condition of the baby and the placenta. Consequently, the amount and especially the color of amniotic fluid is very important in assessing the birth condition, predicting the course of the birth process and further tactics of the medical staff.

    How water leaves before childbirth: the amount

    The amount and composition of amniotic fluid changes throughout pregnancy. Before childbirth, their volume is approximately 1.5 liters, but this does not mean that exactly so much is poured out immediately when the membranes of the membranes rupture. As a rule, a certain part of the amniotic fluid first leaves, while simultaneously advancing the fetus to the cervix. When the child presses tightly against the walls of the birth canal, a so-called contact belt is formed, while part of the amniotic fluid will still remain in the bladder and leave with the birth of the baby, making it easier to slide through the birth canal. Thus, the amniotic fluid during childbirth is divided into anterior and posterior.

    If the rupture of the fetal bladder occurred from below, then the entire portion of the anterior waters can be poured out at once: it may seem to a woman that involuntary urination has taken place. Very often this happens at night during sleep or when getting out of bed, with tension in the abdominal muscles.

    The opening formed on top or on the side of the fetal bladder leads to a gradual discharge of amniotic fluid - in small portions or even drops. This complicates the correct understanding of the situation: the pregnant woman doubts - water is leaking, amniotic fluid is leaking, vaginal discharge before childbirth has increased, or urinary incontinence occurs. Sometimes, it is worth putting on dry linen, as soon you have to change it again.

    How water leaves before childbirth: color

    Difficulties also arise because the normal amniotic fluid is colorless or slightly yellowish, which is very similar to the color of urine. But other options are also possible ...

    Greenish, brown, cloudy, dirty waters indicate fetal hypoxia, and sometimes the development of intrauterine infection. An unpleasant smell of water is a bad sign. Impurities of blood in the amniotic fluid indicate placental abruption and require urgent medical attention!

    This is why it is very important to know what color the amniotic fluid is. If they left at home, then you should definitely pay special attention to their color.

    When the water is poured out before childbirth, the pregnant woman usually does not experience pain, discomfort, or other special sensations, except for moisture in the perineum. Often, women hear a characteristic sound with which the fetal bladder bursts if all the amniotic fluid is poured out at once: it resembles a click, pop or crack.

    The fetal bladder can burst at the peak of one of the contractions, and therefore, when water is poured out, a slight cramping spasm in the lower abdomen, slight pulling pain, heaviness is possible. But the outpouring of water can occur without any sensations at all.

    If there was an outpouring of all the front waters at once, then it may seem as if a lot of water has suddenly poured out of you (although, in fact, its amount is much less than it seems), as if a full bucket was turned over, for example.

    How to understand that water is leaving during pregnancy

    If the water is discharged in portions, in small doses, then you should make sure that the situation does not threaten the baby. To do this, it is best to notify your doctor about what is happening. If the due date has not yet arrived and there are no contractions, then he will take a swab for analysis or conduct a test for leakage of amniotic fluid. You can also buy such a test at a pharmacy to do it yourself at home.

    If the watery discharge before childbirth is abundant, then most likely it is, nevertheless, water. They, as we have already said, are normally transparent or slightly yellow, may contain flaky impurities (particles of primordial lubricant from the baby's skin), mucus. A characteristic feature of amniotic fluid is a subtle sweetish odor. Unlike urination, amniotic fluid flow cannot be delayed or stopped.

    No matter how the water leaves you, if this happened or if you suspect that this is happening, there is nothing to wait: you need to take the bag to the hospital and go to the hospital. Any discharge of amniotic fluid indicates that the sterility inside the bladder is broken - and infections are open to the child. In addition, the fetus is able to stay in a waterless space without danger to itself only for a certain time. As a rule, if childbirth does not occur within 10-12 hours after the outpouring of water, doctors stimulate the labor process, and in some cases resort to a cesarean operation. One of the indications for this may be the prolapse of the umbilical cord or limbs of the fetus during the outpouring of amniotic fluid (more often this occurs with a transverse presentation of the fetus), which is detected when examining the woman in labor.

    The main conclusion of all of the above is the following: if the amniotic fluid has departed at home, then it is imperative to evaluate their color and approximate amount and immediately go to the hospital. In the hospital, you will certainly be examined and will begin to prepare for the delivery - depending on the situation (the beginning or absence of labor, the degree of maturity of the cervix). If the waters have departed in the early stages, then the pregnant woman is necessarily hospitalized to take measures to preserve the pregnancy and save the fetus. In most cases, with timely measures taken, pregnancy, in which the waters have departed after 20 weeks, can be prolonged.

    In general, it should be understood that the outpouring of water before childbirth is one of the signs of their onset, that is, it is the norm and should not frighten. If the waters have not moved away, then this is completely harmless.

    Especially for - Larisa Nezabudkina

    2 Sep 0 2934

    Natalia Tomilina, doula, psychologist, body therapist: First, you need to understand a little about the anatomy. There is a uterus, there is a bladder in the uterus, it contains the baby, the umbilical cord, the placenta, as it were, on one side (and the reverse side is attached to the wall of the uterus) and amniotic fluid. There is usually quite a lot of water, and the baby on the eve of childbirth is large and occupies almost the entire space of the uterus. His head (or butt) is at the bottom and inserted into the pelvis.

    Further, about the two situations of water drainage, the difference between drainage and leakage, what risks are there from the point of view of doctors, are they justified, what increases and decreases them, what to look for, what factors to monitor, what protocols are adopted in Russian maternity hospitals, in maternity hospitals other countries, at home.

    So. Bubble rupture can happen in different ways

    1. The integrity of the bottom is broken, where the cervix and the head of the child are, usually in this case, about half a glass of water is poured out, because of this, the head sinks lower, and it can be compared to a cork that was plugged into a bathtub so that water does not leak out. This option is called the discharge of the anterior (that is, between the head of the child and the cervix of the woman) waters... You need to know that on top of the abdomen, where the baby's belly and arms are, there is a decent amount of water, the so-called back ones, that is, as a rule, they do not flow out all and completely, there are a lot of them. And you need to know that every three to four hours, new portions of water are produced by the mother's body.
    If a woman strongly changes her body position (got up, lay down, turned over, got up again, sat down), then the water will flow out. If you take one position, then they can stop flowing completely, because the head is tightly pressed against the pelvis.

    What risks does medicine tell us about?

    I'll start with the worst thing. Yes, I'm not afraid to talk to pregnant women about death. I believe that it is better to call her by her own name and say in what cases it can be at all, than to be silent, thereby heating up the illusion that "childbirth is safe if ...". Yes, you need to prepare, you need to know certain investigated laws of childbirth, you need to take care of safety, but not go to the extreme of overcontrol. Doctors know and in fact among themselves they say that childbirth is a process that does not fit into absolutely precise schemes. There are landmarks, yes. But childbirth is unpredictable. Childbirth is a compressed in time, concentrated model of life itself, and no one has yet been able to fit life into schemes.

    So, most of all they are afraid of sudden antenatal (before birth) death of a child. But it is not connected only with the flowing away waters. It is even more associated with severe overmaturity (later than 43 weeks), and according to some reports it is higher at 37 weeks than at 42-43, while no one is stimulated at 37 weeks. In general, this is a very mysterious thing - antenatal death. There are always risks in childbirth, simply because death is there. And this is not a reason for everyone to do a planned cesarean. And this is not a reason to monitor the child's condition around the clock. Just as we live, despite the fact that we know about the suddenness and unpredictability of death, we also go to childbirth, knowing that sometimes, oh-oh-very rarely, some children do not live to see their birth and this is how this peace. Personally, during my practice, I encountered two such cases, in both of which the exact reason has not been established.

    Well, I wrote about death, now let's return to the opposite pole, which is about life. In general, childbirth is about life, really. Childbirth is the emergence of a new life. Therefore, you can exhale and remember that most births go well for mom and baby).

    What, however, can be done to reduce the risk described above?

    ♦️ with drained waters and / or post-term pregnancy - monitor the baby's movements and heartbeat (you can right at home, I will write below how). If something is alarming, then seek help.

    Risk of prolapse of the umbilical cord

    With spontaneous discharge of water, it is rather tiny. In my doula opinion, the situation of amniotomy is much more dangerous - a puncture of the bladder in the hospital, when this is done as a stimulation of the birth process, thereby interfering with the work of the body.

    In what situation can loss occur?

    ♦️ When the baby's head is high and not inserted into the pelvis and the bubble bursts. In this case, the water can rush out in a stream, and the umbilical cord may fall out, because the child's head has not yet had time to "plug" the pelvis.

    But this is really a very rare complication and the article is not about it, so let's continue.

    Inflammatory process, infection

    This is a big myth and, alas, most of our doctors firmly believe in it.
    In fact, the risk of inflammation is also very small. It increases if: you are in a maternity hospital (the hospital environment is more aggressive) if you have a lot of vaginal examinations if you have a complicated pregnancy or have infections. But even if these three points are there, there will not necessarily be inflammation.
    Which reduces the risk of infection:
    ♦️ exclude vaginal examinations
    ♦️ do not go to public places where there are a lot of people
    ♦️ do not swim in common pools and ponds (otherwise you suddenly decide to swim)
    ♦️ do not have sex with your husband (here it is really - no need)
    ♦️ maintain normal hygiene
    ♦️ track the factors listed below.

    What are we paying attention to?

    The color and smell of water. The norm is light, transparent, pinkish waters. The smell should also be pleasant, if it is unpleasant and / or if the waters are green, brown, any dark shade, then consult your midwife or doctor. If we are talking about childbirth in the hospital, then they will definitely tell you to come and go to bed. This does not mean that everything is bad (about what the "green waters" mean, I will write another article), it means that more careful observation is needed. If we are talking about home birth, then your midwife will most likely come to you immediately and monitor the situation.

    Next, I write about the situation when the waters are light

    We draw attention to your general condition, temperature (should not rise), emotional background. Fear and fear are adrenaline that blocks oxytocin and childbirth, so it's important to calm down and create safety for yourself. Moreover, for some women it is safe to immediately go to the hospital and go under observation, while for others it is safe to stay at home, do your usual things and calmly wait until the contractions begin.

    And, perhaps, the most important thing that we pay attention to is the condition of the child. Here, it seems to me, many women are in the dark that, in fact, the only way to understand if everything is in order with a child is to listen to his heartbeat. Yes, there is still ultrasound, but ultrasound cannot be done continuously, for many hours. It can show that the baby is in order, the placenta is working, the water is preserved (although it has decreased), the cervix is ​​ripe. But that's all.

    Then CTG or Doppler comes into play. These are devices that are applied to the abdomen and they read the rhythm of the heartbeat. In maternity hospitals, there is a large device that records the readings and recognizes strong changes and deviations by itself. And home midwives carry portable hand-held dopplers or wooden tubes with which they listen to the heart in the same way, only the device does not record and does not recognize the signal itself, here the midwife's ear is already working.

    I seem to be an amazing thing for many women. If you are calm and confident enough in yourself, then you can (and let the doctors shower me with tomatoes) track your heartbeat on your own. It is enough to learn how to determine in which place of the abdomen you need to listen, and find out about digital indicators. I am not encouraging everyone to do this. For many, this will be too dangerous. But I know for sure that there are those for whom it will be, on the contrary, important - to find out what they can do themselves.

    So, the only way to determine if everything is in order with the baby in the situation of the receding waters and further throughout all childbirth is the heartbeat. If it is normal, it means that the flight is normal.

    Based on all of the above, in many countries a protocol has been established - after the water leaves, wait 72 hours, during which, as a rule, a woman begins to have contractions and she enters into labor. That is, the passage of water without contractions is not yet childbirth!

    In Russia, the protocols are as follows:

    In many maternity hospitals, a woman is given 6 hours. If the contractions have not begun, then stimulation begins by the type: artificial oxytocin → epidural anesthesia → weak attempts → extrusion (Christeller's trick, banned in many countries) → episiotomy. Or immediately a cesarean section.

    Why? Because they are afraid of the first point, antenatal death and do not want to mess with a woman (after all, this is a free delivery and she is in the assembly line).

    In addition, antibiotics are prescribed. Why? Because they are afraid of the point about infection:

    - in some maternity hospitals they give 12 hours and then everything is the same
    - in advanced maternity hospitals give 24 hours
    - in Moscow, literally in a couple of maternity hospitals (or maybe in only one), a woman is given 72 hours

    ♦️ It is important to know that "in the hospital they give" I refer to as a turn of speech, and not as a fact. You can always refuse stimulation, write refusals and continue to wait, even if the hospital "did not hear" about 72 hours and considers it a fiction.

    Physicians are not gods, they can be very wrong, many are stuck at the level of medical knowledge of the last century and are not interested in modern medical research and protocols. And yes, some kind of you, an ordinary woman reading the Internet, may be more competent than a whole, a huge DOCTOR.

    In home births, they usually wait for the same 72 hours, the midwife listens to the heart, life goes on as usual and, as a rule, contractions begin and labor starts during this period, the solo-giving births wait as long as they decide themselves, and monitor their condition themselves.

    2. The second variant of bubble bursting is when it bursts somewhere high. In this case, during manual inspection, we find a whole bubble, but the water leaks and then it is obvious that the gap is much higher. This option will be called water leakage.

    In this case, it's even more interesting:

    ♦️ at the bottom, the bubble is intact, the head has not moved so much down, there is no pressure on the neck and thus there is no stimulation of it either, so there may not be any contractions at all for a very long time
    ♦️ water leaks little by little, they are updated and with limited mobility (bed rest) on the ultrasound you can see that the water index increases, although initially it was dropped
    ♦️ the practice of home obstetrics, and especially the practice of lucid solo childbirth, shows that with such a situation of leakage, a woman can take longer than 72 hours. In my personal practice (this is when I saw it with my own eyes) it took 4, 5 and 8 days. In the cases I read and heard, it even took a couple of weeks. Irina Martynova's book "Confessions of a Midwife" describes a case when a woman lay like this at home for 6 or 7 weeks (the water began to leak at 32 weeks, if I remember correctly). But this is an exceptional case, which I just mention to show that this happens. Usually we are talking about a full-term pregnancy and childbirth begins spontaneously within a week.
    ♦️ in the maternity hospital for this situation, the same maximum protocol is 72 hours, they will not be allowed to walk for a week, perhaps, anywhere.

    What should you be afraid of?

    The same as in the first situation: worsening of the heartbeat (this is perhaps the main thing) of green, brown, dark-colored waters. ♦️ The norm is light, transparent, pink waters. An unpleasant smell, an increase in temperature, a deterioration in the general state of the development of infection.

    Summarizing

    I am a doula and I do not make recommendations. A recommendation is an imperative verb that calls for action. I am giving information. The information is provided with the help of phrases “there is such an experience”, “it happens so and so”, “you can do this” (but you can not do it, you are free in your choice). That is why I will now write below the word “you can”, which implies that there is a certain opportunity, but everyone decides for himself whether to use this opportunity or not.

    ♦ ️ You can stay at home and not go to the hospital immediately after the discharge or leakage of water for at least 6 hours, but at least about 3 days

    ♦ ️ If you are already in the hospital, you can write a receipt and refuse stimulation if it is offered earlier than 72 hours later and the condition of the woman and the child is good

    ♦ ️ You can stay at home with drainage / leakage of water and call a midwife with whom to arrange for her supervision of you and the baby until the moment contractions start and you go to the hospital (this service is usually called escort to the hospital, or it is possible, if you have a contract for an individual midwife during childbirth)

    ♦ ️ You can buy a manual doppler, study the information yourself and monitor the baby's heartbeat until the contractions begin.

    And the important thing is that these possibilities are based not only on experience, but also on evidence-based medicine data. I don't want to overload the text with links to research. To whom it is important, a lot of information can be found on pubmed and in English-language sources.

    See also online workshops on childbirth by rehabilitation doctor Oleg Leonkin from the cycle Lecture by Marina Golubtsova

    Photo by Natasha Hanks

    Dilation of the cervix, contractions, rupture of membranes, outpouring of amniotic fluid, three stages of labor, early attachment to the breast. Almost every woman carrying a child knows about all this. Few of expectant mothers do not attend special courses, do not read literature or are not interested in information that is freely available. But not everyone succeeds in recognizing that the waters have departed during pregnancy and then adhere to a certain algorithm of actions. The rupture of amniotic fluid does not always occur in the ideal order that is described in medical journals. Often a woman is simply not ready for something not to happen according to plan.

    Among women, there is an opinion that if the water began to drain, then this means labor. The outpouring of fluid triggers physiological changes in the body, which ultimately lead to the birth of a child. For this reason, artificial opening of the fetal bladder is used to stimulate labor. But normally, the secret of the amnion is poured out during contractions.

    Can labor start without draining water? Yes, the onset of labor is the appearance of regular contractions. Their increasing intensity leads to the opening of the cervix and preparation for the expulsion of the fetus. At the end of the first stage of labor, the amniotic bladder is opened and the fluid is drained. Then attempts begin, ending with the birth of a child, and then the process of separating the placenta.

    This is the optimal scenario, in medicine called the timely discharge of amniotic fluid. There is also premature and early effusion, that is, before the onset of contractions and simultaneously with them, until the cervix is ​​fully dilated. In a full-term pregnancy, both options do not always mean pathology, but they require more careful monitoring.

    If the rupture of the fetal bladder occurred in the clinic, after the woman had contractions, then it is difficult not to notice this. But often, the discharge of amniotic fluid takes a woman by surprise when there is no question of any contractions of the uterus. That is, in fact, the only symptom of the onset of labor is the sudden discharge of water.

    Signs

    Massive rupture of amniotic fluid is difficult to miss. The beginning is always unexpected and abrupt. Unlike urination, a woman is unable to restrain the flow of the sphincter. The amount of water during childbirth can reach up to 1 liter, on average it is 400-800 ml. But, according to the sensations of pregnant women, it seems that much more fluid has left.

    The baby's head divides the amniotic water into anterior and posterior, so they re-depart, in a volume of up to 200 ml, after the fetus has been expelled. The woman does not feel this, as she is busy giving birth to the placenta.

    The outpouring is accompanied by a squeezing feeling in the lower abdomen. The fetal membranes are devoid of nerve endings, so they cannot hurt when they rupture. Discomfort is associated with the simultaneous contraction of the uterus, that is, a contraction.

    What are the waters during childbirth:

    • colorless, slightly cloudy;
    • yellowish tint;
    • normal inclusion of mucous membranes or small blood veins is allowed.

    With massive outpouring, women often hear a characteristic crackling or pop, indicating a rupture of the fetal bladder. Sometimes the plug, a dense mucous lump, is expelled along with the amniotic fluid.

    Can water drain gradually? Yes, the condition occurs when the rupture of the membranes is high. In such cases, the amniotic fluid flows out in small portions, sometimes completely in drops, but contractions always begin after this.

    It can be difficult to determine the discharge of amniotic fluid. Differential diagnostics is also difficult. It is possible to confuse small portions of fluid with the appearance of urinary incontinence or vaginal discharge, which intensifies immediately before childbirth.

    Deviations from the norm

    If the amniotic fluid flows out little by little, this is a dangerous condition even at the term of full-term pregnancy. When labor does not begin, there is a risk that the fetus will be left without fluid and become infected as a result of the loss of sterility. The shorter the term of pregnancy, the higher the risk of complications, up to the death of the fetus.

    There are quick tests, special strips that allow you to determine the amniotic fluid in the vaginal discharge. You can use a clean, dry cotton cloth as a spacer. Water, after drying, leaves a stain on it with a yellow or light brown border. Sometimes a woman, if she pushes, will be able to move away more water than before.

    But, these methods do not guarantee a reliable result. If there is a suspicion of leakage, you must go to the hospital. Doctors will conduct an examination for cervical dilatation, assess the condition of the fetus using an ECG and the amount of water with an ultrasound scan, determine the composition of the secretions in the laboratory and, if necessary, hospitalize.

    With a massive one-stage rupture of amniotic fluid, the severity of undesirable consequences is directly proportional to the term gestation. Without water, the fetus often simply does not survive in the early stages. In a full-term pregnancy, fluid draining triggers the onset of labor.

    Bright scarlet waters are a bad sign. They signal bleeding in the mother or child, detachment of the placenta. Green, brown, or dirty amniotic fluid indicates premature discharge of meconium or oligohydramnios, and often leads to fetal hypoxia.

    When to go to the maternity hospital if the water has moved away? As soon as possible. On average, without risk for a child, it is permissible for him to stay in the womb for up to 12, sometimes up to 24 hours. If the liquid had an uncharacteristic color or smell, then the time is much less. The only thing that is strictly prohibited in this case is ignoring the situation.

    Algorithm of actions

    The first thing to do after pouring out the waters is to find out the exact time, write it down or remember it, do not panic, pull yourself together and focus on the upcoming birth. An exciting moment of meeting with the child comes. But, it is not recommended to stay and wait for the onset of contractions. The longer the period the fetus is in the womb without fluid, the higher the risk of complications.

    If the water has left at home, you need to change clothes, take the things already collected in the last stage of pregnancy and go to the hospital. If it happened on the street, in a public place, an ambulance is called.

    If the waters are bad and you feel unwell, it is better to go to the nearest clinic so as not to waste extra time on the road. If the outpouring occurred in a small amount, it is required to arrive at the hospital in 1.5-2 hours.

    What to do after the water has departed:

    1. remember the exact time, nature and approximate volume of the liquid;
    2. then you need to stand in the knee-elbow position for 15 minutes to prevent the umbilical cord from falling out and pinching;
    3. if contractions have appeared or have already been going on, you need to start performing special breathing exercises.

    It is impossible to predict when the labor will begin after the passage of water. After ten minutes, after an hour or 10 - it all depends on the characteristics of the woman's body, the readiness of the fetus. It often happens that the premature rupture of amniotic fluid, on the contrary, indicates a weak labor. Therefore, at the end of the allotted "waterless" period, doctors begin stimulation.

    How long does labor last after the waters leave? It depends on several factors. It is important whether the contractions began on their own or were caused, what are the births, the duration of pregnancy. When stimulated with oxytocin, the duration of labor after the passage of water is reduced to 5-6 hours. If a wait-and-see tactic is used, the process is delayed for a whole day.

    Development of events

    To determine the further plan of action for doctors in each specific situation, the fundamental role, first of all, is played by the gestational age. The well-being of the mother, the suffering of the fetus and the amount of fluid lost are taken into account.

    With a premature pregnancy, 34-37 weeks, it is necessary to determine the degree of maturity of the baby's lungs, the readiness of the cervix. During this period, antibacterial and supportive therapy is carried out. At an earlier date, the prognosis is poor.

    Starting at 38 weeks, one of two patient management tactics is used. Active - involves the stimulation of labor 2-4 hours after the passage of water. Expectant - allows the woman's body to prepare and start the process itself.

    It is not recommended to wait more than 12-24 hours for the onset of labor due to the high risk of infection of the fetus and compression of the umbilical cord. At this time, the rehabilitation and preparation of the paths must be carried out, the condition of the fetus and the well-being of the mother are constantly monitored. But the number of examinations with mirrors and other vaginal examinations should be kept to a minimum - to exclude the introduction of infection.

    What happens after the water has departed:

    1. if minor contractions were before the outpouring, now they will intensify, the neck will begin to open faster;
    2. when the waters left in a stream at the peak of labor, then, most likely, attempts will soon begin;
    3. if no contractions of the uterus were observed, then on average 90% of women have contractions on their own within 24 hours.

    There are also contraindications to expectant tactics. These include: complications of pregnancy, increased woman's pressure, the onset of the inflammatory process, bleeding and other indications for emergency delivery by cesarean section. The operation is resorted to, and when the stimulation of labor did not give an answer.

    The discharge of amniotic fluid, one way or another, speaks of the upcoming birth. Contractions will begin on their own or they will be stimulated in the hospital - it does not matter. It is only important that the child will be born soon. The task of the woman is not to risk the health of the baby and to come to the hospital faster.