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How do you feel when the waters recede. Special tests for home checking. Feeling when the amniotic fluid is draining

Amniotic fluid has been a natural environment for your baby for all 9 months, but it's time for a baby to be born, and many mothers are very worried about how the water leaves, whether they will not miss this moment. Particularly fearful and those who give birth for the first time, in a panic, ask more experienced mothers if it hurts.

Such an important point is simply impossible, if, of course, the waters really moved away, and did not leak quietly. But first things first.

How does water drain during pregnancy?

When the time comes, the baby presses the head against the wall of the bladder, after which the latter bursts and the amniotic fluid flows out. The birth process is considered to be running, and only a few time remains before the baby is born.

In theory, the bubble should burst on its own, but in practice it is sometimes necessary to pierce it. More details about the indications for such manipulations, the necessity and possible risks will be written in the article below.

How to understand that the waters have moved away?

Ideally, the normal discharge of water occurs according to the following scenario: with the intensification of contractions before the discharge of water, a woman hears a cotton, after which a lot of liquid flows out of her at once. The volume can vary from 100 to 300 ml. In this case, the fluid flows out in a stream or stream, and this is comparable to urinary incontinence, when nothing depends on you.

But in reality, things can go very differently. It so happens that the waters leave without any prerequisites. Even if contractions begin after that, they will be weak and less productive, since the cervix is ​​not yet ready. In this case, it is necessary to urgently call an ambulance and go to. Most likely, the doctor will prescribe stimulation of contractions to open the cervix.

How long will it take for the contractions to start?

Before the water leaves, pregnant women should have strong contractions, but in 10% of expectant mothers this happens before the contractions start. This condition is not very good due to the fact that there is a threat of infection. With premature discharge of water and prolonged presence of the fetus in this state, doctors inject antibacterial agents into the pregnant woman.

There is such a thing as early outpouring. In this case, before the water leaves, contractions nevertheless appear, but they are still very weak, and the cervix did not have time to prepare enough. The throat is open 4 cm or less.

Timely departure is ideal for the course of circumstances. The bladder bursts and water pours out as soon as the opening of the pharynx becomes more than 4 cm. The contractions are painful and prolonged.

The case when an outpouring occurs at the moment of full disclosure of the cervix or water leaves in pregnant women just before childbirth, as you know, is infrequent, but quite possible. In this case, we are talking about a belated outpouring.

As a result, water can drain both before and after labor. Timely outpouring of water provokes an increase in contractions and accelerates the dilatation of the cervix.

Amniotic fluid

Each pregnancy is individual, but there are norms by which doctors determine the degree of threat of a pregnant woman's condition. It is believed that with a positive course of pregnancy, the volume of amniotic fluid should be 1-2 liters.

As a rule, at the last ultrasound examination, the specialist checks the amount of water and diagnoses of "high water" or "low water" can be made. Both conditions are fraught with complications and require hospital treatment. If you are concerned about the question "how does the water drain before childbirth?", Know: they never flow out completely. At first, about 300 ml of fluid leaves, and the rest directly comes out with the baby.

We look at the color of the waters

We figured out how pregnant women drain water, now let's talk about the color of the liquid. Under whatever conditions the discharge of water occurs, the pregnant woman should first pay attention to the color, this information is extremely important for the doctor. So:

    Yellow Waters. Of course, normally, the amniotic fluid should be colorless, but yellowness is considered a variant of the norm. You should not panic too much, but you still have to hurry up, because after the water leaves, you will have a few hours before the onset of labor.

    Green waters are already serious. The reason for this color may be lack of water, which is fraught with fetal hypoxia, that is, the baby will have oxygen starvation. Another reason is that the child managed to empty the intestines, which is also very dangerous. If the baby swallows meconium, pneumonia may develop.

    Water with blood. If, with the normal color of the liquid, you notice small streaks of blood, this should not scare you. The fact is that before the water leaves in pregnant women before childbirth, the cervix opens and small discharge is possible. It is quite another matter if there is a lot of blood in the fluid, in this case, placental abruption is possible and immediate hospitalization is required.

    Leakage of water

    There are times when the water does not leave at once, but only leaks. This happens for two reasons: if the bubble bursts along the side seam and if the bubble does not burst, but only cracks. It is very difficult to figure out on your own whether it is water, urinary incontinence or discharge.

    So how to understand that the waters have departed? Everything is very simple. At any pharmacy, you can buy an amniotest to determine the nature of the leaked fluid at home. This test is a strips similar to panty liners. It is very convenient to use such a test, it gives a 100% result.

    If you did not have a test at hand or you could not find it in the pharmacy, then in this case you can try the following: after the toilet, wash and dry yourself dry. Then you should lie down on a white sheet and rest for an hour and a half. If a wet spot appears on the sheet, then water is leaking.

    What to do, how to behave?

    It is very useful to know how the waters drain from pregnant women before childbirth, because very often this happens at home or on the road, and the expectant mother and her loved ones have to take emergency measures.

    What to do:

      Call an ambulance and explain the problem.

      Change clothes and underwear.

      In no case do you need to wash yourself, because there is a threat to bring an infection.

      If there is blood in the waters, be sure to lie down and not move.

      If everything is normal with the waters, you can carefully prepare to go to the hospital.

      Try to calm down. Just a little bit is left, and you will soon meet your baby.

    Medical intervention

    In cases where the contractions intensify, the neck opens, but the bladder does not burst, the doctor can pierce it on his own. The procedure is painless and practically harmless for the baby and mother. Since amniotomy is a medical intervention, it requires the following indications:

      A very dense bladder that does not rupture even when the cervix is ​​fully dilated.

      Long and weak contractions. If labor is prolonged, the doctor may puncture the bladder to speed up the opening of the cervix. In addition, some drugs cannot be administered with a full bladder, such as oxytocin.

      Pierce the bubble if more than 40 weeks have passed and the process has not yet begun.

      Low placentation.

      Rhesus conflict.

      Polyhydramnios or flat bladder.

    The bladder is pierced with a long hook, the procedure is painless, since there are no nerve endings in the same place. The puncture is carried out on or on a couch.

    Now you know how water flows before childbirth. The most important rule is to stay calm and tune in to get things done successfully.

How does water drain from pregnant women, when and why does this happen? The baby is in the uterus in a special bladder - the amnion. The fluid in which the fetus floats plays the role of its first habitat and is called amniotic. This is the amniotic fluid, which will be discussed in the article.

They perform many different functions: maintain temperature, protect, cushion shocks. Amniotic fluid is produced in different volumes, but constantly. The longer the gestation period, the greater its volume. But pathological variations are also possible - polyhydramnios or low water, which are determined by ultrasound.

What you need to know about how amniotic fluid leaves in pregnant women? Most often, discharge is confused with involuntary urination. But, concentrating, the woman understands what is happening. Sometimes a soft sound, crackling or popping sound is heard. This burst the membranes of the fetal bladder, and the water began to flow out. The process of discharge of amniotic fluid in each pregnant woman can take place in different ways. In some, it resembles mild incontinence, while in others, the discharge occurs so rapidly that it is impossible to contain it.

Knowing how the water leaves before childbirth, you can roughly navigate when it is worth going to the hospital. This will depend on the position of the gynecologist. Some believe that if a colorless liquid leaks a little, you can observe the situation for 2 days. Especially if it is not known for sure whether it is water or vaginal discharge. Others insist that a woman must give birth within 24 hours, otherwise the fetus will not survive without fluid, and an inflammatory process may begin. The bubble may burst as a whole, and a small hole may form, through which prenatal outpouring of water will occur.

Physiologically, the water should drain just before the onset of the second stage of labor. And it is believed that the amniotic fluid promotes the opening of the cervix. But sometimes it turns out the opposite, if the amniotic fluid is flat. In this case, the doctor may decide on a puncture. The procedure is completely painless for a woman and safe for a child. Performed with a slight opening of the cervix. If the pregnant woman has lost water, it is worth considering the timing of this event. After 35 weeks, the fetus is already ready to meet with the mother, so it is quite obvious that doctors can induce labor. And at an earlier stage, pregnancy can be prolonged if you go to save. But a prerequisite for this is bed rest and antibiotic therapy, since an inflammatory process can begin in the uterus, due to which both the uterus and the child can be lost.

What does the waters look like?

It is a colorless liquid, with a sweetish odor, containing a certain amount of flakes (lubricant from the baby's skin).

Attention! If the liquid is greenish, cloudy, dark - call a doctor immediately! This indicates problems with the baby's health, or rather, about hypoxia. The green color of the water becomes due to the meconium released in them - the original feces. This is due to the relaxation of the baby's sphincter as a result of the lack of oxygen.

If you suspect that amniotic fluid is leaking or draining, you should see your doctor. He will recommend a special test. You can buy it at the pharmacy to reliably find out if it is water or not. A white fabric pad will help you evaluate the discharge. The stains will be odorless and colorless to match urine output.

Every woman in an "interesting" position is well aware that with the approach of childbirth, the likelihood of sudden discharge of amniotic fluid.

With no experience, expectant mothers listen to the slightest change in their body, fearing to miss this important moment.

They are even more worried about the question of what to do when the water broke during pregnancy.

Is it always the flowing away signal the onset of labor or can you calmly wait until the appointed time?

How to understand that the waters have moved away?

Throughout pregnancy, the baby grows and develops in a special shell filled with liquid. It is this fluid that is called amniotic fluid. In fact, the amniotic fluid is formed from the maternal blood plasma and is constantly renewed and, if necessary, replenished.

This substance is absolutely sterile, which provides reliable protection for the developing body from various infections. The content of a large amount of immunoglobulin in the liquid is an additional barrier against external influences.

A comfortable water environment allows the baby to turn freely and prevents the bladder from compressing the uterus. Regardless of the environmental conditions and the condition of the mother, constant pressure and temperature indicators are maintained in the amniotic fluid. Due to the presence of water, the baby is reliably protected from physical and noise external influences.

If you feel the release of warm fluid from the vagina (this usually happens when a woman is lying and trying to stand up), in an amount of more than 100 milliliters or more (it happens that a liter and a half is poured out at once), which do not have a specific smell of urine - these are they, the water has moved away.

Why does the water drain?

As the child grows, the volume of the surrounding waters also increases. By the time of delivery, their number can reach 1.5 liters. Excess amniotic fluid or a low content is considered pathological conditions that threaten the normal development of the baby.

With the approach of labor, the hormonal background of the expectant mother begins to change rapidly. Such processes contribute to the natural birth process. Under the influence of the hormone oxytocin, which also contributes to the contraction of the uterus, the fetal membrane becomes looser. And the pressure in the bladder increases significantly under the onslaught of the baby, trying to leave the hostile pulsating uterus.

Fetal membranes do not withstand, and their rupture occurs. This moment is accompanied by the discharge of water during pregnancy. The woman can even hear the bubble burst. Unusual popping or clicking sounds confirm the violation of the integrity of the shell.

Ideally, the discharge of water occurs after the first stage of childbirth, when the cervix is ​​open by more than 4 cm. This development of events is considered optimal for both the baby and the woman in labor.

But in life, processes do not always coincide with descriptions in reference books. This does not mean that other options necessarily confirm the pathology. But the woman must be prepared for the premature discharge of water.

How does the water drain?

Some pregnant women, on the eve of childbirth, are even afraid to take a shower so as not to miss such an important moment.

Anxiety is also present about involuntary urination, which often occurs over long periods. But the discharge of water has its own specific features, and it is difficult to confuse them with other physiological processes.

Water can drain in completely different ways. So, if the baby is prepared for childbirth and took the correct position, his head rests against the bosom and the amniotic fluid is divided by his body into two parts.

The anterior part of the amniotic fluid contains up to 250 ml of fluid. It is this liquid that is poured out when the fetal membrane bursts. Women feel like they are pouring out a lot more fluid. Moreover, this flow cannot be stopped by muscle tension or a change in body position.

In order for a woman to imagine how the process will take place, in antenatal clinics in the classroom, they are advised to experiment with their own perception in advance at home. To do this, it is recommended to pour a glass of warm water on your feet in the shower. Such an experiment will allow you to remember the sensations.

In cases where the child takes the wrong position or did not have time to roll over, the volume of the outgoing fluid can be much larger. Sometimes all the water can pour out at once up to 1.5, or even up to 2 liters. Such a "waterfall" is difficult to confuse with ordinary discharge. But even in this case, the waters can all gush out at the same time, or they can flow out in a small trickle.

Another option for draining water during pregnancy is dripping... Such situations arise if the fetal membrane bursts in the upper part or microcracks appear. Leakage is difficult to distinguish from urinary incontinence or increased vaginal discharge. It can last for hours or even weeks.

There are situations when water does not drain even during childbirth... If the contractions are prolonged, and the fetal membrane remains intact, doctors resort to forced piercing.

This is not a whim of doctors. In this way, the uterus is saved from overvoltage, which can provoke its rupture during childbirth.

What kind of water flows away?

Female must definitely fix the time discharge of waters, as well as their condition. By the appearance of the waters, the doctor will determine the presence of deviations and will be able to decide on further actions.

Normally, the waters are absolutely transparent, may have an admixture of flakes or a slightly yellowish tint.

Such waters do not have a specific odor. so that they can be distinguished from urine. For amniotic fluid, a sweetish smell, reminiscent of fresh milk, is considered natural.

If the waters are green, and even more so black, this indicates the presence of meconium in the waters.

Red waters confirm the presence of blood in them. This is an alarming signal. Blood appears with placental abruption.

Reliable self-diagnosis methods

If a woman doubts the correctness of her conclusions about the fluid that has appeared, you can resort to well-known methods of self-diagnosis or contact a doctor. The need for additional diagnostics arises when the water flows out in an abundant stream, and leaks in small portions.

Dry sheet test

This is a fairly common, informative and accessible way to determine the discharge of amniotic fluid.

To carry it out, a pregnant woman needs to visit the toilet to empty the bladder.

Then the genitals are washed and wiped dry. The woman lies down on a dry white cloth. You can use a diaper or sheet.

If after 15–20 minutes wet marks are found on the fabric, the drainage is confirmed.

Test strip

At home, you can use a more modern way to determine the discharge of water. Test strips are available at a pharmacy. They allow you to confirm the type of discharge with high accuracy. Such a pad is impregnated with a special substance that reacts to the acidity of the discharge.

Normally, the vaginal flora has a balance within the pH range of 4.5. In amniotic fluid, acidity reaches pH 7.0. The gasket begins to react to liquids in which this figure exceeds 5.5.

For the test, the pad is placed on the underwear and is not removed until fluid leaks are felt. If there is no such sensation, the gasket can be left on until 12 hours.

An indicator of the presence of fetal waters is a change in the color of the pad to a blue or green tint.

If you do not trust home diagnostics, you can contact the doctors... In gynecology, it is customary to determine the questionable discharge of water using:

Gynecological examination;

Smear microscopy;

Aminotest with the use of a dye introduced into the amniotic fluid;

Cytoscopic examination

Send the waters: when will labor start?

In most cases, water is drained on the eve of childbirth. Contractions can begin literally immediately after the discharge of water, if the fetus is ready for birth and the neck has time to prepare for labor. It may take some time and labor will begin in 2-3 hours.

In pregnant debutantes, the cervix opens more slowly. In an hour, the neck can open only half a centimeter. Therefore, labor in such pregnant women begins no earlier than after 9-12 hours.

For women with birth experience, the process is developing much faster. Their neck is able to open in 5-6 hours. In these cases, if there is no desire to give birth at home or on the road, you will have to hurry up.

It is more difficult if the cervix is ​​not ready for labor, and the waters have already departed. In such cases, it may take 12 or 72 hours before the onset of contractions. What to do if labor does not begin, doctors decide on a case-by-case basis.

There is a widespread belief among pregnant women that a baby cannot live more than 6 hours without water, since he can die from a lack of oxygen. Such rumors absolutely baseless.

Despite the lost water, the baby's nutrition and respiration continues to be provided by the mother's body through the placenta. The lack of water will not in any way affect its oxygen requirements.

In addition, the waters do not drain out in full and they are constantly renewed. Therefore, literally in 4 hours, if the fetal membrane has retained its integrity and only leakage is observed, their volume will be replenished with new fluid.

What is the real danger to the baby? In the public domain for infections. If earlier the child was in practically sterile conditions, then the crack that appears in the fetal membrane opens up direct access for the penetration of various pathogens.

The baby, still in the uterus, did not have time to develop protective mechanisms. Any infection is now fatal for him.

If the anhydrous period lasts more than 12 hours, doctors begin antimicrobial therapy with drugs that are safe for the child.

What if the water broke?

What should a woman do when her water has broken? The answer is unequivocal: urgently go to the hospital. Do not wait for the next visit to the gynecologist, namely, collect the necessary things, documents and call an ambulance.

The further development of events will depend on the timing of the withdrawal of the waters, their characteristics in terms of color and volume.

38-40 week

Most likely, the baby is already ready for birth. If the water has receded in a normal volume or is constantly leaking, besides, their color is absolutely transparent, there is no reason for concern. A natural process has begun, and prenatal contractions will begin soon.

Mothers who give birth for the first time still have a couple of hours left to calmly gather, gain strength and even have a little rest.

In no case, after the water has departed:

To take a bath;

Be exposed to physical stress;

Having sex;

Use tampons or sanitary napkins.

If there is a need to carry out hygiene procedures, for example, to treat or shave the genitals, you need to use the shower. Wash only from front to back to prevent germs from entering the vagina.

If the water is constantly leaking, instead of pads, which are saturated with fragrances and are not always sterile, you need to use a cotton cloth.

Herbal teas made from chamomile, echinacea, mint will help to calm down. In addition, such drinks also have antimicrobial properties.

For moms who give birth not for the first time, there is no time for tea drinking. Contractions and childbirth can begin at any time. For such women, the discharge of water is not alarming, but an important signal. Therefore, they should immediately go to the hospital.

The reason for immediate seeking help is the abundant drainage of water. If the water departed at the same time and in a large volume, it means that the entire fetal bladder has emptied. This confirms that the baby did not have time to take the correct position.

In such situations, it is extremely rare, but it is possible for one of the baby's limbs or even part of the umbilical cord to fall into the neck or vagina. If you do not provide assistance to such a woman in labor in time, childbirth will be complicated. In addition, the prolapsed umbilical cord can be pinched by the muscles of the cervix or the fetus, and the baby will have problems supplying oxygen.

If the waters have an unnatural color or smell, you cannot postpone the visit to the hospital. The presence of blood in the waters is a wake-up call. The natural process should not be accompanied by bleeding.

35-38 week

By 35 weeks, the baby has already formed lungs and is able to breathe independently at birth. Therefore, if the waters drain during this period, the doctors decide to stimulate the birth process according to vital signs.

If nothing threatens the baby and the expectant mother, it is advisable to prolong the pregnancy. Expectant tactics allows you to deliver the baby and give birth on time.

The woman is admitted to the hospital for the waiting period. Doctors monitor changes in condition and test indicators. I use antibiotics to prevent infection of the fetus.

If there is a suspicion of the presence of infections, they resort to forced labor or caesarean section.

20-34 week

In order to prevent the birth of a premature baby and ensure a safe continuation of pregnancy after an early discharge of water, doctors in most cases adhere to expectant tactics. They try to prolong such a pregnancy as long as possible.

The woman will have to spend the remaining period before labor in a hospital under close supervision. The expectant mother is placed in a sterile ward, where she must be in a supine position.

To control the condition of the baby and mother:

Once every four hours, measure the temperature and heart rate;

Every day, a blood test is performed for the level of leukocytes;

The volume and quality signs of the amniotic fluid are constantly being monitored, for which the diaper is regularly changed under the woman;

Vaginal culture is performed every 5 days;

The baby's condition is monitored using ultrasound and cardiotocography.

The decision on the timing and method of delivery is made in each case individually.

Up to 20 weeks

Water in the early stages can leave due to:

Fetal infection;

Inflammatory processes;

Careless sex;

Hormonal disruptions;

Excessive physical activity.

There is no single tactic for the early drainage of water. The decision is made after a detailed examination. But in most cases, such a pregnancy cannot be maintained.

The waters are gone, and there are no contractions

Only during ideal labor will the water drain during labor. Various "variations" are characterized by the discharge of water in the absence of contractions. Doctors recommend in any case to go to the hospital.

You should not wait for a long time in the hope that labor will begin. Contractions may not start in the next 48 hours. Women, fearing the stimulation of labor, postpone the visit to the hospital, which creates favorable conditions for the development of infectious processes.

In some maternity hospitals, the practice is still preserved to stimulate labor in 4-6 hours after the discharge of amniotic fluid. This tactic is absolutely inconsistent with modern medical views.

Doctors have proven that nothing threatens the baby for the next 12 hours. And even the absence of contractions for 48 or even 72 hours is not considered a pathology.

The decision to deliver urgently is justified:

With complete discharge of amniotic fluid;

With the threat of displacement or detachment of the placenta;

If the contractions were present, and with the passage of the waters, they began to fade;

In case of unnatural smell or color of amniotic fluid;

When the state of either the mother or the baby changes.

When a baby is infected;

If concomitant pathologies are present.

The doctor chooses the method of delivery in the absence of contractions in accordance with the condition of the woman:

1. If there is an abnormal position of the fetus, the woman in labor has health problems or a too narrow pelvis, a cesarean section is performed.

2. If the cervix is ​​ripe, but labor is inhibited, labor is stimulated. For this, the hormone oxytocin is injected, which makes it possible to accelerate uterine contractions and cervical dilatation.

3. With an immature cervix, labor is stimulated by the introduction of a gel or suppositories into the cervix containing prostaglandins hormones.

In any situation, when the water is draining, regardless of the timing and presence of contractions, it is necessary not to postpone the visit to the hospital. Trust the doctors. In a hospital setting, all conditions have been created for a successful delivery or prolongation of pregnancy.

Throughout the gestational period, the fetus is, in fact, in a bladder that is filled with fluid. This habitat contributes not only to the harmonious growth and development of the child, but also protects him from the possible influence of negative factors. However, a vital education in the gestational period, it is completely unnecessary for the baby at birth. That is why, before childbirth, the bladder ruptures, accompanied by the discharge of amniotic fluid.

This is a very important point, since it unequivocally testifies in favor of the need for early hospitalization, since the delivery process should begin any minute. This issue will need to be given considerable attention.

It is especially interesting for those pregnant women who are about to become mothers to know about what the discharge of water looks like before childbirth. This interest is quite understandable, since there is no desire to miss the moment and it is commonplace to be outside the walls of the maternity hospital at the time of delivery. In order to make sure that the waters have really moved away, it is necessary to correctly assess the most significant signs of the phenomenon under consideration. It is for this reason that it is worth considering the question of exactly how they look, as well as other characteristics of amniotic fluid.

How much liquid appears as a result of the discharge of water? What does a woman feel when her water runs out?

Here everything is purely individual, and each woman has a different amount of fluid resulting from rupture of the amniotic fluid. The determining factor is the force with which the bubble burst.

In the event that a complete rupture occurs, a significant amount of liquid will be discharged, amounting to about 150-250 ml. Agree, the discharge of such an amount of liquid is impossible by definition. This happens, as a rule, at night, while the expectant mother is resting, and she wakes up from a strange sensation of a wet bed under her. There are times when women at 38 weeks of gestation take on some kind of hard work. With a high degree of probability, it will be possible to predict here the discharge of amniotic fluid, which is accompanied by a feeling of heaviness in the lower abdomen and a feeling of rupture of the bubble inside the abdomen. On the contrary, if this happens during a period of relative rest, then the maximum that the expectant mother will feel is completely insignificant discomfort.

With a slight rupture of the bladder, amniotic fluid is discharged over a long period of time in small portions. This process, frankly, will be frankly unpleasant for a woman, and in addition, it can lead to completely unnecessary doubts about the nature of the discharge - the expectant mother may well decide that there is not a discharge of amniotic fluid, but banal urinary incontinence or excessively abundant leucorrhoea. But what is most dangerous in this situation is that a slight rupture of the bladder can become dangerous for the child, so in such a situation it is necessary to immediately send it to the maternity hospital.

What does it mean - the waters have moved away? What is the color and smell of amniotic fluid?

The smell arising from the discharge of amniotic fluid cannot be called unpleasant. It even has a specific sweetish flavor. The color of the amniotic fluid is transparent, with a small amount of impurities. Please note that the appearance of amniotic fluid of a transparent color is a sign of a normal pregnancy, however, if they acquire a certain shade (it can be greenish, brown or black), then this clearly indicates the presence of a certain pathology.

The thing is that all these color changes unambiguously indicate that the amniotic fluid is contaminated with original feces - meconium, and it is released only if the fetus suffers from oxygen deficiency. Sometimes you have to deal with the presence of blood in the fluid, which directly indicates the onset of detachment of the placenta. In this situation, hospitalization in an urgent mode is clearly indicated, and delivery should be carried out by caesarean section. This is the only way to save the life of the mother and the child. All of the above factors unambiguously indicate that attention should be paid to the very fact of amniotic fluid discharge, and to the nature of the discharge, in view of the fact that after assessing the water before childbirth, one can decide on the correct tactics for managing a pregnant woman.

When should amniotic birth go?

The process should occur at 36-38 weeks, as well as delivery. It is very important to remember that the birth of a child must occur no later than 12 hours from the moment the water leaves - otherwise there is a threat to his life.

It is customary to distinguish several options for the discharge of amniotic fluid:

  1. Premature. Occurs before the start of the delivery process - the water leaves, and the onset of contractions has not yet begun. This condition is dangerous, and therefore stimulation of labor is shown;
  2. Early. In this case, the outflow of amniotic fluid in time practically coincides with the contractions. The size of the cervical dilatation should be more than 4 cm;
  3. Timely. The outpouring is accompanied by severe contractions, while the cervical dilatation is more than 4 cm;
  4. Later. Outpouring occurs after the cervix is ​​ready for the release of the fetus.

2 Sep 0 2670

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 birth 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 drainage of water, 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 with a cork that was plugged into a bathtub so that water does not leak out. This option will be 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 rear, 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 drastically 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 pressed tightly 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 weeks, while at 37 weeks nobody is stimulated. 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 appearance 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 bladder puncture in a maternity 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 can 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 has a more aggressive environment) if you do many 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)
♦️ not to have sex with your husband (here it is real - 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 make yourself safe. 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 domestic 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.

Doctors are not gods, they are capable of 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, upon 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 down so much, 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, a woman can take a leak 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 water. ♦️ The norm is light, transparent, pink water. 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. 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 at the same time 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 agree on her supervision of you and the baby until the time when 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, independently study the information 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