How to behave during childbirth and labor, as well as in the postpartum ward, what behavior of a woman in labor is unacceptable, reviews

“What should I do if contractions start but my water doesn’t break?” - It would seem a strange question, but Google gives more than 200 thousand results for it, not all of which are medical articles and recommendations. Expectant mothers are seriously worried that their water may not break until the very moment the baby is born? What to do if contractions are in full swing, but the amniotic sac is still intact? Is this dangerous for the mother and baby? Let's try to figure it out.

Let's start with the fact that normally the amniotic sac should rupture at the height of contractions, when the dilation of the cervix is from 4 to 8 cm.

If the opening is smaller, then along with the bladder, several of its important functions will be “lost” - the walls of the uterus will put more pressure on the baby’s body, and the cervix, on the contrary, will not have enough pressure from the membranes for a softer and more successful opening. In some cases, this can even lead to weakness in labor.
If the cervix is almost completely open, and the water doesn’t seem to break, then this may prevent the baby’s head from completely descending - which means that pushing will begin later than necessary.

Signs

If during urination a clot of mucus falls out with a splash or remains on your underwear, it means that your water will break soon. For some mothers, the plug comes off in parts over a couple of days. In the absence of pathologies during pregnancy, there will be no other obvious signs. But there are a number of possible changes in the body.

How does a pregnant woman feel when her water breaks?

pain in attacks if contractions begin;
pulling in the lower abdomen is a harbinger of the onset of contractions;
abundant moisture in the genitals;
the sound of a pop inside.

A woman should feel that her water has broken at the moment of a strong flow from the vagina. From this moment, labor activity begins to actively develop. If there are no contractions within 10-12 hours, surgical intervention is required. Without amniotic fluid, the baby will experience asphyxia.

How to tell if your water has broken or peed:

if the flow of fluid is controlled, then it is urination;
if not, then the water began to break.

Does it hurt to break your water?

No, pain is associated only with the onset of contractions. Since the amniotic sac does not have nerve endings, the woman does not feel the rupture.

If a pregnant woman claims that while she was washing, her water broke or that it happened in the toilet, then this is 90% true. The phenomenon is typical for well-timed contractions, when the uterus expands and puts pressure on the bladder. At the same time, the amniotic sac also ruptures.

How to recognize real contractions?

Labor contractions usually start with a slight pain or tension in the abdomen, intensify, reach a peak, weaken and stop until the next contraction. They appear at certain intervals, and these intervals become increasingly shorter.

Along with contractions, mucous discharge may occur. A little blood in them is perfectly acceptable. There is no need to be afraid of this. This is a mucus plug that blocked the entrance to the uterus. But severe bleeding requires urgent examination.

The amniotic sac ruptures under pressure when the uterus is fully dilated.

Difference from discharge

Water leakage is dangerous at any time; you need to be able to distinguish it from discharge. Concerns about whether water breaks or discharge is justified.

period: leakage is systematic for a long time, and discharge disappears for a long time;
consistency: the discharge is thicker and denser, in case of leakage, water flows;
the color of the discharge is white, and the amniotic fluid is transparent;
the smell is not characteristic of natural secretions.

During physical activity, the intensity of the humidity increases, and a feeling appears as if labor is about to pass. If this feeling doesn't go away, it's more likely a leak.

How to determine that amniotic fluid has broken during pregnancy:

when the membranes rupture, a soft pop is heard, the sound will be reflected in the ears;
the liquid is transparent, the laundry gets wet through;
Positive leak test readings.

How to determine the leakage of amniotic fluid at home using a test:

pee, wash, dry thoroughly and lie down on a white cotton diaper. If after 30 minutes a wet spot forms, it means that the pregnant woman’s amniotic fluid has broken or there is leakage;
attach a special pad to your panties. The tests, sold at pharmacies, contain a specific reagent that reacts with color to the bubble fluid. The instructions describe detailed meanings and rules for the procedure.

In a maternity hospital or gynecological clinic, such a procedure is required to be performed free of charge upon request. The service is provided in a private clinic, without a queue, but for a decent fee. An examination by a gynecologist gives a 100% guarantee whether the water broke before childbirth or not.

Can contractions begin without the plug first coming out?

The mucus plug is dense in structure, transparent or with a yellowish tint, and has no odor. There should be no traces of blood in it. The green color of the discharge, streaks of blood, and an unpleasant odor are warning signs. The volume of the cork is no more than 40 ml (2 tablespoons).

This is what a mucus plug looks like during pregnancy (more details in the article:)

Usually the plug comes off on its own one to two weeks before giving birth, but in some women it may come out during delivery along with amniotic fluid or during an examination by a gynecologist. Both options do not pose a risk to the health of the mother and child. If the plug does not come out, it will be removed by an obstetrician before the birth.

If a mucus plug comes off while going to the toilet or while washing in the bath or shower, a woman may simply not notice it. For some expectant mothers, the cork leaves the body not entirely, but in parts. When the plug comes out, there may be nagging pain in the lower abdomen, but sometimes there may be no pain at all.

Not everyone understands how a plug differs from amniotic fluid. Because of this, pregnant women panic when they find a clot of mucus on their underwear in the last months, thinking that it is time to give birth. The main difference between cork and water is in consistency and color: cork is viscous, jelly-like, colored pale yellow, pinkish or brown; waters are clear and liquid.

Contractions and pushing may begin before the plug comes out, but a situation in which it does not come out at all is impossible. If the plug does not come away before birth, then either it will leave the body along with the placenta, or the woman simply did not notice it.

Deadlines

Regardless of whether the pregnancy is pathological or not, it is important to notice the process of rupture of the amniotic bladder. This can be expected at different times.

At what point does your water break?

When the uterus is ready to begin labor, the amniotic sac bursts. In the period from 32 to 37, as well as after the end of 42 weeks, there are serious risks of complications during childbirth and a threat to the health of the baby. It is forbidden to manage without doctors in this situation.

Differences in onset time:

prenatal;
timely;
lingering.

Prenatal effusion. In the period before 37 weeks, rupture of the amniotic sac is called premature and carries the risk of serious complications. The degree of danger depends on the duration of pregnancy and timely hospitalization.

Consequences:

umbilical cord entanglement;
malposition;
death due to physiological prematurity.

Labor does not occur in the early stages, so urgent surgical intervention will increase the chances of a successful outcome. To avoid bad developments, you need to eliminate risk factors.

ignoring leaks;
hit;
injuries;
exacerbation of chronic infections;
excessive physical activity;
severe stress.

Timely outpouring. In the absence of pathologies, by the 37th week the uterus is ready to let the fetus through, the organ becomes softer and open by 3.5-5 centimeters. The gradual release of water should begin before the end of 42 weeks, due to the natural rupture of the amniotic sac. Contractions should begin at the same time or within the next 10-12 hours.

Prolonged effusion. In approximately 10% of women in labor, the water does not break on time. In this case, an amniotomy procedure is prescribed - puncture or rupture of the amniotic bladder. With the right medical approach, the procedure goes well, without consequences.

There is a method for pregnant women to speed up the process of labor and water breaking. Slow, constant walking increases the speed of the onset of labor by 30%.

How to speed up the discharge of amniotic fluid:

special medications sold without a prescription in pharmacies;
eating fresh pineapple;
light physical work;
sexual contact;
nipple stimulation.

Doctors insist not to stimulate the process on their own. If necessary, the obstetrician will perform the puncture operation in the hospital on time.

What to do?

If the waters do not break due to the fact that the fetal sac remains intact when the cervix is fully dilated, doctors perform an amniotomy - a procedure in which the membranes are opened mechanically.

Obstetricians insert a hook into the vagina, held between the thumb and index finger. This hook is used to pierce the bubble. The obstetrician controls with his hand the intensity of the outflow of water and makes sure that the umbilical cord does not fall out. The operation lasts several minutes, it is painless for both mother and child, since there are no nerve endings in the bladder.

Excessive density of the membranes, due to which the bladder does not open on its own.
Rare or weak and short contractions.
Polyhydramnios. With polyhydramnios, spontaneous discharge of amniotic fluid is fraught with placental abruption, prolapse of the umbilical cord and fetal limbs (see also:). After dissection of the bladder, the volume of the uterus decreases and the risk of complications decreases.
The preliminary period (the intermediate stage between the appearance of precursors of labor and childbirth) lasts more than 6 hours. They talk about the pathological nature of the preliminary period if the tone of the uterus is increased, contractions last more than a day, and the fetus is located high and is difficult to palpate.
Flat bubble. If the walls of the bladder are too dense and there is no anterior water at all, it will not be able to stimulate the dilatation of the cervix. After the puncture, the baby’s head will directly press on the cervix, which will speed up the process of labor and avoid artificial stimulation.
High blood pressure.

Low placenta previa. Due to its location, it is subject to greater pressure from the child, which increases the risk of rupture or detachment.
The edge of the placenta peels off. When the bladder is opened, the edge of the placenta is pressed and the bleeding stops.
Preeclampsia. This life-threatening condition for the mother, which is the leading cause of maternal and perinatal mortality, is accompanied by seizures. With gestosis, the likelihood of dying increases with every minute of labor. An amniotomy is performed to speed up delivery.
The cervix dilated completely, but the bladder remained intact. If the waters have not broken by the time the cervix is fully dilated, the baby may suffocate, so at this stage it is necessary to open the bladder.
The period is more than 41–42 weeks. Due to postmaturity, the baby may begin to starve of oxygen, and the bones of the skull will become less flexible and plastic, which will make it difficult for the fetus to exit the birth canal.
Rh conflict during pregnancy. From the 28th week, the blood flow between mother and fetus becomes more active, as a result of which the likelihood of the baby’s red blood cells entering the woman’s circulatory system increases. If a pregnant woman is Rh negative and the child is Rh positive, the mother’s body will produce antibodies that will destroy the fetal blood cells. This can lead to developmental defects and, in some cases, stillbirth.

When a woman enters the last weeks of pregnancy, along with preparing the children's dowry and packing things for the maternity hospital, she involuntarily thinks about how everything will really be.

The main question is how will labor begin? With the breaking of the waters or with the appearance of characteristic labor pains? In this article we will try to answer this difficult question.

Actions upon spillage

After the water breaks, excitement begins. Mom is confused, there is a feeling that the woman does not control the actions. As soon as the volume of liquid is released, this feeling goes away. It is believed that if the water breaks, the weight decreases, but this is not true.

If a woman is in the maternity hospital, obstetricians will do everything necessary for the safe birth of the baby and stimulate labor. When the woman in labor is still at home, you need to mentally plan the course of action in advance and strictly follow the accepted procedure.

Actions upon spillage:

calm down and breathe out;
call emergency help;
if necessary, take a shower, change panties;
collect documents (it is better to do this in advance);
collect things for the maternity hospital;
wait for the doctors to arrive;
if contractions begin, breathe deeply;
if the waters are red or green, you need to lie down and not move.

Can I shower if my water breaks?

Yes, but the uterus may already be open, so you shouldn’t wash it deeply, just rinse the outside. The sensations after the water breaks do not bring negative effects to the mother in labor. Firstly, it is absolutely painless. Secondly, thoughts and feelings are filled with excitement in anticipation of meeting your own baby.

Does your stomach change after your water breaks?

Obstetricians say that only the position of the fetus changes, the child goes down. This is logical, since after effusion the head crashes into the cervix. You can see from the belly that the baby is moving down.

About 10% of women claim that their belly shrinks after their water breaks. These are unsubstantiated facts; the stomach looks voluminous and elastic until delivery.

Towards the end of pregnancy, most women, especially those expecting their first child, begin to worry about the upcoming birth, including the release of amniotic fluid. Many doubts arise: what to do in such a situation, how not to miss the moment when the waters break, how not to confuse them with ordinary ones, and many others.

The plug comes out when labor begins

There are certain signs that signal the imminent birth of a baby. After all, the body prepares for this process in advance. The main signs that labor will begin soon include the following harbingers of delivery:

false contractions (after the 20th week);
prolapse of the abdomen (2-3 weeks before birth);
weight loss of the expectant mother (half a month before delivery);
lack of appetite;
changes in physical and emotional state (fatigue, apathy);
decreased motor activity of the baby;
the appearance of discomfort (as during menstruation).

The presence of all of the above signs is not necessary. Usually there are no more than two or three of them, and sometimes they are absent altogether. If you feel any of the things described above, there is no need to rush to the maternity hospital. This is a natural course of events.

Every woman in labor should experience a discharge of the mucous plug, which is one of the clear indicators of impending labor.

The female body itself takes care of the safety of the fetus. Therefore, with the onset of pregnancy, a secretion begins to be produced in the cervix, which looks like a thick jelly and acts as a plug. It blocks the entrance to the uterus, preventing harmful microorganisms from entering there.

No one can say exactly when the cork will go away. It all depends on the individual characteristics of the body, on the process of pregnancy. But the removal of the plug does not mean that labor has already begun, if the due date has not approached. For some, this may happen two weeks before delivery, for others, just before delivery.

But you should definitely inform the doctor you are seeing about this. The reason to immediately go to the maternity hospital is if the plug comes out more than half a month before the expected date of delivery. Every woman in labor can understand that the plug has come off. Jelly-like clumps of mucus will appear on her underwear. Their color can be:

white;
pink-red;
yellowish-brown;
transparent.

If the clots are slightly stained with blood, it means that birth should occur in the next 24 hours.

You should be alarmed if they contain a lot of bright red blood. This is also a reason for an immediate trip to the maternity hospital. Regardless of the upcoming birth, the signs of its approach are the same. The only thing that should be noted in first-time mothers as the first signs of labor beginning is the prolapse of the abdomen.

It is almost impossible to name a specific time when labor will begin after your waters break. But every expectant mother should know that a water-free period of 6 hours is considered safe, 24 hours is acceptable, and 72 hours is considered dangerous.

The moment of discharge of amniotic fluid

remember

You should know that the discharge of amniotic fluid can occur at any stage of pregnancy, but it is optimal, of course, if this happens no earlier than 38 weeks, because at such a time the child is already fully ripe for birth.

Depending on the presence of labor and the degree of dilatation of the cervix, the discharge of amniotic fluid occurs:

Premature effusion
: occurs before the onset of labor, i.e. The water broke, but there were no contractions. This option is the most undesirable, but it occurs in approximately every tenth pregnant woman;
Early outpouring
. With this option, the waters break when regular labor is already present, but is less than 4 cm;
Timely effusion
: occurs in the first stage of labor with regular contractions and cervical dilatation of more than 4 cm;
Delayed rupture
: rupture of the membranes occurs some time after the cervix is fully dilated.

Premature and early discharge of amniotic fluid is considered a complication, because in the absence of a fetal bladder, the child is not protected from the effects of various infectious agents. As a result, with a long anhydrous interval, infection of the fetus and internal genital organs is possible, especially if the woman suffered inflammatory diseases of the vagina, cervix, and external genital organs during pregnancy. For this reason, to prevent infectious complications, 6-8 hours after the rupture of the amniotic sac, the woman begins to be administered antibacterial drugs that do not have a negative effect on the child (ampicillin, oxacillin).

What to do if contractions do not occur

Normally, it is believed that pregnancy should last 36–40 weeks. But it happens that 41 and 42 weeks pass and even occasionally they reach 43, but labor does not begin. In this case, you should resort to additional ways to solve this problem.

Read: Photos during childbirth

First, you should try traditional methods. But in this regard, it is worth adhering to the rule that the main thing is safety. So, there are several ways to speed up delivery, which even gynecologists advise.

First of all, it's sex. This is the most common method. It is popular for the reason that a man’s semen contains prostaglandins, which soften the cervix, making it more elastic. Also, when orgasm is achieved, contractions of the uterus occur, which also has a beneficial effect in this position. But there are several contraindications for this method, such as:

various infections (including genital infections) in one or both partners;
placenta previa or low position;
uterine tone.

Physical activity also helps:

mopping floors on all fours;
squat;
walking up stairs;
long walks.

However, you should be careful with this method, since excessive load can provoke placental abruption, fetal hypoxia and other troubles.

It is better to replace such activity with a calmer and more permitted one: swimming, yoga, quiet walks, oriental dancing. If there is no threat, then such exercises should be carried out throughout pregnancy, in which case childbirth will be easier.
Cleansing the intestines also accelerates the labor process. For the same reason, in the maternity hospital they give an enema before childbirth. This also includes taking various laxatives: castor oil, parsley, beets.
Some herbal infusions also cause uterine tone and contractions. It can be raspberries (including leaves), mint, lemon balm and others.
Evening primrose oil is also a good way to soften the cervix. To do this, you will have to rub it in place every evening. Additionally, you can take it orally in capsule form.
You can take a hot bath. This also stimulates the onset of labor. It should be remembered that the temperature of such a bath should not exceed 38 degrees and last no more than 15–20 minutes. At the same time, you should carefully monitor the pressure, as there may be sharp jumps or, on the contrary, a drop. In this case, the procedure should be stopped.

All of the above methods can be effective, but they do not help everyone, as each organism is individual.

If a woman is overdue for more than 1.5–2 weeks of the prescribed period, doctors themselves offer options for solving this problem.

There are also several of them:

Doctors most often use various drugs that stimulate the onset of labor. These can be intravenous and oral. For fully mature pregnancy, Oxytocin is used. In order to speed up this process - Dinoprostin, Dinoprost, Mifepristone.
It is also quite common to puncture the amniotic sac. Thanks to this, the cervix begins to open and contractions begin.
In some cases, sticks of kelp seaweed are used.
Foley catheter placement.
Use of gels with prostaglandins.
Mechanical dilatation of the cervix. That is, the obstetrician-gynecologist expands it with his fingers and thus releases the lower part of the amniotic sac.

Read: If your temperature rises at 38 weeks of pregnancy

All methods are quite effective, but there is a percentage of women for whom medical methods do not help. In this case, they resort to artificial obstetrics - caesarean section.

How amniotic fluid drains

How can you tell when your water has broken? Many women ask this question, afraid to miss this moment. To accurately recognize the situation, it is necessary to have a good knowledge of the symptoms of amniotic fluid leakage.

Amount of amniotic fluid

The question of liquid volume is quite complex, because... Water breaks in pregnant women in different ways.

If a complete rupture of the amniotic sac occurs, a fairly large amount of fluid is released at the same time (most often about 150-250 ml), so it is quite difficult to miss this option. Most often, effusion occurs at night during sleep, and the woman does not experience any sensations, simply waking up in a wet bed. If a pregnant woman is awake, she may notice a feeling of heaviness in the lower abdomen and a sensation of “popping” or “tearing inside” when the water breaks.

If the rupture of the membranes occurs high up and there is only a small hole, then water can flow out in small drops for a long time. In this case, the woman can really get confused, because... such discharge can often be attributed to excessive leucorrhoea from the genital tract or urinary incontinence. However, even a slight leak of amniotic fluid is dangerous for the baby, so if any suspicion arises, you should consult a doctor to monitor the presence or absence of amniotic fluid. In addition, you can check this yourself using special pharmacy tests.

Color and smell of amniotic fluid

Normally, amniotic fluid is clear with a small amount of impurities and has a somewhat sweet odor. If the discharged liquid is greenish, brown or black in color, this indicates the presence of meconium in it, which the fetus secretes when there is oxygen deficiency. If before childbirth the waters break with blood, this is an extremely dangerous sign and requires immediate hospitalization of the woman in the maternity ward.

Contractions and water at the same time

After the woman has analyzed that there are true contractions, it is important to evaluate the interval between them. When the break is 15-20 minutes, you need to go to the maternity hospital, the bubble will burst soon.

What comes first, water or contractions?

With the normal development of labor, uterine contractions begin first, followed by the release of water. The more intensely the cervical canal opens, the faster the fluid flows out.

Subsequence:

the cervix is smoothed;
the muscle fibers of the organ contract with each spasm and shorten in length;
the fibers shorten and expand in density;
the thickness of the uterine walls increases;
due to the tension of the body membranes, the lower segment is stretched, the neck expands;
the external pharynx opens under the pressure of the head;
each contraction puts pressure on the amniotic fluid inside the bladder;
it rushes to the cervical canal;
is tightly embedded and presses on the circumference of the passage;
first, the external pharynx opens during contractions;
the fetal sac bursts.

In the intervals, the tension of the shell does not go away, so a rupture occurs in the next few minutes. By the time the water breaks, contractions are repeated every 5 minutes, they are painful and intense.

Normally, water is released when the external cervical os is fully opened; this is called timely effusion. The lower part of the liquid comes forward, about 300 ml, and the remaining part comes out with the fetus. The rupture of the bubble is also facilitated by a change in the structure of the shells - density and elasticity decrease. Therefore, intrauterine pressure is sufficient for tissue divergence.

Feel:

dull pain in the sacral region, spreading around the circumference of the pelvis;
heaviness in the lower abdomen, similar to menstruation, but stronger;
wavy sensations - embrace, smoothly release;
become regular;
a stream of liquid pours out;
attempts begin.

If a woman is at home, when regular contractions begin, it’s time to get ready. To avoid any difficulties in the maternity hospital, you need to pack your bag in advance.

Actions:

collect documents - passport, insurance policy, SNILS, exchange card, birth certificate;
take a shower, shave your crotch;
wear clean underwear;
cut your nails so as not to scratch yourself and the midwife when pushing;
Call an ambulance before your water breaks.

You can sit on a fitball, sway, stroke your lower abdomen, stand on all fours, massage your ankles. If you move and walk when contractions begin, the bubble will burst earlier and labor will begin faster. Therefore, when the road to the maternity hospital is long, it is better to take a bath, lie down and wait for the ambulance to arrive.

If the water breaks during contractions, fetal movement will begin in the next 3-4 hours. The better the cervix is prepared, up to 5 cm, the sooner the baby will be born. If the woman has no signs of complications, obstetricians wait until the woman starts to rupture spontaneously before pushing, and only then perform an amniotomy.

What to do if your water breaks

important

If a woman’s water breaks, the main thing she should do is quickly get ready and go to the maternity hospital. Under no circumstances should you stay at home and wait for contractions to start.

As mentioned above, the anhydrous interval is dangerous for the child, and labor may not begin immediately after the rupture of the membranes. When the waters have not completely broken, but only leakage is present, the woman may not give birth for a long time. In this case, while the patient is in the maternity hospital, doctors will begin to stimulate labor, which will help reduce the anhydrous gap.

In addition, after the discharge of amniotic fluid, the woman must be examined in a gynecological chair.

dangerous

The fact is that along with the water, the umbilical cord may fall out, which is extremely dangerous: when it is compressed, asphyxia and death of the fetus quickly occurs. If the doctor is unable to set the umbilical cord back, the woman will have an emergency caesarean section.

It is also possible for small parts of the fetus to fall out (arms, legs), which will lead to disruption of labor and the impossibility of inserting the presenting part of the fetus into the pelvic cavity.

A pregnant woman, especially, should be urgently hospitalized if the amniotic fluid is “bad” with the presence of impurities in it.

False contractions

Starting from the 20th week, women may experience some tension in the uterus, so-called false contractions.

How to distinguish real contractions from false ones?

False contractions can occur after physical activity or fast walking. This is a kind of preparation of the body for future childbirth.

The main signs of false contractions:

false contractions are usually painless;
the intensity of false contractions does not change or fades away;
the frequency of false contractions is irregular;
the intervals between false contractions range from 10 to 30 minutes;
false contractions are not accompanied by the passage of the mucous plug.

Contractions. signs of contractions. what to do during contractions

Absence of contractions after rupture of amniotic fluid

As a rule, labor begins within 3-4 hours after the rupture of amniotic fluid. If contractions do not begin, then the question of starting labor stimulation is raised.

The time issue in this situation is widely discussed and becomes the subject of dispute among various experts. For example, in many European countries they choose the waiting method: artificial stimulation begins only one day after the rupture of the membranes. In Russia, the deadline is considered to be 12 hours of absence of labor, but at the same time, many obstetrician-gynecologists try not to wait that long due to the high risk of infection of the child and begin stimulation earlier.

Most women, of course, strive for a natural course of labor without the use of various medications, but it should be understood that in such a situation one should not argue with a specialist. Waiting can be dangerous and sometimes lead to disastrous consequences.

In this article:

Amniotic fluid or amniotic fluid is a biologically active environment that surrounds the fetus, ensuring its intrauterine life. Before or during labor, the membranes rupture and the woman's water breaks. Their outpouring is considered a sure sign of the baby's imminent birth.

Shortly before, every expectant mother should listen carefully to her own feelings. Many women are afraid of missing the onset of labor, especially if it is their first pregnancy. But gynecologists believe that this is impossible. Even with this, the woman will understand that this is the most crucial moment.

When does your water break? The ideal time for the release of amniotic fluid is the first stage of labor, at the time of active dilatation of the cervix. In the process, the membranes rupture again, and after this the force of uterine contractions begins to increase with redoubled energy. In this case, experts say that the birth of the baby is not far off.

But not all women in labor experience a similar scenario. Some people's water may break, but there will be no contractions. Usually this happens unexpectedly, and we are talking about premature outpouring of water. Even if mild contractions appear soon, they will be unproductive, that is, the cervix has not yet had time to prepare for labor. In this case, the question of the nature of delivery must be decided by the doctor.

How do the waters break? The process of their outpouring may be different. The anterior waters, which are located in front of the fetal head, depart first; their volume usually does not exceed 200 ml. The remaining part of the water in the uterus will recede after the birth of the child. That is why colorful stories about how water breaks during pregnancy in a stream are most often not believable.

Many women report that their underwear suddenly became wet, and at first they confused the water with involuntary urination. Less often, the amniotic sac is slightly damaged, and then the amniotic fluid begins to partially leak, and the woman confuses it with suddenly increased vaginal discharge. This condition is commonly called leakage of amniotic fluid.

How to understand that it’s time to go to the hospital

The overwhelming majority of all births begin with the appearance of contractions - rhythmic contractions of the uterus, which gradually increase in intensity and frequency. They feel like squeezing and tension of the entire abdomen, which is initially accompanied by moderate pain. However, women can experience mild contractions long before the baby is born - these are the so-called precursors of labor, Braxton-Hicks or training contractions. Their essence lies in the tension of the muscles of the uterus, which is not accompanied by dilatation of the cervix as during labor. This process is part of the body's preparation for the upcoming event, and begins to become noticeable after the 20th week. Training contractions are not an indication for hospitalization; they differ from real contractions in a number of characteristic parameters:

frequency. During the day, a woman may experience up to 6 episodes of uterine tension, while real labor is characterized by the occurrence of at least 8 contractions over 2 hours;
duration. False contractions are usually short and never increase in duration;
intensity. The severity of sensations during Braxton-Hicks contractions weakens and fades over time, while real contractions only increase;
regularity. There will not be the same amount of time between training contractions; pauses can be 10–30 minutes or more.

One of the main features of Braxton Hicks contractions is the ability to “extinguish” them. You can check whether the alarm is false in several ways: take a pill or put a suppository with an antispasmodic (No-Shpa, Papaverine, Buscopan, etc.), take a warm shower, take a different, more comfortable position, use deep breathing techniques. If at least one method of relaxation gives results, then the contractions were training, but this simply will not work on real contractions.

Having felt muscle contractions, you need to monitor your condition - if contractions increase and lengthen, and the intervals between them shorten, then they are real

Having felt tension in the abdominal area, a woman does not need to panic - it is better to relax and listen to her feelings, this is the only way to identify whether labor is beginning, or whether the body is just getting ready. Having established that the contractions are real, there is no need to rush too much, especially if this is your first birth. In primiparous women, the first phase of labor, during which dilatation occurs, lasts on average 8–11 hours, and in multiparous women – 5–8. It will be more comfortable for a woman in labor to stay at home in her usual environment for as long as possible, and go to the hospital closer to the birth. It is worth going to the maternity hospital when the pause between true contractions is less than 10 minutes, and their duration is about 30–40 seconds.

About 20% of births begin not with tangible contractions, but with the rupture or leakage of amniotic fluid - the fluid that is in the bladder surrounding the baby. In this case, you should go to the maternity hospital immediately, since it is better that the duration of the water-free period does not exceed 6–8 hours, otherwise complications for the child may begin.

List of things needed for the hospital

Having decided in which hospital the birth will take place, it is better to ask in advance for a list of necessary things that you will need to take with you. The list may vary depending on the institution; some women in labor will even have to bring syringes and an umbilical cord clamp with them, while others will only need clothes for themselves and the baby. It is better to pack your bags in advance, because it is unknown how quickly labor will develop. It is recommended to start preparing things from 34–36 weeks, and by 38, when the pregnancy is already considered full-term and delivery can begin at any time, they should already be completely assembled. Before leaving, you need to check if everything is ready:

clothing for a woman in labor - in the delivery room and for staying in the postpartum ward for several days;
clothes and diapers for the baby;
medications according to the list from the hospital;
water and food for a snack (childbirth takes a lot of time, it would be a good idea to have a snack for both the woman in labor and her partner);
clothes for the partner and the results of his fluorography for permission to visit the delivery room (if the birth is a partner);
documents (passport, exchange card, birth contract if concluded, etc.).

To the maternity hospital you need to take things for the baby and yourself, and, if necessary, also medicines

What comes first - contractions or water breaking?

Many expectant mothers, especially those who are concerned about the question: when does the water break - before or after contractions, and why does this happen? In fact, amniotic fluid can drain both before the onset of the first contractions, and already during childbirth, during the period of active dilatation of the cervix.

If the water pours out before the first contractions begin, we are talking about their premature departure. A similar situation occurs in 10% of women in labor and is accompanied by a certain risk.

The water may break during weak contractions, when the cervix is dilated no more than 4 cm. In this case, they speak of early rupture of water.

If contractions are regular and intense, and the cervix is dilated by 4 cm or more, the water breaks in a timely manner.

Delayed rupture of water is said to occur when the membranes rupture some time after the cervix is fully dilated.

Classification of weak labor

Depending on the time of occurrence, weak labor can be primary or secondary. If contractions from the very beginning of the labor process are ineffective, short, and the period of relaxation of the uterus is long, then they speak of primary weakness. In the case of weakening and shortening of contractions after a certain period of time of sufficient intensity and duration, a diagnosis of secondary weakness is made.

Secondary weakness, as a rule, is noted at the end of the period of dilatation or during the process of expulsion of the fetus. Primary weakness is more common and its incidence is 8 – 10%. Secondary weakness is observed in only 2.5% of cases of all births.

Also identified are weakness of pushing, which develops in multiparous women or in obese women in labor, and convulsive and segmental contractions. Convulsive contractions are indicated by prolonged contractions of the uterus (more than 2 minutes), and with segmental contractions, the uterus does not contract entirely, but only in separate segments.

How to cause water to break?

Of course, you should not provoke the rupture of water on your own, as this is fraught with serious consequences for the fetus.

Premature discharge of amniotic fluid can be caused by the following unfavorable factors:

fall or physical force, blow applied to a pregnant woman;
diseases of the expectant mother, for example, of an infectious nature;
heavy physical and psycho-emotional stress, stress.

In all of the above cases, the water breaks without contractions, what to do in this situation is decided by the doctor.

If for some reason the water does not recede, medical personnel in the maternity hospital can cause it to drain artificially. In such a situation, a decision is made to puncture the membranes ahead of schedule in order to intensify labor, provided that there are contractions and the waters do not break.

Puncture of the bladder usually goes without complications if the cervix has begun to dilate and the fetus is ready for birth. In other cases, this manipulation is unjustified and can cause negative consequences, primarily for the child.

How do contractions occur?

Contractions before childbirth develop gradually, so three stages can be distinguished:

The first stage is the initial stage, lasting 7-8 hours. At this time, contractions occur with an interval of approximately 5 minutes, and their duration is 30-45 seconds.
The second phase is active. Its duration is about 5 hours, uterine contractions become more frequent and last longer - with an interval of 2-4 minutes, the duration of contractions reaches 60 seconds.
The last, transitional phase is from half an hour to 1.5 hours long. Contractions become even more frequent and last longer. They can occur at intervals of a minute and last from 70 to 90 seconds.

If the birth is not the first, the process goes faster.

What to do if your water breaks

If amniotic fluid has leaked, no qualitative or quantitative characteristics of the amniotic fluid should influence the woman’s actions - she should inform the doctor about this fact as soon as possible and go to a medical facility.

Some women are perplexed, why rush, if the waters recede gradually and even after their outpouring, their health does not suffer. The answer is simple: after the integrity of the fetal membranes is damaged, the sterile conditions in which the fetus was located throughout the entire pregnancy are disrupted, opening access to infectious factors.

In addition, after the water breaks, the unborn child cannot be without water for more than 12 hours; delivery after this period can cause irreversible anomalies in his vital organs due to developed hypoxia - oxygen starvation.

Therefore, if labor does not begin 10-12 hours after the water breaks, doctors decide how to induce it artificially. In most cases, experts are inclined to, especially in the case of absolute indications - with a transverse position of the fetus in the uterus and prolapse of the umbilical cord loops or limbs of the child along with the discharge of amniotic fluid.

Premature passage of amniotic fluid is dangerous in early pregnancy. In this case, specialists try to do everything to further preserve it and save the life of the unborn baby.

How to relieve contractions

Preparing for childbirth

The pain during contractions is quite great. It is compared to severe burns, broken bones, etc. If at first they are not so noticeable, they gradually increase and become unbearable. Many women find it difficult to endure such sensations.

To make this easier, the following is recommended:

Correct breathing. How to breathe is usually taught in courses for expectant mothers. At different points in labor, you need to use different techniques. First, you need to take short inhalations and longer exhalations. There is no point in holding your breath. Then, when the intensity of the contractions increases, you can begin to breathe “like a dog,” that is, often and shallowly. This type of breathing is also called shallow breathing.
Massage. A light massage of the back and abdomen also tends to relieve pain. This is done as follows: lightly press on the lower back and stroke the stomach, starting from the sides going down to the womb. This massage cannot be done by yourself; help is required. Therefore, this method can be used during partner childbirth. Or you can ask the medical staff for help.
Movement and postures. This is most important during contractions. In order to give birth faster, most women in labor are advised to walk rather than just lie on the bed. This improves blood circulation and oxygen supply to the fetus. And it’s easier to breathe in this position. Rocking your hips in a circle relaxes the muscles and makes it easier for the uterus to open. However, not everyone has the strength to move vertically. In the first half of childbirth, you can use a special ball, sitting on which you can make circular movements with your pelvis. But this is only until the child rests his head against the mother’s womb. The most preferred position for women is on all fours. Many people say that it reduces the pain of contractions. You can try variations: standing on your feet, but leaning your body on a couch, bedside table, ball. If a woman feels better lying down, then you need to place a pillow under her feet.
Water. Water relaxes and eliminates pain. This method of childbirth is used in rare maternity hospitals and requires a lot of experience and care on the part of the obstetrician-gynecologist. And you should absolutely not resort to it at home, because in this case the child may swallow water at birth. And this will bring many health problems.
Use of epidural anesthesia. This method is used in many maternity hospitals. An injection in the back relieves the condition and helps in opening the uterus. Although many women who used this method subsequently complain of back pain.

The pain experienced during contractions cannot be compared with anything, since most often they surpass everything that has been experienced before. But they can be alleviated using the above methods. It is also worth listening to your body, as it gives signals what needs to be done to reduce pain.

Lecture on soft childbirth from an obstetrician-gynecologist in the following video:

02 Feb 2020 Valeria 327

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Discussion: 4 comments

Irina:
02/03/2018 at 00:13
I didn't have any false contractions. The real ones started right away; personally, I immediately realized that it was them. Maybe also because my water broke first. The first hours of the fight were quite tolerable. And then the pain began to intensify, but not to such an extent as to scream out loud. In the last hours before giving birth, during contractions, I simply switched off, maybe this was the individual reaction of my body.
Answer
Anna:
02/08/2018 at 00:29
I didn’t even realize that I was having contractions. I woke up in the middle of the night, it felt like I was on my period, my back was slightly strained, I went and took a warm blanket, covered myself (this helped me during my period) and went on to sleep. I woke up in the morning and my water immediately broke. We take a taxi and go to the hospital, and that’s it, in half an hour we have a son. The birth was rapid, so I didn’t understand anything either.
Answer
Marina:
01/14/2019 at 21:06
Before giving birth, I had no idea that the pain during contractions could be so severe. I thought I would die from it. They injected No-shpu, Analgin, some hormones, but none of this helped. Epidural anesthesia was not offered.
Answer
Julia:
09/02/2019 at 00:59
The pain during contractions cannot be compared with anything. Before giving birth, I also thought that the pain was like during menstruation; they used to be quite painful. How wrong I was! I envy those who had a rapid labor, but I suffered for 12 hours.
Answer

When does labor begin?

Most often, pregnant women's water breaks at home, and no matter how much amniotic fluid is discharged, you need to see a doctor or go to the maternity hospital yourself. It is difficult to predict the exact onset of labor after the water breaks; everything is individual.

Some women give birth safely 4-6 hours after the discharge of the amniotic fluid, while others may experience difficulties, in which case medical intervention is required, since the baby must be born no later than 12 hours of the water-free period.

No specialist can correctly answer the question of how long before birth your waters break, how to determine their exact time. Labor is an individual process, depending on the course of pregnancy and the characteristics of the woman’s body.

To summarize, it should be noted that if amniotic fluid begins to leak and some water appears on your underwear, you need to immediately get ready for the maternity hospital. After examination by a specialist, the expectant mother will be informed about further tactics of obstetric care.

Usually, when the waters break during childbirth, labor is still weak, and the dilation of the cervix does not exceed 4 cm - the woman is escorted to the maternity ward, where she will remain during the entire first period. During active labor, when the cervix is almost fully dilated, the woman in labor is sent straight to the delivery room.

The rupture of amniotic fluid is a natural process that you do not need to be afraid of, because its result in the near future will be the birth of a baby.

Behavior during childbirth

When the dilation reaches 8 centimeters, the woman in labor will be asked to move to the birthing area. At the transition stage, when the cervix is still expanding to the required 10 centimeters, you cannot push, so the obstetrician will give the command to breathe through the contraction - the woman needs to relax as much as possible and breathe frequently.

After a few minutes, complete dilatation will occur and pushing will begin - strong contractions of the muscles of the uterus and abdominal wall, pushing the baby through the birth canal. At the stage of expulsion of the fetus, everything goes quite quickly; during normal processes, the process will not take more than 20 minutes. Here the woman’s behavior and strict adherence to all the doctors’ instructions play a huge role:

Useful video about how and when your water breaks

Question:

Hello! I recently became the mother of a wonderful baby. The birth went well: quickly, almost painlessly and without ruptures. But one question still remained unresolved for me, the fact is that a day before the start of contractions, my water began to leak, and quite profusely. The waters were clear, the baby was actively moving, and I did not go to the maternity hospital, I stayed at home until the contractions began, which began only 24 hours later. Of course, I understood that it was unsafe to stay at home when my water broke, but I was much more afraid of stimulation in the maternity hospital (I had a negative experience associated with stimulation in my first birth).

In the end, I arrived at the maternity hospital almost in an effort, there was no water, the baby was born on 9/9 according to Apgar, 30 hours after the water started leaking (though I said that the water broke recently, I was afraid of antibiotics). I know that the water-free period should not be more than 12 hours, however, there is information on the Internet that in foreign clinics they wait for 36 hours or even more and only then begin stimulation. Is it so? And in general , what to do if your water breaks but there are no contractions?

? How to behave correctly: can you drink water? When exactly should you go to the maternity hospital?

Answer:

Hello, I congratulate you on the successful and, as I understand it, joyful birth of your baby, unfortunately, I don’t know whether it’s a boy or a girl. Thank you for the question, although it is very difficult to answer it unequivocally, since this is one of the most controversial issues in the field of obstetrics. I mean the question of the duration of the water-free period.

The fact is that the 12-hour period was established by modern Russian obstetrics not from the point of view of the situation of “waterlessness” (even if the waters break, the child is never left completely without amniotic fluid, since the membranes constantly produce it, which is why I advise you to continue drinking, especially if a woman experiences extreme thirst), but from the point of view of violating the integrity of the membranes, and therefore the situation of protecting the child from ascending infection. It is believed that if more than 12 hours have passed since the breach of this barrier, the risk of infection of the baby is minimal. On the other hand, if a woman does not have any infection and does not undergo numerous obstetric examinations, then where does the infection come from?

In your case, you took full responsibility upon yourself, and this is not bad, but I would really like you to understand the doctors, including me, since it is impossible for all women to advise not to rush to go to the maternity hospital with leaking or broken water.

Pregnant women often ask me, when should I go to the maternity hospital? And I, knowing that this will be a different time for each woman, answer this way: “You need to go to the maternity hospital when it becomes scary to stay at home.” And one woman, upon arriving at the maternity hospital, will discover that she is only at the very beginning of labor, and maybe even just the harbingers, while another, like you, is almost in labor. It is no coincidence that today for some women childbirth is a joyful, although not without labor and painful process, while for others it is one of the most terrible pages in life.

Weight loss and bowel cleansing before childbirth

Many pregnant women are surprised to discover that the weight, which is known to grow by leaps and bounds in the last trimester, suddenly decreases by 1-1.5 kg after 37-39 weeks. Weight loss is especially noticeable if severe swelling was observed during pregnancy. Don't be scared - this is an absolutely natural process and another sign that meeting your baby is just around the corner.

— About 2 days before giving birth, I started feeling nauseous (with Polinka I even vomited, but with Leshka I just felt sick) and (sorry for the details) I had loose stools for 3-4 days before the birth itself. The body was cleansing.

Mama and BABY M.

— I woke up at 4 in the morning and realized that my stomach hurt. Well, this is real indigestion. Sorry, I went to the toilet and pushed... And only when my stomach eased did I realize that something was wrong. I noted the time - contractions go every 7 minutes, like clockwork.

We suggest you read: How long can you determine the sex of a child?

Lucien

- I didn’t feel any drooping in my stomach, but... loose stools for 4-5 days before giving birth! And my tummy was aching, it was somehow tugging. And then the water broke in the morning, and she gave birth in the evening.

Tamiri

— The first sign of impending labor was, sorry, diarrhea: about 4 hours before the birth. Then they lowered my water, and after a couple of hours I gave birth. All!

There are contractions, but there is no effusion

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

Use a long hook to pierce the bubble and make sure that the water does not pour out too intensely. Rapid rupture of water can lead to prolapse of umbilical cord loops and prolapse of a fetal arm or leg into the genital tract.

Such childbirth increases the likelihood of the baby receiving a birth injury tenfold. Everything that happens then, after the loss, is a real delicate and almost jewelry art performed by the obstetrician; he needs to quickly and carefully set the child’s limbs back or deliver the child with the prolapsed limb first.

Monitoring the passage of water after amniotomy is an important condition for the prevention of prolapse and complications of childbirth. The reason for the pathological endurance of the fetal bladder, due to which it does not rupture at the right time, may be polyhydramnios, weak dilatation of the cervix, incorrect position of the baby in the uterine cavity, as well as a large fetus.

How does this happen?

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 ones, true contractions cannot be relieved by changing the position of the body or taking the No-shpy tablet; a warm shower will not help, and there will be no benefit from a horizontal position of the body. True contractions, if they have begun, occur with simultaneous smoothing and opening of the cervix, which has been tightly closed throughout pregnancy.

This process is not controlled by the woman’s will and cannot be reversible, and therefore true contractions constantly grow, intensify, become longer, and the intervals between them become shorter.

As soon as the contraction repeats every 10-15 minutes, you need to go to the maternity hospital. There is no point in waiting for your water to break.

If labor proceeds correctly, according to the classical pattern described in all obstetrics textbooks, then the waters break without medical intervention when contractions become sufficiently frequent and strong. The pressure of the walls of the uterus at the moment of tension (at the peak of contraction) provokes a violation of the integrity of the fetal bladder, as a result of which the water flows out and the baby begins to move forward along the birth canal. The attempts begin.

In general terms, ideal births have the following sequence:

the cervix becomes smoother, it becomes comparable to the body of the uterus, dilatation 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 bladder increases;
under pressure from the fetal head and the amniotic sac itself, the internal pharynx opens;
water is poured out and pushing begins - the uterus “pushes” the baby out.

The pushing ends with the birth of the baby, then the placenta comes out within 20-45 minutes. With this, the correct textbook childbirth ends, to the great joy of all participants in this process.

Like everything ideal, classic births are very rare.

There are quite a lot of variants of the norm, and therefore the sequence may be different.

We answered the question of whether contractions can begin without the water breaking, but not completely. Very rarely, the water breaks at the very last moment, and the baby is born in the amniotic sac, in which it passes through the birth canal.

In this case, they say that the baby was “born in a shirt.” Popular rumors and signs attribute to such people incredible luck and great luck throughout their lives.

The waters have broken, but there are no contractions

This type of birth is considered unfavorable. 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 breaks, they are strong enough, and the cervix dilates at an optimal pace, then the prognosis is more favorable. If labor is weak, painful, and the cervix dilates slowly or does not dilate, then an urgent emergency caesarean section is considered the optimal solution.

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

Situations where the water breaks first do not tolerate even a minute's delay.

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

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

The rupture of water before contractions is usually caused by inflammatory or viral diseases that a woman suffered during pregnancy, the presence of isthmic-cervical insufficiency, polyhydramnios, pregnancy with twins or triplets, thin membranes (for idiopathic reasons that cannot be established). Also, early rupture of water before contractions can lead to falls on the stomach, butt, or back in late pregnancy.