When Does the Bag of Waters Break?

[Reasonable Rascal]

When Does the Bag of Waters Break?

Posted 11/22/2004

From Journal of Midwifery & Women's Health

What is My Bag of Waters?

The bag of waters - or amniotic sac - is a bag or "membrane filled with fluid that surrounds your baby in your uterus during pregnancy." The bag of waters is very important to your baby's health. The fluid protects your baby and gives your baby room to move around. The bag itself protects your baby from infections that may get into your vagina.

When Does the Bag of Waters Usually Break?

Usually the bag of waters breaks just before you go into labor or during the early part of labor. It happens most often when you are in bed sleeping. You may wake up and think you have wet the bed. Sometimes women feel or even hear a small "pop" when the bag breaks. Sometimes there is a gush of fluid from the vagina that makes your underwear wet; or maybe just a trickle that makes you feel damp. Sometimes the bag does not break until the baby is being born. In about 1 in every 10 women, the bag of waters breaks several hours before labor starts. Although rare, the bag of waters can break days before labor starts.

Is it a Problem if the Bag Breaks and the Labor Does Not Start Right Away?

If your bag of waters breaks more than 3 weeks before your due date, your health care provider may try to stop labor if the baby would be too premature. Because the bag of waters protects against infection, you will be checked to make sure there is no infection in your uterus.

If your bag of waters breaks within 3 weeks of your due date, your health care provider will recommend either waiting to let your labor start on its own or inducing your labor right away. You can discuss the pros and cons of each of these options with your health care provider. If you have a bacteria, such as Group B Strep in your vagina, your health care provider may want to give you antibiotics or get your labor started (induction). The longer the bag of waters is broken before birth, the more chance there is that infection will get to the baby.

What Should I Do if My Bag Does Break?

The section below gives instructions on what to do if your bag of waters breaks. If you think your bag of waters has broken, your health care provider might check in your vagina with a sterile speculum to find out for sure. Except for that one examination, it is very important that nothing is put in your vagina. Every time you have a vaginal examination after the bag of waters is broken, your risk of getting an infection gets higher. You can help protect yourself and your baby by asking your care providers to only do vaginal examinations when absolutely necessary.

What Should I Do if I Feel Wet But am Not Sure the Bag of Waters Has Broken?

Your health care provider can do a simple test using a sterile speculum to see inside your vagina. A sample of the fluid in the vagina will be collected and placed on special paper that turns very dark blue if it touches amniotic fluid.

What if Your Bag of Waters Breaks, and You Are Not in Labor Yet?

Labor contractions can start any time from right away to many hours or a few days after your water breaks. If you think your bag of waters has broken, call your health care provider.

Instructions

Call your health care provider right away if

· Your due date is more than 3 weeks away from today
· The water is green, or yellow, or brown, or has a bad smell
· You have a history of genital herpes, whether or not you have any herpes sores right now
· You have a history of Group B strep infection ("GBS positive")
· You don't know if you have GBS or not
· Your baby is not in the head-down position, or you've been told it is very high in your pelvis
· You have had a very quick labor in the past, or feel rectal pressure now
· You are worried or discouraged.

Call your health care provider within a few hours if

· Your due date is within the next 3 weeks and
· You are not in labor and
· The fluid is clear, pink, or has white flecks in it and
· Your baby is in the head-down position

Some health care providers will want you to come in to the office to confirm that the bag of waters has broken and listen to the baby's heartbeat as soon as you notice that the bag of waters has broken. Others will suggest you stay home for several hours to wait for labor to start. The bottom of this form can be used to write down what you and your provider agree should be done.

What Do I Do Until Labor Starts?

Most women will go into labor within 48 hours. If you are waiting for labor to start and your bag of waters has broken.

· Put on a clean pad
· Do not put anything in your vagina
· Drink plenty of liquids - a cup of water or juice each hour you are awake
· Get some rest
· Take a shower or bath
· If there is any change in your baby's movements, call your health care provider right away
· Check your temperature with a thermometer every 4 hours - call right away if your temperature goes above 99.6

Other instructions:_________________
Health care provider phone number:______________
Hospital phone number:_____________

This page may be reproduced for noncommercial use by health care professionals to share with clients. Any other reproduction is subject to JMWH approval. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JMWH suggests that you consult your health care provider.

J Midwifery Womens Health 49(5):457-458, 2004.

[gjwandkids]

Good article, although I wouldn't take a bath if my water had broken, infection could get in that way too.

[tangent]

> or inducing your labor right away.

how? and when is it apropriate to do so?


> A sample of the fluid in the vagina will be collected and placed on special paper that turns very dark blue if it touches amniotic fluid.

and this "special paper" is called what? - I would think it would be a little obvious if it had or had not...


> The water is green, or yellow, or brown, or has a bad smell

significance of each? (brown and bad smell is infection, not sure which...)


> The fluid is clear, pink, or has white flecks in it and

significance of each?


> Your baby is in the head-down position

you know this how?


Can't say I'm that impressed w/ "The Journal of Midwifery & Women's Health" - it left me with more questions than it answered and read like something out of Readers Digest - as opposed to a journal for Midwives.

hmmm...

-t

[DrBaboon]

> A sample of the fluid in the vagina will be collected and placed on special paper that turns very dark blue if it touches amniotic fluid.

and this "special paper" is called what? - I would think it would be a little obvious if it had or had not...

It's Nitrazine Paper.

http://www.fpnotebook.com/OB74.htm

When I've seen it, it has typically been a small, flat pack with a roll of "paper tape." You pull out a length of paper tape from the dispenser/pack, and tear it off. There is usually a color chart on the packaging.

[tangent]

Thanks DB,

though:

> # Place Nitrazine paper in fluid
> 1. Paper turns bright blue in alkaline fluid

yet vaginal secreations of carnivores is acidic and those of vegitarians is basic, (don't ask me how I know this... lets just say I've had GF's of both dietary persuasions and leave it at that...) so I guess the latter would be prone to false possitives...

-t

[gjwandkids]

> or inducing your labor right away.

how? and when is it apropriate to do so?


> The water is green, or yellow, or brown, or has a bad smell

significance of each? (brown and bad smell is infection, not sure which...)


> The fluid is clear, pink, or has white flecks in it and

significance of each?


> Your baby is in the head-down position

you know this how?


Can't say I'm that impressed w/ "The Journal of Midwifery & Women's Health" - it left me with more questions than it answered and read like something out of Readers Digest - as opposed to a journal for Midwives.

hmmm...

-t

Hi Tangent. I'll give you the info I have on the questions you have. IMO the article was written for pregnant women who are having a hospital birth with an OB or a Nurse-midwife so most of those questions wouldn't be answered since she would rely on her doctor.

1. Unless the baby is compromised it's not usually a good idea to induce labor. If your body isn't ready it will just tire you out and generally leads to a c-section.

2. If the amniotic fluid is green or yellow or smells bad it usually means that infection is present. If it's brownish the baby has passed meconium which is usually a sign that the baby is in distress. Clear and pink usually means that everything is fine and the white flecks can either be very old meconium which means the baby may have been distressed at one point but isn't now, or vernix. (waxy coating that keeps the baby's skin from getting waterlogged in the amniotic fluid)

3. How do you know if the baby is head down? Well the short answer is you don't unless your birth attendant has told you or you have the ability to palpate your own uterus ( and most midwives can't do that one). So I would take that to mean that the birth attendant has previously told the mom that the baby is head down. Now if the baby is high, you can usually tell unless of course it's your first birth in which case you might not know what it feels like when the baby drops. Again I get the impression that the authors of this article feel that mom is supposed to be relying on her birth attendant for a lot of this information.

[tangent]

Thanks Wendi,

learned some things I didn't know before. However you are incorrect on one point. Meconium isn't brown it's green or black. For some reason I keep thinking it's white from memory, but neithor here nor there.

http://www.babycenter.com/expert/8830.html

> Question: What's the normal color of a breastfed baby's bowel movement?

> Answer: That depends on how old your baby is. In the first few days of life, your baby's stool should be dark green to black. This means your baby is passing meconium, a tarry substance made up of all her bowels have accumulated during nine months in the womb.

> Colostrum, the "first milk," helps your baby pass these stools. The sooner you put your baby to the breast, the quicker colostrum gets into her system. Colostrum acts like a laxative and helps push the meconium out of your baby's bowels.
Your baby will have these stools until your milk comes in — so the sooner and more frequently you breastfeed, the quicker the meconium clears from her system. Since meconium buildup can cause jaundice, it's important to breastfeed at least 10 to 12 times in 24 hours to clear it out of the baby's system. You should be concerned if your baby is having meconium stools for longer than three days. If your baby sleeps a lot, you should pump and hand- or finger-feed the colostrum to your baby to get her digestive tract working properly.

> After the colostrum phase, your milk changes and bowel movements become brown in color, less sticky, and easier to wipe off the skin. As your milk becomes more plentiful, the stools finally transition from yellow green to yellow. Nursing your baby frequently causes the stools to change color more quickly. Plus, the more you nurse, the quicker your milk changes from colostrum to mature milk. Once the stools turn yellow and have a seedy quality, they should stay that way as long as your baby is exclusively breastfed.

> When your baby has a bowel movement look for stools that are loose in texture, with the consistency of pea soup. You may even notice small cottage cheese-type curds. The odor should be mild and not unpleasant. If you notice a succession of watery green stools, your baby may be consuming more foremilk than hindmilk. If you make sure she finishes nursing on the first breast before switching, she'll get more of the high-calorie hindmilk and produce a more yellowish stool as a result. A watery stool also could indicate that she is sensitive to a certain food you're eating or medication you're taking.

> A good first step is to eliminate all dairy products such as milk, cheese, and yogurt from your diet for at least three weeks. If the bowel movements change, you'll know it was the dairy. Add dairy back slowly to your diet, starting with the hardest cheeses. If your baby's stools turn watery again, you'll have to find other sources of calcium and protein for your diet.


I am quite sure a brownish foul smelling fliud represents infection.

Does anyone know what type of infection green, yellow and brown represent?

thanks,

-t

[gjwandkids]

Hi Tangent, I went and looked it up, and here is what I found. I checked Heart and Hands by Elizabeth Davis (pages 96 & 97), Special Delivery by Rahima Baldwin Dancy (pages 113 & 114) and A book for Midwives by Susan Klein. (page 237).

According to Heart and Hands: "old meconium creates a yellow tinge, (to the fluid) and is evidence of some brief episode of hypoxia (lack of oxygen) much earlier in labor or in the days preceding it; new meconium is particulate and green/brown like pea soup, indicative of recent or current fetal compromise.

According to Special Delivery: "Amniotic Fluid Brown or Green indicates that the baby has passed meconium from his intestines due to lack of oxygen causing relaxation of the anal sphincter."

According to A book for Midwives: If the waters are brown or green it indicates that the baby has passed meconium which is common when the baby is breech, but for other babies may be a sign that the baby is having problems. (The heading says-if waters are brown, yellow or green-but the actual paragraphs below don't really mention yellow.)

A bad smell is what indicates infection, but I couldn't find anything to indicate how you tell what kind of infection it is.

I was only able to find an actual explanation of the yellow color in Heart and Hands, but the green and the brown were in all three references.

Meconium itself is dark green or black, it reminds me of tar. Maybe reacting with the fluid is what gives it the brown color, especially when it's fresh?

Thanks BTW, I love learning new things too, but sometimes I don't look things up and rely too much on memory.

[gjwandkids]

Oh I forgot to ask. I couldn't find a reference to what kind of infection either. Does anyone out there have the resources to look this up? I'd like to know as well.

Thanks