Ask Nurse Stewgler: No, you didn't pee your pants

I want to use this blog to offer insights from my job as a L&D nurse in addition to my job as a mom. Perhaps I'll add a weekly post to that effect. If you have a burning question for me, something you've ALWAYS wanted to know about pregnancy, labor, delivery, hospitals, etc. please let me know. Please be aware that the information or advice presented here is not intended as a substitute for medical care or information from your own provider.

Did my water just break?

Ahh, the eternal question and, you'd think, a simple question to answer. Why then are labor and delivery triage areas filled to the brim with women who think their water broke? Let's just say that, it rarely happens in life the way it happens in the movies.

First, let's talk about amniotic fluid. Amniotic fluid has two sources -- in the early months of your pregnancy your body produces the fluid and in the later months it created as a by product of the fetus' kidney function (meaning it's fetal urine). It is contained within a membranous sac inside your uterus -- this sac is called the "amnion" (hence the name).

The fluid is crucially important -- it cushions the fetus, cushions you against the kicks & punches of fetal movement, contributes to the growth and development of the fetus (it contains nutrients key to early development), and most importantly it aids in fetal lung development. As your fetus matures, he or she "breathes" in amniotic fluid which prepares the fetus' diaphragmatic muscles for the work of actual breathing upon birth. In addition, the fetus will ingest amniotic fluid -- you'll see the byproduct of this in the baby's early poops called meconium.

OK, so now that we know what we're dealing with, let's get back to the question at hand. Did your water break?

Let's set up an ideal scenario... you're 39.5 weeks pregnant, you've been contracting every five minutes for the last three hours, you're wearing waterproof pants while you bake a last minute batch of brownies to hand out to the nurses at the hospital (hey, I said ideal, OK)... when all of the sudden you get an unmistakable GUSH of fluid. It will feel warm, wet (duh) & perhaps slightly slimy. Get used to it because you'll be leaking fluid from now until you deliver.

Now what? OK, let's be realistic... the first thing you'll do is mop up the situation. Literally. Change your clothes, put on a pad (or three), call your partner to clean up any puddles, or change the sheets. As you clean up, you need to make note of one REALLY IMPORTANT detail. WHAT COLOR IS THE FLUID? Amniotic fluid might be totally clear, it might be blood tinged, it might be yellow or it might be green. It may smell briny, but it shouldn't be foul smelling.

Next, you need to call your provider. Your conversation is going to go something like this... You: "Hi doctor/midwife. Sorry to wake you. Uhh, I think my water just broke." Doctor/midwife: "OK. What color was the fluid?" Ok, Ok, so they might first ask you when it happened or whether you felt a gush or a trickle, but trust me they're going to want to know about the color.

Why do they care about the color? Primarily, they're trying to find out whether the baby has passed any meconium in utero. It's a fairly common occurrence -- especially in babies that are past their due date. Meconium in the amniotic fluid is sometimes an indication of stress on the fetus and may mean that your labor & delivery will be closely monitored (we can cover that in a future post). Be aware that meconium in the amniotic fluid can cause subtle color changes -- it's best to compare the color of the fluid against something white like toilet paper or a maxi-pad.

Your provider will also want to know if you see blood in the fluid. It's totally normal for "clear" fluid to have flecks of blood in it or to be very, very pale pink. If the fluid is dark pink or red your provider needs to know ASAP. It could be a sign of a placental abruption which is a medical emergency.

But what if you don't get a gush?

First, try to rule out peeing your pants. Does the fluid smell like urine? Is it yellow (but remember, this could be amniotic fluid stained with meconium, so don't be fooled)? Did you just sneeze or cough (stress incontinence is pretty common in late pregnancy because there's so much pressure on your bladder)? No, no, and no? Well, you may be in business.

If you have any question as to whether or not you're "ruptured", you should call your provider. They may ask you to come to the hospital or to their office to be evaluated. You may undergo a speculum exam during which they'll test a sample of the fluid with a nitrazine swab (the pH of amniotic fluid will turn the nitrazine paper/swab blue).

Because any break in your amnion could be an entry point for infection you should be careful to to put anything in your vagina if you suspect that your water is broken -- no sex, no tampons, no fingers, no douches and don't take a tub bath (a shower is OK). And because infection is a risk once your membranes have ruptured, your provider will likely want to deliver your baby within the next 24-48 hours.

Which brings me to my final point... ruptured membranes might happen because you've been in good labor for a while, but it might also happen before you ever experience a contraction. It might bring on contractions or make existing contractions WAY more intense. In any case, breaking your water means GAME ON.

So get those brownies out of the oven, you're having a baby.