Updated: May 11
When will it happen? How do I know I've not just peed myself? What's a mucus plug? What happens if they're not clear? Why are some people induced after their waters release? Will a doctor or midwife break them for me?
When will it happen?
Surprise surprise, this is something else that is always shown in TV shows and films to be very dramatic. Yes, you might be surprised by the amount of fluid there actually is (can be around 500mls!) but usually this does not result in a mad dash to hospital immediately after.
I'd like to point out that if your waters release prior to 37 completed weeks of your pregnancy, you would still be classified as preterm - therefore it would be important to get in touch with your healthcare providers if you think this might have happened. This blog post is focussing on "term pregnancies" which would be after 37 completed weeks of pregnancy.
More often than not, you'll find that your waters release when you're already well into your labour. Only 10% of people will find their waters release before labour starts and 90% will find that their waters release during labour or the pushing phase. Babies are occasionally born completely inside their amniotic sacs, which is called "en caul". This is said to be extremely rare. I've been lucky enough to see this TWICE!
There are stories in folklore of sailors paying very large sums of money for the "caul" as it was thought the possession of such would bring good luck and protect that person from death by drowning.
How do I know I've not just peed myself?
A logical question... Pregnancy causes many changes to your body and unfortunately your pelvic floor and bladder are included in this. Hormonal changes causes muscles to be more relaxed and the pressure of baby on your bladder and pelvic floor can cause stress incontinence. This means when coughing, sneezing etc. you can pee a little. It stops very quickly after. However, it is your waters you will usually feel a pop and a gush. This is called "spontaneous rupture of membranes". This will not stop - it will keeeeep coming. When you move and when you feel baby move, you'll also get another gush. Their head can be like a little plug, so when they move - more fluid can come away.
You can also get something called a hind-water rupture which is a bit more confusing. This is when the water in front of baby's head is still intact but there has been a leak further up which is trickling down. Which can make you think you have just peed. My first suggestion would always be - to get a pad on and get walking around and bouncing on your ball. If more fluid comes away have a good sniff. That usually gives a pretty quick answer. Doesn't smell like pee? Probably your waters! This video below shows it well!
Is it definitely my waters?
You can also have vaginal loss at the end of your pregnancy and during early labour. This is different in consistency to amniotic fluid. It's more mucusy, so funnily enough is called your "mucus plug". As your cervix starts to change and prepare for labour, you might find a little (or big) blob of jelly-like mucus in your underwear or on wiping. Which can very confusing if you're not expecting it or have never heard of it...
But it's all good and normal!! This is usually pink in colour and is also called "show". It's been plugging your cervix throughout pregnancy but is now no longer needed as labour is approaching. It's an exciting sign as it shows your cervix has opened up enough for it to come away, however it could still be a good few days before labour starts. You don't need to let your midwife know when this happens or go to the hospital. However, fresh red bleeding at any stage of pregnancy is not normal and would always warrant a call to the hospital to get checked over.
If you find green, brown or black in your released waters or on your maternity pad it might be a sign of meconium (baby's first poo). Your midwife will offer you monitoring to assess how baby is coping with labour and will also assess the fluid to see if it's thick or thin. Sometimes "show" can contain older blood which can look like brown streaks through the waters. If you are concerned about the colouring, you can take a photo of any pads to show your midwife when being checked over.
Meconium stained waters is not only normal, but very common if you have gone well past your due due date. This is because baby's digestive system has matured enough and it has already started to function, even if they haven't been born. Resulting in the meconium passing through into your waters. After 42 weeks, 30-40% of pregnancies will have meconium-stained amniotic fluid.¹ There is a belief that meconium in baby's waters is a sign that they are severely distressed. However, this is a theory that has not been proven. Most babies who become distressed in labour do not pass meconium in utero and most babies who do pass meconium show no signs of distress.¹ Regardless, in view of this theory, most babies who pass meconium will be treated as if they are distressed. This is due to care providers believing that meconium stained amniotic fluid can cause a rare condition called "Meconium Aspiration Syndrome". This is when a baby inhales the meconium into their lungs during birth and can cause serious complications. (I plan do another blog post soon explaining this more thoroughly).
If it's confirmed to be significant meconium which is thick and baby is showing signs of distress, your maternity care team will want to discuss your options for birth. It's likely they will strongly recommend birthing on a labour ward with continuous monitoring of baby using a CTG machine. These recommendations are based on common practice rather than research evidence. The National Institute for Health and Care Excellence (NICE) recommend that you should not be offered CTG monitoring for "non-significant" meconium (yellow coloured, light meconium staining) unless there are other risk factors.² "Significant" meconium would be the presence of dark green, black or lumpy meconium.
Group B Strep
If you have a history of Group B Strep, it's likely that you will be asked to come into hospital when your waters release for intravenous antibiotics. This is not your only option. I would strongly recommend having a look at Dr Sara Wickham's wonderful website here. It is a great website with balanced, non-biased, evidence-based, free resources on all things pregnancy and birth. She has also dedicated an entire book full of information on Group B Strep which can be bought on Amazon following the link below.
Little disclaimer that this is an Amazon affiliate link which means I get a small commission, if you do decide to buy through this link. It doesn't cost you any more and there's no pressure to purchase this way but helps me out if you do!
Waters releasing before labour starts
As mentioned earlier, only 10% of people will experience their waters releasing prior to contractions starting. This is called "pre-labour rupture of membranes". If choosing to birth in hospital, your maternity unit would likely invite you in to get checked over and confirm that your waters have released. This might just involve a chat and if it sounds pretty convincing then they may not ask to do an examination. If you're not so sure, then they may ask to do an examination with a speculum to confirm. It is up to you whether you accept. It's important to note that hospital environments can have an impact on your birthing hormones which can delay labour starting.
However, of these 10%, 79% will go into labour within 12 hours and 95% will go into labour within 24 hours of their waters releasing.³ So pretty high chances that labour will start soon after, if your body is given the chance.
If this is the case, why do we hear of people being induced if labour has started soon after? Well, NICE guidelines recommend that induction is offered to those who are still not in labour 24 hours after their waters have broken. ⁴ This is called "augmentation" of labour. So why would this be recommended?
Well, the amniotic sac protects baby from infection throughout pregnancy so once this has been released, baby no longer has this protection. Therefore augmentation is offered to reduce the chance of possible infection for the birthing person and also baby. But what does research say about this chance of infection?
A Cochrane review of available research looked at induction for pre-labour rupture of membranes vs waiting for labour to start on it's own without intervention (spontaneously).⁴ The review did conclude that the rate of infection may be reduced for the babies who are induced. However, this review did highlight concerns about the low quality of the research. The only finding backed by what we would classify as "moderate" quality evidence, was that were actually no differences in the rate of infant deaths between the induction and waiting groups. Interestingly, the review did find a slight increase (still less than 2%) in "definite and possible" infections for babies when waiting for spontaneous labour. However, if the "possible" infections were removed, the difference was no longer significant. The "possible" infections rate was based on healthcare providers's observations of symptoms, rather than based on a clinical diagnosis of an infection. This means, for example, if the birthing person had a raised temperature in labour - baby may have been assumed to have a possible infection. It's important to note that there are other factors which can have an effect on increasing parent and baby's temperature in labour - such as dehydration and epidural use.
So yes, you can be induced. But you also can wait for labour to establish. I could right a whole other blog post on the above Cochrane review!
What if they don't release?
I mentioned back at the start that on occasion (although rare) the amniotic sac stays intact and they don't break at all and babies are born inside them. This is not a problem and does not cause any harm to baby. However, this is more and more uncommon due to increasing interventions. If labour slows down or the cervix doesn't dilate "efficiently enough" ie. 0.5cm every hour - then healthcare providers may ask to break your waters to speed things up. This is called artificial rupture of membranes. This is also done during the induction process, as the hormone drip Syntocinon does not work as well when the amniotic sac is still in tact. Breaking the amniotic sac does make an induced labour quicker, however research shows it does not speed up a spontaneous labour and can result in unnecessary complications and possible increase in caesarean section.⁵
The aim of this post is not to overwhelm you with information and the scenarios that I have discussed, but to empower you to become more in tune with your body, trust your instincts and research your options. If interventions are being offered, I would always recommend using the BRAIN acronym which I teach in my Hypnobirthing classes.
It stands for:
B - what are the Benefits?
R - what are the Risk?
A - what are the Alternatives?
I - what are your Instincts?
N - what if you do Nothing?
You have complete autonomy over your body and your baby and should never feel coerced into making a decision that doesn't feel right for you. We have guidelines to guide us, because there would be chaos without them... However, they have been written to suit the general public - not to suit you and your individual needs. So take the time to explore your options.
I offer 1-1 online consultations, which can be booked via my Calendly Page. If you're wanting to explore your options for birth, discuss a certain birth topic or support in accessing up-to-date, evidence-based resources in a supportive, unbiased environment - I am here for you! I would also strongly suggest accessing the resources I have mentioned during this post.
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1. Unsworth, J., Vause, S., "Meconium in labour," Obstetrics, Gynaecology and Reproductive Medicine (2010), 20(10), pp. 289-294.
2. "Intrapartum care for healthy women and babies", NICE, available at https://www.nice.org.uk/guidance/cg190 [accessed 27th April 2020].
3. Middleton, P et al, "Planned early birth versus expectant management (waiting) for prelabour rupture of memrances at term (37 weeks or more)", Cochrane Database of Systematic Reviews (2017), Issue 1. Art. No.: CD005302. DOI: 10.1002/14651858.CD005302.pub3.
4. "Inducing labour: clinical guideline", NICE (2008), available at https://www.nice.org.uk/guidance/cg70 [accessed 27th April 2020].
5. Smyth, R.M.D et al, "Amniotomy for shortening spontaneous labour", Cochrane Database of Systematic Reviews (2013), Issue 6. Art. No.: CD006167. DOI: 10.1002/14651858.CD006167.pub4.