Research shows that about 10% of labors begin with the water breaking. Usually, if left intact, the water will break on its own shortly before pushing. This could be around 8-9cm or more and is very different from what is portrayed on TV and in movies. More often than not, people will have their water broken for them at some point in labor.
Just in case you are one of the few who may suddenly find yourself in a situation where your water has broken, here are a few options and observations I’ve learned over the years.
Membrane Sweep
This procedure goes by several names: membrane sweep, sweeping of the membranes, or stripping of the membranes. This is a procedure in which the care provider inserts a finger into the cervix and attemps to separate the bag of waters from the inside of the cervix. This is intended to stir things up and try to convince the body that labor is beginning. It may or may not put someone into labor. Some studies have shown that it doesn’t necessarily put people into labor, but that it will shave off a few days from when they would have gone into labor in the first place. I’ve noticed that those who call me saying their water has broken have more often than not had their membranes stripped that day or the day before. This is merely my observation, but it is worth researching the risks and benefits of membrane sweeping.
Full moon
I have not noticed this myself, but I’ve had a few conversations with nurses who swear that they see more people coming into Labor & Delivery with membranes ruptured when there is a full moon. I’ve asked them if they have noticed if the full moon puts people into labor, and they usually respond with, “No, but I notice that more people show up with their water broken when there is a full moon out.”
Communicate with care provider
I recommend finding out long before labor begins what your care provider likes to do in the event your water breaks before labor. Some care providers want you to go straight to the hospital and start pitocin immediately. Some care providers want you to go straight to the hospital, yet are willing to wait several hours before starting pitocin. Some care providers are willing to wait much longer, even up to 24 hours or more, before starting any methods to get labor going. The good news is that most people go into labor on their own within 24 hours of their water breaking.
Consider risk of infection
You will likely hear the words “risk of infection” several times during your communications with care providers and hospital staff. They are worried that your risk of infection increases the longer you go with ruptured membranes. The bag of waters has spent 9 or so months providing a barrier between your baby and the outside world. Once it breaks, that protective barrier is no longer able to protect against infection. One of the biggest causes of increased infection is vaginal exams. Even though they use sterile gloves in order to perform vaginal exams, their fingers can push the bacteria that is already in your birth canal further up into the cervix.
Antibiotics
This may or may not be an option in some cases, but ask your care provider if antibiotics can be used to decrease your risk of infection during labor with ruptured membranes. Antibiotics are often used during a labor with someone who is GBS positive, so it stands to reason that they could also be used in a labor where other risks of infection are present.
Take temperature
If you’ve discussed with your care provider beforehand about staying at home for awhile if your water breaks before labor begins, they may ask you to take your temperature every few hours. If you are in the hospital, they will monitor your temperature. A fever can often mean an infection is beginning. If someone has an epidural, there is also something known as an “epidural fever.” You may need to ask them to explain how they can tell the difference between a fever caused by an epidural or a fever caused by an impending infection. A temperature of 100.4 is usually the magic number where other options will need to be discussed.
Breast pump
If you are interested in waiting for labor to begin on its own and do not want to start pitocin immediately, a breast pump may be an option to try to encourage contractions to begin on their own. Your care provider can guide you on exactly how long this should be done in order to stimulate contractions.
Walking
Getting up and walking around may help contractions to begin on their own once your water has broken. Even if you are in the hospital, you may be able to walk the halls for awhile.
Affection and Orgasm
This is similar in nature to the breast pump in that it helps get your own naturally-occurring oxytocin flowing. There is one important rule when your water is broken: nothing should be inserted into the vagina, including fingers and/or penis. Intercourse may be out of the question at this point (unless your care provider gives the green light), but there are other creative ways to experience an orgasm. If having an orgasm seems like something you are not interested in doing, kissing, hugging, and snuggling can also stimulate your own oxytocin.
Massage and comforting touch
Massage is great for getting oxytocin flowing. It may be helpful to get a massage before heading into your birth facility if you and your care provider feel there is time to do so. If there is not time to get one outside of the hospital, some hospitals offer massage services. It may be something to consider. If that is not an option, your loved one and/or doula can offer comforting touch in order to help your oxytocin to flow.
Informed Consent
All of these ideas boil down to making sure that you have enough information in order to make the best decision that you can. The earlier you have these conversations during pregnancy, the easier it will be to make decisions if the situation actually comes up. If you have not had time to discuss these options with your care provider ahead of time, and easy way to remember which questions to ask is the acronym BRAIN.
B- What are the benefits of proposed procedure?
R- What are the risks of proposed procedure?
A- Are there any alternatives to proposed procedure?
I- What is my intuition telling me?
N- What happens if we do nothing?
Pitocin
Even if it comes to the point of you needing to use pitocin in order to stimulate contractions, that does not mean all is lost if you were planning to have a natural childbirth. It does not mean an automatic epidural. It is still possible to have an amazing birth, even if you have pitocin.
Keen Doula Care 