The Waters
A common image in futuristic movies is someone floating in a tank of water in order to heal from injuries, illness, or cryogenic stasis. This idea of submersion in an enclosed aquatic tub that is restorative and salubrious is extremely evocative of the womb. Our babies float in exactly such a substance in our bodies, fully submerged, growing and gestating, until they are ready to emerge. This is amniotic fluid, “the waters” that surround and support our baby.
The ‘waters’ refers to the amniotic fluid that envelops and insulates your baby in the uterus. Your baby floats in it. It is made mostly of water (98%) which is rich in minerals and electrolytes, with a little bit of hormones, antibodies, and nutrients mixed in. It comes from the water in your body, the liquid (serum) from your blood, your baby’s urine, and your baby’s lung secretions.
The amniotic fluid maintains a steady and perfect temperature for your developing baby, providing the consistent level of warmth needed for growth. These waters also cushion your baby, buffering them from jostling or impact. Picture a goldfish in a sealed bag of water, and how protective that water is if the bag should fall. The fluid helps develop the baby’s lungs so that they can shift from umbilical to neonatal circulation as soon as they’re born. And the waters passively transmit immunities and hormonal information to the baby through its environment. The vernix helps these protective factors stick to your baby so they can get absorbed through the skin even after the birth.
The amniotic fluid, and your baby within it, are contained by the amniotic sac, which is actually made of two membranes: the chorion and the amnion. It is when this sac tears that your ‘waters’ come out.
In movies the waters often break before labour begins, which gives the false impression that this is extremely common. It’s not rare, but neither is it what happens most of the time. In fact, the waters breaking prior to the onset of contractions happens only about 10% of the time. More often, labour begins with contractions.
The movies also make it seem like when the waters break first, contractions begin immediately and suddenly, with hard labour resulting right away. In real life, this is not very common. If the membranes do break before labour begins, it is more usual that nothing else happens for a while. Contractions typically will begin within the next 48 hours or so, but not usually right on the heels of the waters breaking.
If your membranes do break before contractions begin, most caregivers (doctors and midwives) appreciate a call, just as a heads up that this has happened. They are alerted that your labour will likely begin within the next couple days, and they can track the length of time that your amniotic sac has been ruptured, since the chance of infection increases after 48 or 72 hours. If this happens, the best way to reduce the chance of infection is to limit internal vaginal exams, since these significantly increase the risk.
When your waters break, you will also be asked to note the appearance of the fluid. If it looks like clear water, all is well. If it looks murky or textured (like lentil soup), all might still be well, or the baby might be a bit stressed. Your caregiver will often suggest a non-stress test just to make sure.
More often, the waters breaking is not the first sign of labour. It is more usual for labour to begin with contractions, and for the amniotic sac to rupture at some point during labour, often towards the end of first stage, closer to when pushing begins. Some people feel a slight “pop”, or a sensation of pressure suddenly releasing. It is not painful. We do not have nerve endings in the amniotic sac. Sometimes it feels like a relief.
When the amniotic sac does rupture, you might see a dramatic gush like in the movies, or you might see just a small trickle. It also might be a constant drip, or a series of big leaking events (like pouring a cup of water) every time you move or stand up. The size and volume depends on the shape of the tear–a tiny pinprick in the sac empties differently than a large gash. It also depends on the location, and whether the tear is sealed by the baby’s head meeting your pelvis until you change positions, or whether it’s exposed all the time. You might want to include large pads, or even newborn diapers, in your labour kit, in case you find the leaking fluid uncomfortable. If you’re labouring in water, you might not be aware of it at all.
You might also notice that the ‘emptying’ of the waters is not a singular event, but something that happens over and over again. This is because our amniotic fluid is constantly replenishing and refilling. While pregnant, we excrete the baby’s amniotic fluid through our own eliminations, and replace it with fresh fluid continuously, so that the water our baby is bathing in is completely cleansed and refreshed every few hours. This is why you might want to have extra socks or slippers during labour, since they may get soaked more than once.
Very rarely, the waters don’t break at all during labour, and the baby is born in an intact amniotic sac. This is sometimes called being born “in the caul”. Most cultures believe that this is a sign of good luck–that the baby will live a life protected from harm. It’s also a very cool sight to see.
But more often, the waters will break spontaneously while you’re pushing, if they did not already do so earlier in labour. When the waters do break, many people notice an immediate escalation in their contractions, and in the sensations of labour. A full amniotic sac provides a cushioning buffer between the baby and your cervix, which can also mute both the sensation of the contractions, and their effectiveness. This is why some caregivers offer to artificially break the waters if it hasn’t already happened by the time you’re pushing. It is a painless procedure that involves an ‘amnihook’ which looks like a small crochet hook. Some people agree to this, which might accelerate the labour. And some people decline, and let labour take its own course. The trade off is sometimes just speed versus intensity, but sometimes it needs to be done if there is an urgency to get the baby out quicker, or if the careteam suspects the membranes are preventing your labour from progressing. If this comes up, you can ask “what would happen if we don’t do it?” to get a clearer sense of the necessity.
It is no wonder we see the image of deep healing and restorative growth in a small enclosure of water in speculative films, we use flotation tanks as a gateway for deep relaxation, and we take a warm bath when we need to unwind. Babies soak in the enriching amniotic fluid, swallowing it, and absorbing it, and growing in it, until the waters release so that the baby can be born.
Stephanie Ondrack has been a member of the Childbearing Society since 2003.
She lives in East Van with her partner, 4 kids, 5 cats, 3 chickens, and 2 rats. You can read her thoughts on child development and learning at www.thesmallsteph.com