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For a long time the child is without water. Is a long waterless period dangerous for a child

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The waterless period is one of the stages of childbirth. In the normal course of pregnancy, it occurs at the end of the first period. However, there are situations when the departure is about amniotic fluid starts much earlier than it should. Long anhydrous period during childbirth can pose a threat to the health and life of both the child and the mother.

The term "anhydrous period" means the time interval from the beginning (immediately after the rupture of the fetal bladder) to the birth of the baby. A waterless period is considered even if amniotic fluid departs in small portions through microcracks in the fetal bladder.

When does the rupture of the fetal bladder occur

Departure amniotic fluid can be normal, early and premature:

  • Normally, the rupture of the fetal bladder occurs during labor and the opening of the cervix by about 6 cm.
  • If the rupture occurred during childbirth, but with insufficient opening of the cervix, this is an early outflow of water. This situation does not pose a great danger in full-term pregnancy. However, the process of childbirth can be delayed, since the pressure of the fetal bladder during contractions helps the cervix to open at the first stage. And when the bubble burst in advance, generic activity may subside.
  • Premature discharge is considered to be the outflow of water before the onset of labor. This pathological condition can occur at any stage of pregnancy. It carries greatest danger for a child, in most cases, this is the beginning. The question of how long a child can be without water determines further medical tactics.

The duration of the anhydrous period is normal

How long can the anhydrous period last during childbirth? Here everything is individual. However, the duration of the anhydrous period in childbirth up to 6 hours is considered the norm.

Women who have already had an outpouring of amniotic fluid are naturally interested in how long a child can be without amniotic fluid. Pathology is the duration of the anhydrous period of more than 72 hours. It can reach from several days to several weeks, and without medical cover, complications in the mother and fetus will definitely arise during such a period.

As soon as the pregnant woman's water has broken or there is a suspicion of their leakage, an urgent need to contact an obstetrician-gynecologist. After all, how much a child can be in the womb without water in a particular situation is unknown before the examination by a specialist.

What is the danger of a long anhydrous period

If premature water breakage occurs after 34 weeks normal pregnancy, we are talking O early birth with a high probability of a successful birth of a viable premature baby. The most fatal consequences for the fetus will be with premature outflow of amniotic fluid on early dates pregnancy.

Possible complications of a long anhydrous period:

  • Spontaneous abortion or premature birth. Their danger to the baby directly depends on the gestational age.
  • Premature detachment of the placenta.
  • Protracted "dry" childbirth. while very painful and may be ineffective. The time between them lengthens, they become weak, thus, labor activity can completely subside.
  • Prolapse of the umbilical cord along with the waters.
  • Childbirth trauma.
  • Infection of the fetal membranes.
  • Intrauterine fetal death from hypoxia or infection.
  • The development of endometritis in a woman.
  • The development of sepsis, up to the death of the mother.

Infection during a long anhydrous period does not indicate the uncleanliness of the pregnant woman. The fact is that all women have their own unique microflora of the vagina, which includes lactic acid bacteria and many opportunistic microorganisms.

The fetal membranes form a sterile environment for the amniotic fluid. If their integrity is violated, the bacteria quickly rise up from the vagina, penetrate through the holes into the bladder and begin to develop in the amniotic fluid, infecting the fetus. Of course, the presence of vulvovaginitis and vaginosis in a pregnant woman greatly complicates the situation, greatly increases the risk of bacterial inflammation and accelerates its development.

How long can a fetus live in an anhydrous period

How long can a baby stay in the womb without water? It has already been said above that the duration of the anhydrous period of up to 6 hours does not threaten the child.

How many hours a child can be without water depends on the viability of the fetus and on many other factors:

  • Gestational age.
  • Volume of amniotic fluid.
  • The presence of intrauterine infection.
  • Is it fetal hypoxia?

So, how long a child can be without amniotic fluid depends largely on the factors listed above. In a healthy mother later dates pregnancy (over 28 weeks), in the absence of congenital pathology baby, correct presentation, the absence of infection, competently managed by a doctor, pregnancy can be maintained until required time for several days or even weeks.

Examination in the anhydrous period

At the very beginning of the anhydrous period or if you suspect a discharge of water, you should contact a gynecologist who will prescribe an examination. Because without holding diagnostic measures no one knows how long a child can be in the womb without water.

Stationary examination includes:

  • Ultrasound of the fetus with dopplerometry, which will determine the volume of amniotic fluid, the integrity of the membranes and the condition of the child.
  • Analysis for the determination of amniotic fluid in the vaginal secretion.
  • CTG (cardiotocography) of the fetus to clarify the condition of the child and the presence of hypoxia in him.
  • Tests for the detection of latent infection of the fetus.
  • Gynecological examination to determine the dilation of the cervix, as well as for prolapse of the umbilical cord or parts of the fetus.
  • Other general clinical studies - blood and urine tests, assessment of the mother's condition.

Tests for examination at home

When a woman feels well, but suspects amniotic fluid leakage, you can buy tests at the pharmacy to determine the amniotic fluid in the vaginal discharge:

  • Frautest Amnio pads . Most convenient option for use at home, represented by a conventional gasket. This method allows you to observe the secretions for 12 hours. The test is located in the pad itself, so the result is evaluated by considering the presence of stains on it. At negative result it is either colorless or yellowish. Positive result for the presence of amniotic water - the appearance of blue or green spots on the gasket of any size and intensity.
  • AmniSure test kit . This technique will give more exact result. The kit includes a vaginal swab, a reagent and a test strip. The swab should be inserted for a while, then immersed in the reagent for 1 minute. You need to lower the test strip into the liquid and wait for the result for 10 minutes. A positive result is the presence of two stripes.

Treatment for an anhydrous period

When the amniotic fluid is discharged, regardless of the gestational age, the woman is hospitalized. It depends on medical tactics how long a child can be without water. It is very important for the patient to comply with the therapeutic and protective regimen and aseptic conditions of stay. Antibiotics are prescribed for a pregnant woman for prophylactic purposes, which cannot harm the baby. Also used drugs that suppress labor activity, and other necessary drugs.

If the gestational age is more than 34 weeks, the pregnancy is not extended. The woman is hospitalized for normal course childbirth. If necessary (if the anhydrous period lasts more than 6 hours, and there are no contractions, or they are weak and ineffective), labor activity is stimulated with medication. According to indications, mechanical dilation of the cervix is ​​performed.

Termination of pregnancy or stimulation premature birth carried out in the presence of an unfavorable prognosis for the child or mother:

  • massive bacterial infection of the uterus, placenta, membranes and the fetus itself;
  • development of sepsis in the mother;
  • multiple deformities of the child and pathologies of its development;
  • detachment of a significant part of the placenta;
  • intrauterine fetal death.

How long can a baby be without amniotic fluid? important question for a doctor. Anhydrous period - normal stage childbirth, but its long course can be dangerous. A woman does not know how long a child can be without water, so delay is absolutely unacceptable in this case. Obstetrician-gynecologist supervision is required for selection right tactics management of pregnancy and childbirth.

Useful video about the anhydrous period

Moirody.ru

The anhydrous period in childbirth is a normal stage, at a certain point in labor, the amniotic sac is no longer needed, and spontaneously opens. For most women, this moment comes at the end of the first stage of labor, when the cervix has dilated enough, but sometimes the water breaks even before the onset of contractions (premature rupture of amniotic fluid). This period is dangerous, when the waters have receded, and childbirth has not begun.

This stage begins from the moment of any tear or rupture of the fetal bladder and outpouring, leakage of amniotic fluid and ends with the birth of a child. It must be understood that even a small crack in the amniotic sac, even the leakage of amniotic fluid drop by drop indicates its beginning.

If the anhydrous period in childbirth is the norm, then what should be its duration, and when can we talk about complications?

The question of how long an anhydrous period can last is not unambiguous. It is believed that it should not exceed 6, maximum 24 hours. If more than 6 hours have passed since the opening of the amniotic membranes, it poses a certain danger to the woman in labor and the baby.

Why is a long waterless period dangerous?

In the human body, on the skin, on the mucous membrane, including the vagina, a huge number of neighbors, microorganisms normally live, which under normal conditions do not cause harm. We know how to coexist safely, the human immune system does not allow these opportunistic microbes to multiply. The child grows up in an absolutely sterile environment. The amniotic fluid is very clean, there is no place for a single microbe. Unfortunately, if microbes get into the amniotic fluid, the baby's immune system can't do anything to stop them from multiplying. At autopsy amniotic sac there are all conditions for these uninvited guests from the mother's vagina to get into the amniotic fluid and begin to actively multiply on the membranes of the fetus.

If the waters have broken, more than 6 hours have passed or even a longer period, the consequences can be very dangerous. Infection of the fetus occurs, the child will be born already sick, chorioamnionitis develops due to infection of the membranes, their inflammation, after childbirth, the mother often has severe septic complications, postpartum endometritis. Thus, prolonged labor threatens the life and health of both mother and fetus.

However, this stage does not always cause evil. At premature pregnancy it becomes a chance to save the baby. Babies up to 34 weeks of pregnancy have almost no surfactant, a substance that is responsible for straightening the lungs after childbirth, which means that when born, the child is unable to breathe on his own. If a woman's water broke before 34 weeks, doctors try to prolong the process under antibiotic protection and strict infection control so that the baby has time to prepare for birth. Thus, the duration of the waterless period becomes a chance for life.

How long is the acceptable waterless period in childbirth?

Its duration up to 6 hours is normal and does not threaten mother and baby. If it lasts from 6 to 72 hours, there is already a risk of complications, but most often childbirth takes place without complications. With a duration of more than 72 hours, if the woman does not receive preventive treatment develops chorioamnionitis.

Women are afraid to miss the moment of amniotic fluid discharge, we wrote about how the water leaves. Suspecting that the waters have receded, future mother should immediately consult a doctor.

If the waters receded prematurely, and your position does not exceed 34 weeks in terms, it will be prolonged. Doctors avoid vaginal examination of the patient, it is necessary to create a sterile environment, antibiotic protection and careful monitoring of temperature, pulse, blood test of the pregnant woman, prenatal state fetus. Under favorable circumstances, pregnancy can last up to 2 weeks without risk to the baby and mother, this is enough time to help the baby prepare to breathe on its own.

If the pregnancy exceeds 34 weeks, the anhydrous period does not need to be extended, and the woman gives birth. Usually, they wait for the independent onset of labor for no more than 4 hours, if contractions do not begin, labor induction is performed.

During pregnancy, the baby is in the fetal bladder, filled with a special fluid - amniotic fluid. For a long nine months, the waters form a favorable habitat for the fetus. It is obvious that the processes of respiration of the fetus and its movements differ from its vital activity after birth. Let's see why amniotic fluid is needed.

Is the baby breathing amniotic fluid?

Many parents believe that the baby receives oxygen from the surrounding waters. Perhaps the basis for this myth was involuntarily a picture from a school biology textbook, which depicts an embryo with gill slits on its neck. In fact, fetal breathing is carried out in a completely different way. The baby receives oxygen in a "dissolved" form from the blood supplied to him through the vessels of the umbilical cord and placenta. Mom makes a breath for the baby; from her lungs, oxygen enters the pulmonary capillaries ( small vessels), where it is "captured" by hemoglobin. With the blood flow, oxygen is transferred through the vessels of the uterus, placenta and umbilical cord to the baby. Back to the mother's body, these vessels carry carbon dioxide, which is formed as a result of the cellular respiration of the fetus, which is excreted through the lungs of a woman. So amniotic fluid has nothing to do with fetal breathing, and gills are an intermediate step embryonic development and disappear by the first month of the intrauterine period.

Is amniotic fluid necessary for fetal nutrition?

Near amniotic fluid really saturated with proteins, amino acids, organic salts, carbohydrates and other nutrients. This composition of water provides ideal condition the skin of the baby and the membranes covering the umbilical cord, placenta and uterine walls. It can be said that waters perform a nutritional function for the integumentary tissues of the fetus and the uterine cavity, however, the process of nutrition and digestion of the baby itself amniotic fluid has no relationship. The nutrition of the child, as well as his breathing, depends only on placental blood flow. From the food consumed by the mother, in the process of its digestion, end products necessary for the life of the body are released - proteins, fats, carbohydrates, vitamins and trace elements. These substances enter the blood future mother and delivered to the uterus. From the uterine capillaries, "food" penetrates into the placental bloodstream, and from the placenta through the vessels of the umbilical cord are delivered to the fetus. Thus, the baby does not eat in the usual sense of the word for us: he does not eat, does not drink, does not digest and does not excrete food. All these processes are carried out for him by the mother's body, and the fetus only receives the necessary nutrients in a "ready" form. And these substances do not come from amniotic fluid, but from cord blood, bypassing the baby's digestive tract.

The more amniotic fluid, the better?

Many mistakenly believe that the more water, the more comfortable for the baby. Unfortunately, this is not the case: excess amniotic fluid is not good for either the baby or the expectant mother. With polyhydramnios, the fetus moves freely in the uterus until the last moment. Often this excessive movement results in the umbilical cord wrapping around the fetus. Normally, the umbilical cord is quite long (50-70 cm), so it is located in the uterus in loops. With polyhydramnios, its loops lie freely, and an actively moving fetus can stick its head, arms and legs into them. The entanglement itself is not dangerous for the baby. However, if multiple entanglement is formed, the fetus will become entangled in the loops of the umbilical cord. As a result, the baby will not be able to move, and the length of the umbilical cord may not be enough for childbirth. Moreover, it can lead to the formation wrong position fetus in the uterus before childbirth.

Normally, by the end of pregnancy, it is located head down and can no longer change position at the last moment: it is fixed by the walls of the uterus. With polyhydramnios, the walls of the uterus are overstretched, and this allows the fetus to change position even on the eve of its birth. As a result, by the beginning of labor, the baby is often in breech presentation(buttocks or legs down) or even in a transverse position.

During childbirth, excess amniotic fluid interferes with normal development tribal activity. The overstretched walls of the uterus do not contract well, and the huge fetal bladder restrains the strength of contractions. As a result, weakness of the tribal forces develops - a complication of childbirth, dangerous for mother and baby. Often, against the background of polyhydramnios, the fetal bladder bursts with the first contraction, when the cervix has just begun to open. This complication is called premature rupture of amniotic fluid. Because of it, weakness and discoordination (violation of nervous regulation) of childbirth often develops, and the risk of infection of the fetus and uterus increases. With polyhydramnios during the outflow of amniotic fluid, more often than usual, there is a prolapse of the loop of the umbilical cord and the handle or leg of the fetus - this complication requires an emergency caesarean section.

How much amniotic fluid should be normal?

Normally, the amount of water gradually increases and by the end of pregnancy is approximately 800-1500 ml. If they become smaller before childbirth, this may indicate a prolonged pregnancy. The walls of the fetal bladder "age" and secrete less water, which can worsen the condition of the baby.

Many expectant mothers think that the amount of water is decreasing because the baby drinks it. But this is a delusion: the child does occasionally swallow a small amount of liquid, but he does this not at all to quench his thirst. Swallowing water, the baby “works out” the swallowing reflex and flushes the walls digestive tract, but water is not absorbed into the baby's body, does not participate in its metabolism and is excreted back. All necessary liquid, as well as food and oxygen, the baby receives in dissolved form from the mother's body through the vessels of the placenta and umbilical cord. Thus, a decrease in the amount of amniotic fluid is in no way connected with the fact that the baby "drinks" them.

Why is amniotic fluid green?

Normally, the amniotic fluid is transparent, it has neither color nor any specific smell. However, sometimes the fetal fluid changes color, acquiring various shades green, which is a sign chronic hypoxia(lack of oxygen) fetus. Green amniotic fluid becomes due to the premature release of meconium - the baby's original feces. Normally, the baby's intestines are emptied for the first time only after birth and the first independent breath. However, when oxygen starvation the crumbs have intestinal spasms, and meconium enters the fetal waters. At the same time, the color saturation indicates the amount of meconium released: than brighter color the more serious the fetal hypoxia.

Other possible reason The green color of the water lies in the infection of the fetal membranes - the walls of the fetal bladder, producing and filtering water. The infection can penetrate into the fetal membranes with blood flow if the expectant mother suffered an acute viral disease (ARI, influenza) during pregnancy, or through a hole in the wall of the fetal bladder during premature outflow of water.

Does the baby suffer after the water breaks?

Of course, the importance of amniotic fluid for the development of pregnancy and the fetus is enormous. They create a unique habitat for the baby, prevent the formation of adhesions between the wall of the fetal bladder and the skin of the fetus, create an opportunity for active movements crumbs needed for its correct and full development. At the same time, the waters protect the umbilical cord and placenta from pressure from large parts of the fetal body, and the baby from shocks and bruises from the outside, make his movements less noticeable for the expectant mother, and influence the formation of the correct position of the fetus in the uterus by the end of pregnancy. The fetal bladder, filled with water, is involved in the process of opening the cervix in the first stage of labor and protects the baby from excessive pressure on the walls of the uterus during labor. With premature (before the onset of contractions) outflow of amniotic fluid, the risk of infection of the fetus increases, the process of childbirth often becomes more complicated ... However, there is no immediate threat to the life of the crumbs. After all, after their outpouring, he still continues to receive oxygen and nutrition through the vessels of the placenta and umbilical cord. Of course, the discharge of water is a risk factor for the health of the crumbs, but this is not due to the impossibility of its existence without the fetal fluid (as fish cannot exist without water), but with the risk of infection entering the uterine cavity through the hole formed in the burst fetal bladder. Therefore, with a premature outflow of amniotic fluid, you should immediately go to the hospital.

If you drink a lot, will there be a lot of amniotic fluid?

Often, expectant mothers ask themselves the question: will there be polyhydramnios if you drink a lot, and should you try to limit fluid intake for this reason?

This is not so: the amount of amniotic fluid does not directly depend on how much fluid the expectant mother consumes. for the development and maintenance desired composition amniotic fluid meet the walls of the fetal bladder. If you look at them under a microscope, it turns out that they look like a cobweb: the fetal membrane is permeated with a network of tiny blood vessels. From the plasma (liquid part) of the blood in these vessels, the fetal fluid is formed. The amount and composition of amniotic fluid can change if the fetal membranes are affected by a viral infection, placental blood flow is disturbed, or after pregnancy. In these cases, the normal functioning of the fetal bladder is disturbed, including the function of excretion of amniotic fluid. As a result, their number may either increase or decrease. In order to prevent the development of polyhydramnios, you need to be regularly observed by a doctor during pregnancy, undergo all recommended examinations on time, carry out prevention and timely treatment viral infections(SARS, influenza, etc.). But limiting drinking during pregnancy can lead to dehydration of the body of the expectant mother, a decrease in the volume of circulating blood and, as a result, to oligohydramnios! Therefore, a pregnant woman is recommended to consume at least 1.5 liters of fluid during the day.

Why does fetal water become cloudy?

At the beginning of pregnancy, the fetal waters are clear and clean. In the second half, and especially towards the end of pregnancy, the amniotic fluid becomes cloudy. This is caused by special substances that accumulate as the gestational age increases:

  • Lanugo - the so-called delicate hairs that cover the baby's skin in certain period embryonic development, they subsequently fall out.
  • Primordial lubrication - fatty lumps covering the skin of the fetus in the form of a curdled or cheese-like mass. This lubricant protects the skin from excessive exposure to fluid.
  • Desquamated epidermis - scales of dead skin cells of the fetus. The skin of the baby is constantly updated.

2 Sep 0 2728

Natalya Tomilina, doula, psychologist, body therapist: First you need to delve a little into the anatomy. There is a uterus, there is a bladder in the uterus, in it there are a child, an umbilical cord, a placenta, as it were, on one side (and reverse side it is attached to the wall of the uterus) and amniotic fluid. There is usually quite a lot of water, and the baby on the eve of childbirth is large and occupies almost the entire space of the uterus. His head (or butt) is below and inserted into the pelvis.

Further, about two situations of water discharge, the difference between discharge and leakage, what risks are there from the point of view of doctors, are they justified, what raises and lowers them, what you need to pay attention to, what factors to monitor, what protocols are adopted in Russian maternity hospitals, in maternity hospitals other countries, in home births.

So. Bubble burst can happen in different ways

1. The integrity is broken below, where the cervix and the head of the child are, usually in this case about half a glass of water is poured out, because of this the head drops lower, and it can be compared with a cork that was plugged into a bath so that water does not leak. Let's call this option the discharge of the anterior (that is, located between the head of the child and the cervix of the woman) waters. You need to know that on top of the belly, where the belly and arms of the baby, there is a decent amount of water, the so-called back, that is, as a rule, they do not flow out all and completely, there are a lot of them. And you need to know that every three to four hours new portions of water are produced by the mother's body.
If a woman strongly changes the position of her body (she got up, lay down, turned over, got up again, sat down), then the water will flow out. If you take one position, then they can stop flowing completely, because the head is pressed tightly against the pelvis.

What risks does medicine tell us about?

I'll start with the worst. Yes, I'm not afraid to talk to pregnant women about death. I believe that it is better to call her by her name and say in what cases she can be at all than to remain silent, thereby fueling the illusion that "childbirth is safe if ...". Yes, you need to prepare, you need to know certain researched laws of the course of childbirth, you need to take care of safety, but not go to the extreme of overcontrol. Doctors know, and in fact they talk among themselves, that childbirth is a process that does not fit into absolutely precise schemes. There are directions, yes. But childbirth is unpredictable. Childbirth is a compressed in time, concentrated model of life itself, and no one has yet been able to put life into schemes.

So, most of all they are afraid of the sudden antenatal (before birth) death of a child. But it is not connected only with receding waters. It is even more associated with severe overgestation (after 43 weeks), and according to some reports, it is higher at 37 weeks than at 42-43, while at 37 weeks no one is stimulated. In general, this thing is very mysterious - antenatal death. There are always risks in childbirth, simply because there is death. And this is not a reason for everyone to have a planned cesarean. And this is not a reason to monitor the child's condition around the clock. Just as we live, despite the fact that we know about the suddenness and unpredictability of death, we also go into childbirth, knowing that sometimes, oh, very rarely, some children do not live to see their birth and this is how this world. Personally, in my practice I have encountered two such cases, in both the exact cause has not been established.

Well, I wrote about death, now let's return to the reverse pole, which is about life. In general, childbirth is about life, really. Childbirth is the birth of a new life. Therefore, you can exhale and remember that most births go well for mom and baby).

However, what can be done to reduce the risk described above?

♦️ with broken waters and / or a post-term pregnancy - monitor the baby's movements and heartbeat (you can do it right at home, I will write below how). If something is bothering you, then seek help.

Cord prolapse risk

With spontaneous discharge of water, it is quite tiny. In my doula opinion, the situation of amniotomy is much more dangerous - a puncture of the bladder in the maternity hospital, when it is done as a stimulation birth process thus interfering with the functioning of the body.

In what situation can fallout still occur?

♦️ When the baby's head is high and not inserted into the pelvis and the bladder breaks. In this case, the water may rush in a stream, and the umbilical cord may fall out, because the child's head has not yet had time to "plug" the pelvis.

But this is indeed a very rare complication and the article is not about it, so let's continue.

Inflammatory process, infection

This is a big myth, and alas, most of our doctors firmly believe in it.
In fact, the risk of inflammation is also very small. It increases if: you are in the maternity hospital (the environment is more aggressive in the hospital) if you have a lot of vaginal examinations if you have a complicated pregnancy, there are infections. But even if these three points are present, there will not necessarily be inflammation.
What reduces the risk of infection:
♦️ exclude vaginal examinations
♦️ don't go to public places where there are a lot of people
♦️ do not swim in public pools and reservoirs (otherwise you suddenly decide to swim)
♦️ do not have sex with your husband (here it’s real - don’t)
♦️ observe normal hygiene
♦️ track the factors listed below.

What are we paying attention to?

The color and smell of the waters. The norm is light, transparent, pinkish waters. The smell should also be pleasant, if it is unpleasant and / or if the waters are green, brown, any dark shade, then consult your midwife or doctor. If we are talking about childbirth in the hospital, then you will definitely be told to come and lie down. This does not mean that everything is bad (about what “green waters” means, I will write another article), it means that more careful observation is needed. If we are talking about home birth, then your midwife will most likely immediately come to you and monitor the situation.

Next, I write about the situation when the waters are clear

We pay attention to your general condition, temperature (should not rise), emotional background. Fear and fear are adrenaline that blocks oxytocin and childbirth, so it is important to calm down and create safety for yourself. Moreover, for some women it is safe to immediately go to the maternity hospital and go under observation, while for others it is to stay at home, do ordinary things and calmly wait until the contractions begin.

And, perhaps, the most important thing that we pay attention to is the condition of the child. Here, it seems to me, many women are unaware that in fact the only way to understand whether everything is in order with the child is to listen to his heartbeat. Yes, there are also ultrasounds, but ultrasounds cannot be done constantly, for many hours. It can show that the baby is in order, the placenta is working, the water is preserved (albeit decreased), the cervix is ​​ripe. But that's all.

Then CTG or Doppler comes into play. These are devices that are applied to the stomach and they read the rhythm of the heartbeat. In maternity hospitals there is a large device that records readings and itself recognizes strong changes and deviations. And home midwives carry portable hand-held dopplers or wooden tubes with them, with which they listen to the heart in the same way, only the device does not record and does not recognize the signal itself, here the midwife's ear is already working.

I find something surprising for many women. If you are calm and confident enough, then you can (and let the doctors throw tomatoes at me) track your heartbeat yourself. It is enough to learn to determine in which place of the abdomen you need to listen, and find out about digital indicators. I don't encourage everyone to do this. For many it will be too dangerous. But I know for sure that there are those for whom it will be on the contrary important - to find out what you can do yourself.

So, the only way to determine whether everything is in order with the baby in the situation of receding waters and further throughout all births is the heartbeat. If it is normal, it means that the flight is normal.

Based on all of the above, in many countries a protocol has been established - after the discharge of the waters, wait 72 hours, during which, as a rule, the woman begins contractions and she goes into labor. That is, the discharge of water without contractions is not childbirth!

In Russia, the protocols are as follows:

In many maternity hospitals, a woman is given 6 hours. If contractions do not start, then stimulation begins by type: artificial oxytocin → epidural anesthesia → weak efforts → squeezing (Kristeller's maneuver, banned in many countries) → episiotomy. Either immediately C-section.

Why? Because they are afraid of the first point, antenatal death, and do not want to mess with a woman (after all, this is a free birth and she is in the pipeline).

In addition, antibiotics are prescribed. Why? Because they are afraid of the point about infections:

- in some maternity hospitals they give 12 hours and then everything is the same
- in advanced maternity hospitals they give 24 hours
- in Moscow, literally in a couple of maternity hospitals (or maybe in a single one) a woman is given 72 hours

♦️ It is important to know that “they give in the hospital” I mention as a figure of speech, and not as a fact. You can always refuse stimulation, write refusals and continue to wait, even if the maternity hospital “has not heard” about 72 hours and considers it a fiction.

Doctors are not gods, they can be very wrong, many are stuck at the level of medical knowledge of the last century and are not interested in modern medical research and protocols. And yes, some kind of you ordinary woman Reading the Internet can be more competent than a whole, huge DOCTOR.

In home births, they usually wait the same 72 hours, the midwife listens to the heart, Life is going in their turn, and as a rule, contractions begin and childbirth is launched during this period, solo-children wait as long as they decide for themselves, and monitor their condition themselves.

2. The second option for a bubble burst is when it bursts somewhere high. In this case, when manually inspecting, we find a whole bubble, but the water is leaking and then it is obvious that the gap is much higher. This option is called water leakage.

In this case, it's even more interesting:

♦️ below the bubble is intact, the head has not moved down so much, there is no pressure on the neck and thus there is no stimulation either, so there may not be contractions at all for a very long time
♦️ the water leaks little by little, they are renewed, and with limited mobility (bed rest) on ultrasound, you can see that the water index increases, although it was originally fallen
♦️ the practice of home obstetrics, and especially the practice of conscious solo birth, shows that a woman can pass from such a situation of leakage for longer than 72 hours. In my personal practice (this is when I saw it with my own eyes) there were 4, 5 and 8 days. In the cases I have read and heard, it has gone up to a couple of weeks. Irina Martynova's book "Confessions of a midwife" describes a case when a woman lay at home like this for 6 or 7 weeks (water began to leak at 32 weeks, if I remember correctly). But this is an exceptional case, which I just mention to show that this happens. Usually we are still talking about a full-term pregnancy and childbirth begins spontaneously within a week
♦️ in the maternity hospital for this situation, the same maximum protocol is 72 hours, they will not let you walk for a week, perhaps nowhere.

What should be feared?

The same as in the first situation: worsening of the heartbeat (this is perhaps the main thing) green, brown, dark color of the water. ♦️ The norm is light, transparent, pink water. general condition infection development.

Summarizing

I'm a doula and I don't make recommendations. A recommendation is a verb in the imperative mood that calls for action. I give information. Information is provided using the phrases “there is such an experience”, “it happens this way and that”, “you can do this” (but you can not do it, you are free to choose). That is why I will now write the word “can” below, which implies that there is some possibility, but everyone decides for himself whether to take advantage of this opportunity or not.

♦️ You can stay at home and not go to the maternity hospital right after the discharge or leakage of water for at least 6 hours, and at most about 3 days

♦️ If you are already in the maternity hospital, then you can write a receipt and refuse stimulation if it is offered earlier than after 72 hours and the condition of the woman and child is good

♦️ You can stay at home with water breaking/leaking and call a midwife, with whom you can arrange for her to monitor you and your baby until the contractions start and you go to the hospital (this service is usually called escort to the hospital, or it is possible, if you have a contract for an individual midwife in childbirth)

♦️ You can buy a manual doppler, study the information yourself and monitor the baby's heartbeat until the contractions begin.

And the important thing is that these opportunities are based not only on experience, but also on data from evidence-based medicine. I don't want to overload the text with links to research. Who cares, a lot of information can be found on pubmed and in English sources.

See also online workshops on childbirth by a rehabilitation doctor Oleg Leonkin from the cycle Lecture by Marina Golubtsova

Photo by Natasha Hanks

Every woman who is in an “interesting” position understands perfectly well that with the approach of childbirth, the likelihood of sudden discharge of amniotic fluid.

Inexperienced future moms listen to the slightest change in their body, afraid to miss this one. important point.

They are even more concerned about the question of what to do when the water has broken during pregnancy.

Do broken waters always signal the onset of labor Or you can safely wait until the appointed time?

How do you know if the water has broken?

The baby throughout pregnancy grows and develops in a special shell filled with liquid. This fluid is called amniotic fluid. In fact, amniotic fluid is formed from maternal blood plasma and is constantly updated and replenished if necessary.

This substance is absolutely sterile, which ensures reliable protection developing organism from various infections. Content in liquid a large number immunoglobulin is an additional barrier against external influences.

The comfortable water environment allows the baby to turn freely and protects the bladder from uterine contractions. Regardless of environmental conditions and the condition of the mother, constant pressure is maintained in the amniotic fluid and temperature indicators. Due to the presence of water, the baby is reliably protected from physical and noise external influences.

If you feel the release of warm liquid from the vagina (usually this happens when a woman lies down and tries to get up), in an amount of more than 100 milliliters or more (it happens that a liter and a half is poured out at once), without a specific smell of urine - this is them, the water has departed.

Why are the waters breaking?

As the child grows, the volume of the surrounding waters also increases. By the time of birth, their number can reach 1.5 liters. Excess amniotic fluid or low content is considered pathological conditions threatening the normal development of the baby.

With the approach of labor hormonal background the expectant mother begins to change rapidly. Such processes contribute to the natural birth process. Under the influence of the hormone oxytocin, which also promotes uterine contractions, the fetal membrane becomes looser. And the pressure in the bubble increases significantly under the onslaught of the baby, seeking to leave the hostile pulsating uterus.

The fetal membranes do not withstand, and their rupture occurs. This moment is accompanied by the discharge of water during pregnancy. The woman may even hear the bubble burst. Unusual popping or clicking sounds confirm the violation of the integrity of the shell.

IN ideal the discharge of water occurs after the first stage of childbirth, when the cervix is ​​open by more than 4 cm. This development of events is considered optimal for both the baby and the woman in labor.

But in life, processes do not always coincide with descriptions in reference books. This does not mean that other variants necessarily confirm the pathology. But woman must be prepared for premature discharge of water.

How does the water leave?

Some pregnant women on the eve of childbirth are even afraid to take a shower so as not to miss such an important moment.

There is also concern about involuntary urination, which often occurs over long periods. But the discharge of water has its own specific features, and it is difficult to confuse them with other physiological processes.

Water can flow in completely different ways. So, if the baby is prepared for childbirth and takes the correct position, his head rests against the womb and the amniotic fluid is divided by his body into two parts.

The anterior part of the amniotic fluid contains up to 250 ml of fluid. It is this liquid that is poured out when the fetal membrane bursts. Women have the feeling that a lot more fluid is pouring out of them. At the same time, this flow cannot be stopped by muscle tension or a change in body position.

So that a woman can imagine how the process will take place, in women's consultations in class, they are advised to experiment with their own perceptions in advance at home. To do this, it is recommended to pour a glass in the shower warm water to your feet. Such an experiment will allow you to remember the sensations.

In cases where the child takes the wrong position or did not have time to roll over, the volume of the outgoing fluid can be much larger. Sometimes all the waters up to 1.5 or even up to 2 liters can be poured out at once. Such a "waterfall" is difficult to confuse with ordinary secretions. But even in this case, the waters can gush all at the same time, or they can flow out in a small trickle.

Another option for water discharge during pregnancy is leakage. Such situations arise if the fetal membrane has burst in the upper part or microcracks have appeared. Leakage is difficult to distinguish from urinary incontinence or increased vaginal discharge. It can last for hours or even weeks.

There are situations when water does not break even during childbirth. If the contractions drag on, and the fetal membrane remains intact, doctors resort to forced piercing.

This is not a medical whim. In this way, the uterus is saved from overvoltage, which can provoke its rupture during childbirth.

What waters are leaving?

Woman must record the time discharge of water, as well as their condition. By appearance the doctor will determine the presence of deviations and will be able to decide on next steps.

Normally, the water is absolutely transparent, may have an admixture of flakes or a slightly yellowish tint.

These waters do not have a specific odor., which allows them to be distinguished from urine. For amniotic fluid, a sweet smell reminiscent of fresh milk is considered natural.

If the waters are green, and even more so black, this indicates the presence of meconium in the waters.

Red waters confirm the presence of blood in them. This alarm signal. Blood appears with placental abruption.

Reliable self-diagnosis methods

If a woman doubts the correctness of her conclusions about the fluid that has appeared, you can resort to known ways self-diagnosis or consult a doctor. The need for additional diagnostics arises when the water leaves in an insignificant stream, but leaks in small portions.

Dry sheet test

It is quite common, informative and affordable way determine the discharge of amniotic fluid.

To carry it out, a pregnant woman must visit the toilet for emptying Bladder.

After that, the genitals are washed and wiped dry. The woman lays down on dry white cloth. You can use a diaper or sheet.

If after 15–20 minutes wet marks are found on the fabric, the discharge of water is confirmed.

test pad

At home, you can use more modern way determination of water discharge. Test pads can be purchased at a pharmacy. They allow you to confirm the type of discharge with high accuracy. Such a gasket is impregnated with a special substance that reacts to the acidity of secretions.

Normally, the flora of the vagina has a balance within pH 4.5. In amniotic fluid, the acidity reaches pH 7.0. The gasket begins to react to liquids in which this indicator exceeds 5.5.

For the test, the gasket is placed on underwear and do not remove until a fluid leak is felt. If there are no such sensations, the pad can be left on for up to 12 hours.

An indicator of the presence of fetal water is a change in the color of the gasket to blue or green tint.

If you do not trust home diagnostics, you can contact the doctors. In gynecology, it is customary to determine the dubious discharge of water using:

Gynecological examination;

smear microscopy;

Aminotest with the use of a dye introduced into the amniotic fluid;

Cytoscopic examination

The waters have broken: when will the birth begin?

In most cases, the water breaks on the eve of childbirth. Contractions can begin literally immediately after the discharge of water, if the fetus is ready for birth and the cervix has time to prepare for labor. Some time may pass and labor activity will begin in 2-3 hours.

In pregnant women, the cervix opens more slowly. In an hour, the cervix can open only half a centimeter. Therefore, childbirth in such pregnant women begins no earlier than after 9-12 hours.

For women with childbirth experience, the process develops much more rapidly. Their cervix can open in 5-6 hours. In these cases, if there is no desire to give birth at home or on the road, you will have to hurry.

It's harder if the cervix is ​​not ready for labor and the waters have already receded. In such cases, before the onset of contractions, both 12 and 72 hours can pass. What to do if labor does not begin, doctors decide in each specific case separately.

There is a widespread belief among pregnant women that a baby without water is not able to live more than 6 hours, since he can die from a lack of oxygen. Such rumors absolutely unfounded.

Despite the departed water, the nutrition and breathing of the baby continues to be provided by the mother's body through the placenta. The absence of water will in no way affect its oxygen needs.

In addition, the waters do not drain in full and they are constantly updated. Therefore, literally after 4 hours, if the fetal membrane has retained its integrity and only leakage is observed, their volume will be replenished with new fluid.

What is the real danger for the baby? In open access for infections. If earlier child was practically in sterile conditions, the resulting crack in fetal membrane provides direct access for the penetration of various pathogens.

The baby, still in the uterus, did not have time to develop protective mechanisms. Any infection is now fatal for him.

If the anhydrous period is delayed by more than 12 hours, doctors begin antimicrobial therapy with medicines that are safe for the child.

What to do if the water breaks?

What should a woman do if her water has broken? The answer is unequivocal: urgently go to the hospital. Do not wait for the next visit to the gynecologist, namely, collect the necessary things, documents and call ambulance.

Further development of events will depend on the timing at which the waters receded, their characteristics in terms of color and volume.

38–40 weeks

Most likely, the baby is already ready for the birth. If the waters have departed in a normal volume or are constantly leaking, besides, their color is absolutely transparent, there is no reason for concern. The natural process has begun, and prenatal contractions will soon begin.

Moms giving birth for the first time still have a couple of hours left to calmly get together, gain strength and even get some rest.

In no case after the waters have broken:

To take a bath;

Be subjected to physical stress;

Have sex;

use tampons or sanitary pads.

If there is a need to hygiene procedures, for example, to process or shave the genitals, you need to use the shower. Wash only from front to back to prevent germs from entering the vagina.

If the water is constantly leaking, instead of pads that are saturated with fragrances and are not always sterile, you need to use a cotton cloth.

Herbal teas made from chamomile, echinacea, mint will help to calm down. In addition, these drinks also have antimicrobial properties.

For mothers who give birth not for the first time, there is no time for tea drinking. Contractions and childbirth can begin at any time. For such women, the discharge of water is not an alarming, but an important signal. Therefore, they should immediately go to the hospital.

The reason for the immediate appeal for help is the abundant discharge of water. If the waters departed at once and in a large volume, then the entire fetal bladder was emptied. This confirms that the baby did not have time to take correct position.

In such situations, it is extremely rare, but it is possible for one of the baby's limbs or even part of the umbilical cord to fall into the neck or into the vagina. If you do not help such a woman in labor in time, childbirth will be complicated. In addition, the prolapsed umbilical cord can be pinched by the cervical muscles or the fetus, and the child will have problems with oxygen supply.

If the waters have an unnatural color or smell, you should not postpone a visit to the maternity hospital. The presence of blood in the waters is a wake-up call. The natural process should not be accompanied by bleeding.

35–38 weeks

By 35 weeks, the baby has already formed lungs and is able to breathe on its own at birth. Therefore, if the waters break at this time, doctors decide to stimulate the birth process according to vital signs.

If nothing threatens the baby and the expectant mother, it is advisable to prolong the pregnancy. Expectant tactics allow you to carry the baby and give birth in deadlines.

The woman is placed in the hospital for the waiting period. Physicians are monitoring changes in the state and indicators of tests. To prevent infection of the fetus, I use antibiotics.

If there is a suspicion of the presence of infections, they resort to forced birth or caesarean section.

20–34 weeks

To prevent birth premature baby and to ensure the safe continuation of pregnancy after the early discharge of water, doctors adhere in most cases to expectant tactics. They try to prolong such a pregnancy as long as possible.

A woman will have to spend the remaining period before labor in a hospital under close observation. future mommy placed in a sterile ward, where she must stay in lying position.

To control the condition of the baby and mother:

Once every four hours, temperature and pulse are measured;

Every day they conduct a blood test for the level of leukocytes;

The volume and quality of amniotic fluid released is constantly monitored, for which the diaper is regularly changed under the woman;

Every 5 days, sowing of materials taken from the vagina is carried out;

The condition of the baby is monitored using ultrasound and cardiotocography.

The decision on the timing and method of delivery is made in each case individually.

Up to 20 weeks

Water in the early stages may depart due to:

Infection of the fetus;

Inflammatory processes;

careless sex;

Hormonal failures;

excessive physical activity.

There is no single tactic for the discharge of water in the early stages. The decision is made after a detailed examination. But in most cases, such a pregnancy cannot be saved.

The waters have broken, and there are no contractions

Only when ideal birth water breaks during contractions. Different "variations" are characterized by the discharge of water in the absence of contractions. Doctors recommend in any case to go to the hospital.

Not worth it long time wait in the hope that labor will begin. Contractions may not start for the next 48 hours. Women, fearing the stimulation of childbirth, postpone visiting the maternity hospital, which creates favorable conditions for the development of infectious processes.

In some maternity hospitals until now, the practice has been preserved to stimulate labor activity 4-6 hours after the discharge of amniotic fluid. Such tactics absolutely do not correspond to modern medical views.

Doctors have proven that the next 12 hours the baby is not in danger. And even the absence of contractions for 48 or even 72 hours is not considered a pathology.

The decision on urgent delivery is justified:

With complete discharge of amniotic fluid;

With the threat of displacement or abruption of the placenta;

If the contractions were present, and with the discharge of the waters they began to fade away;

When unnatural smell or the color of the amniotic fluid;

When the state of either the mother or the baby changes.

When the baby is infected;

If comorbidities are present.

The method of delivery in the absence of contractions, the doctor chooses in accordance with the condition of the woman:

1. If there is an incorrect location of the fetus, the woman in labor has health problems or is too narrow pelvis, a caesarean section is performed.

2. If the cervix is ​​ripe, but labor activity slows down, labor induction is used. To do this, the hormone oxytocin is injected, which allows you to accelerate uterine contractions and cervical dilatation.

3. With an immature cervix, labor is stimulated by introducing a gel or suppositories into the uterus containing prostaglandin hormones into the cervix.

In any situation, when the waters break, regardless of the timing and presence of contractions, it is necessary not to postpone a visit to the maternity hospital. Trust the doctors. In a hospital, all conditions are created for successful delivery or prolongation of pregnancy.