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Planning the Unexpected What if...

What if my waters release before labour begins?

Waters usually release as a slow trickle of fluid that you notice as wet underwear. At the end of pregnancy, this fluid can also be urine and the only way to know the difference is to call your midwife or doctor to do a test. That said, there are now special pads available that you can use to tell the difference at home, they are expensive but useful.
If you are leaking amniotic fluid at term, your labour waves will probably begin within 24 hours of your waters releasing. Don’t worry about running out of water, your amniotic fluid replenishes itself over time and in some cases your amniotic sac even re-seals, stopping the flow of fluid. In the meantime, try and get as much rest as possible and follow the about creating the optimal environment for your hormonal orchestra.
If the waters are green, brown or smelly, call your midwife or hospital immediately.
If you experience a large gush of waters, call your midwife or doctor sooner rather than later. When speaking to them give them information about the amount of fluid, how it’s flowing (drops, a trickle, one big gush) and its colour. Decide on next steps with them, keeping in mind the environment your hormonal orchestra needs to function well.

What if I need an induction?
If your midwife or doctor are offering you an induction of labour, make sure that you get all the information you need about why they feel it is necessary. Induction can increase the chances of having a long labour, caesarean or assisted birth (vacuum or forceps). Your baby may also need extra help breathing after an induction.
We still don’t know exactly what causes a woman to go into labour, so many of the methods used are not always effective. Also, the hormones used during an induction are not the same as the hormones your body produces, and they are not released in the same way. It’s definitely not a choice to take lightly.
Some questions you can ask about induction are:
• why do you need to induce my labour
• how will you induce my labour
• what can I expect when you induce my labour
• after being induced can I wait for labour waves to begin at home
Just being a few days “overdue” or your doctor going on vacation is not a good enough reason to have an induction. Waiting for labour to begin by itself is the best way to ensure a normal birth and is safest for you and your baby.

On the other hand, there may be a very good reason for the induction (like severe preeclampsia) that you should know and understand before saying yes - in cases like these the benefits of an induction outweigh the risks. If you are confident that an induction is necessary you will feel better about it and can take steps to ensure that you are in an environment that encourages your hormonal orchestra to do its work as best as it can despite the induction. Also plan to have adequate support available through the process (doulas are especially valuable during inductions).
Midwives do not induce labour at home, if you need an induction you will give birth at a hospital. In some places it is possible for your midwife to be with you at the hospital during an induced birth.

Induction methods
Membrane sweep - this is done during a vaginal exam. Your midwife or doctor gently separates your bag of waters from the sides of your uterus. The hormones your body releases as a result can be a way to kickstart labour, but not right away and not every time. After the sweep you can also experience some spotting, streaking or cramps that can, but might not lead to labour. You can go home after this and if your labour doesn’t begin, you can try another method in a few days. Your baby is perfectly safe.

Balloon or Foley Catheter - this is done by inserting a balloon catheter on the inner edge of your cervix that is then slowly filled with fluid. The logic is that the pressure from the balloon will slowly cause your cervix to open and begin labour. Once the balloon is placed, you can usually go home. The balloon will fall out once you are about four centimetres dilated.

Prostaglandin suppositories or gel - during a vaginal exam this suppository or gel is placed in your cervix. The hormones in the medication should work on your cervix to make it softer and begin opening and bring on labour waves. One out of two women will be in labour within 24 hours after having gel applied. Depending on how you react to the prostaglandin, you may have it inserted or applied more than once over a number of hours. In some hospitals, it may be possible to go home after having the prostaglandin applied.

Breaking your bag of waters (artificial rupture of membranes) - this is done during a vaginal exam where a tool that looks like a long knitting hook is inserted through your cervix and used to make a hole in your bag of waters. The hormones released as the waters begin to flow and your baby’s head puts more pressure on your cervix might cause your body to start releasing labour hormones. If it doesn’t work, you will have to move on to one of the other induction methods discussed below - once your waters are ruptured your baby has to be born within the next few days. In some hospitals and midwifery practices there is a policy for you to get antibiotics within a certain number of hours after your membranes are ruptured (by themselves or by a healthcare provider) - discuss this before agreeing to have your waters broken.

Synthetic oxytocin drip - with this method you are given an IV drip of synthetic oxytocin to encourage your body to begin labour waves. Your labour waves must be monitored with a CTG to make sure you are getting the right dose and that your baby is tolerating the drip well. It can take a few hours and a few increases in the dose of synthetic oxytocin to get labour started. Discuss your options for induction with your midwife or doctor and choose the one that works best for you.

Remember, you can always say no to an induction.

Natural Induction Methods
If your doctor or midwife start discussing the fact that you might need an induction in the next few days, you might want to try out a few natural, less invasive methods. They aren’t guaranteed to work because if your body isn’t ready for labour, it won’t go into labour. Keep in mind that any form of induction is still an induction and makes it more likely that you will have more interventions or complications. Also remember that a watched pot never boils, so sitting around and concentrating on feeling a twinge or change will make it harder for labour to actually begin. Do something to distract yourself that doesn’t require a lot of thinking, like baking, knitting, walking or anything else that doesn’t engage your mind too much.

Sex with orgasm and ejaculation in your vagina offers a double benefit because a good orgasm can help bring on labour waves, as can the prostaglandins in semen. It’s also a good way to relax and “turn off” your brain. If your labour is slowed or stalled, great sex is an option to start it up again.

Nipple stimulation produces oxytocin which can bring on labour waves. You can do this during sex or masturbation or by just massaging your nipples for five minutes (including your areola) and waiting twenty minutes or so to see what happens before trying again.

Acupuncture or acupressure - find an experienced practitioner of either of these therapies and go in for a treatment to encourage labour. Only go in if you are at or past 40 weeks of pregnancy.

Chiropractic, osteopath or massage treatment - find a practitioner that is skilled and experienced in doing treatments to encourage labour. Only go if you are at or past 40 weeks of pregnancy.

Spicy food some women find eating spicy food can help bring on labour waves, while for others this kind of food brings on diarrhoea. Irritating your bowels might be what brings on labour waves - but really who needs irritated bowels or diarrhoea going into labour?

Walking, taking stairs gentle activity can help bring on labour because it might help get your baby into a better position to put more pressure on your cervix and stimulate labour to begin. Don’t overdo it - two shorter walks per day with a nap or rest in between are enough.

There is a Chinese proverb that says “When the fruit is ready, it will fall off the vine.”

The same can apply to pregnancy - you will go into labour when you are ready and not a moment sooner.