What happens when you spring a leak? Most of us go through pregnancy worrying about a public watershed moment when our amniotic membranes will break with enough gush and rush to fuel a water park. I was so worried about it when my second was overdue (on the day I graduated from nursing school) that I wore double Kotex to walk across the stage and get my diploma. It happens on TV and in the movies all the time and yet, most of my patients have a much subtler experience. If only it was a simple as they make it seem on soap operas. A gush of fluid, a grab at the belly, a brief scream of "OMG the baby's coming." Everybody reaches for their cell phones and calls the ambulance. Next thing you know, labor's over and the kid's 3-years-old.
A recent patient, Sharon*, was dozing uncomfortably through mild, irregular contractions at 2AM when all of a sudden she was wide-awake. A moment later, she felt the Pop and sprang out of bed. Sure enough, warm fluid ran down her leg. She grabbed a pair of sweat pants to sop it up and shuffled to the bathroom. The water flowed and flowed and flowed. Who knew there was so much in there? It felt like buckets, though it was probably only about a quart. She took a shower, found her pack of pads, and waddled back to bed, thankful for her husband's messy habit of throwing his pants on the floor. Without them, her bed, floor and path to the bathroom would've been sopping.
She slept fitfully until dawn when her contractions, still irregular but more annoying, made it impossible to doze any later. She called the hospital and drove over, thinking that labor would kick in any minute. After being admitted to the hospital where they confirmed that sure enough, that clear wet stuff on her pad was amniotic fluid, she waited some more. Sure, she was contracting but they didn't seem to be going anywhere. Sometimes she'd have two back to back and then a half hour of regularly spaced contractions. Sometimes she'd go fifteen minutes without anything. Nobody checked her cervix because they didn't want to introduce bacteria into the uterus. It was clear she wasn't in active labor so it wasn't information they needed. Sharon waited, walked, rocked, used the birthing ball and waited some more. At two in the afternoon, her doctor gave her some options: 1) do nothing but wait for labor to progress on its own. 2) try alternative contraction-stimulating techniques like nipple stimulation or 3) start some pitocin and kick start the sucker. Sharon was already exhausted from her previous night of contractions and wet underwear. After discussion with her husband, she decided to gun it and go. Pitocin, baby. Let's get this party started.
By 8PM, the Pitocin had worked its magic and she was 4 centimeters. That was her first cervical exam and her nurse had checked because Sharon was really uncomfortable and wanted some kind of help with the pain. If she'd been less than 2 centimeters, she'd go for some medicine in the IV. If she was more than 3, she wanted her epidural. 4 centimeters was really good news to Sharon. She got her epidural and fell into a deep sleep. Her husband got some dinner, pulled out a cot at Sharon's bedside and caught a few hours too. At 2AM, a full 24 hours after her water had broken; Sharon delivered a lovely little girl.
What would have happened if she hadn't gone for the Pit? Who knows? She'd still have had a lovely little girl, that much we know. It just would have taken a lot longer. That's OK. As long as mom and baby are both handling labor well, there's really no reason to rush. If Sharon had been really focused on a no-intervention delivery, she could have waited it out. Turns out she wasn't all that invested in the all-natural method and was perfectly content to use Pitocin and an epidural.
There are as many labor stories as there are labors. Sharon's was pretty typical. Most of the time, amniotic membranes rupture after labor is in full gear, either spontaneously or artificially. In a hospital setting, artificial rupture is very common. The doctor or midwife takes out what looks like a crochet hook and snags the bag. It doesn't hurt and often times, it effectively turns up the intensity of labor. The nice part is, there's no worry about it happening in the grocery store, your office, in front of a bunch of guys. The downside? Well, it's an intervention.
While there's not much drama in Sharon's story (guess we can't sell this one to the soaps) it had a happy ending. It was a lovely beginning to the story of Sharon's family.
*Names are changed to protect privacy
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