Leaking, Tearing, Saving and Thanking

Stuff you really want to know


I've gotten some great questions this week. Readers want to know the nitty gritty about this whole labor and pregnancy thing. I love it. Brooke wants to know the difference between normal discharge and amniotic fluid. Bo wants to know if tearing or episiotomy is better and whether women should shave or wax for exams and "the big event." Danielle had no idea how important her labor nurse would be in providing emotional and medical support in labor and now that she's expecting baby number two, wants to know how to thank the nurses.

Brooke's question about vaginal discharge is an important one. How can you tell the difference between what's normal discharge (and for many of us there's a lot more than when we're not pregnant) and a leak of amniotic fluid? Most of the time, vaginal discharge is creamy, mucousy or sticky, and doesn't smell bad. Most of the time, amniotic fluid is watery, hopefully clear but sometimes yellow, green or with white specks. It's usually easy to tell the difference between discharge and amniotic fluid but it's not so easy to tell the difference between amniotic fluid and urine. Believe it or not, one of the most common reasons women come to the maternity unit is because they're leaking something. Most of the time, it's not amniotic fluid but— you guessed it—pee. When you've got a baby pressing on your bladder, sometimes it leaks. If you start leaking fluid, put on a pad and ask yourself some questions:

1) Is it clear or does it have a color?

2) Does it smell like urine or have a bad smell?

3) Does it only happen when I laugh, cough or jump on the trampoline?

4) Can I control the leak by squeezing my muscles down there?

If it looks like pee, smells like pee and you can stop the flow by squeezing muscles or getting off the trampoline, it's probably pee. If not, it might be amniotic fluid. It still might be pee but please call the doctor/midwife to discuss it. A true amniotic leak can't be controlled, usually continues leaking once it starts (but not always), is generally clear (with the occasional white specks) unless there's meconium and may or may not be followed up with contractions. Your doctor/midwife should know about it if your discharge is anything other than what you're used to. When in doubt, call. If you get a major leak, your pants will be wet, your car seat or couch will be wet, you'll make a splash at the grocery store and there won't be any doubt in your mind. Call your doctor/midwife anyway and get ready for labor.

Which is better—A tear or an episiotomy? Tough choice, right? Hopefully, you won't have to experience either and most of the time, you won't be the one to make that choice. Most women come in saying they don't want an episiotomy and most doctor/midwifes don't do them routinely. They save that for those times when the perineum (vaginal tissue) just won't stretch anymore and they really, really, need to get that baby out. Then they make a snip and delivery is usually pretty quick after that. Lots of women have tears and they're generally easy to repair. Most practitioners prefer a minor tear to an episiotomy and are very skilled at sewing them up. Ask your doctor/midwife if he/she routinely does them. If he/she's pro-episiotomy and it's an idea you're opposed to (and most of us are), find someone else. It's one of the last decisions that get made in delivery and unfortunately, one you won't be participating in. You're going to be very busy pushing, pushing, pushing and if you need an episiotomy, your practitioner will probably just go for it.

As for waxing or shaving, neither is necessary or expected. We see it all from full-on Brazilians to full growth. We don't shave patients in labor anymore (except for a very small area right over the top of the pubic area prior to cesarean delivery) and the hair doesn't get in our way. We just don't care about the hair. Really.

Danielle—what a sweetie. How to thank the nurses? Well, there are a few ways. We love cookies, coffee, candy, and thank you notes. When our patient care coordinator calls you after delivery (this doesn't happen at every hospital), tell them you had a good experience and they'll pass it on to us. Let your doctor/midwife know if we did an especially good job and again, hopefully they'll let us know. The most effective and easiest way? Just say thanks. You're going to be pretty busy once you leave our care and we totally understand that sending notes and gifts is going to be a challenge. We love to hear when we've done a good job but really, it's just our job. We do it because we care; because we want every woman and her family to have a good experience. We do it because we're nurses and that's just what we do. But thanks for thinking of us, Danielle.

Good luck Brooke, Bo and Danielle. I'll be rooting for you and thanks for the excellent questions. Keep 'em coming, ladies. I'm ready for you.

Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.