Giving Thanks for an Intact Water Bag

We all know there are two membranes that surround the baby in the womb: the inner amniotic membrane and the outer chorionic membrane. These two membranes don’t always release at the same time.  Sometimes a mother may leak amniotic fluid, believing her water bag to be broken, only later to learn the water bag is still intact! How can this be?  Because the chorionic membrane released and the amnion remained intact.

This is a true Thanksgiving story of an intact amniotic membrane after leaking amniotic fluid for 40 hours.

We recently attended Adriana’s inspiring birth of her baby Amos,  whose water bag had been leaking for 40 hours before labor started.  The mother was sure the leaking fluid was amniotic fluid. And we midwives were certain it was amniotic fluid because we confirmed it with nitrazine paper.  When we finally performed the first vaginal exam in active labor, we were surprised! Our midwives’ concerns and surveillance were relieved to discover an intact amniotic membrane.  We knew the risks of prolonged ruptured membranes no longer applied.

water-break-pregnancy

 

Ten minutes before the birth the amnion finally released with a huge gush of clear fluid, quickly followed by a healthy, vigorous baby boy.

As a midwife, I’m grateful when the amnion remains intact because it protects mother and baby against infection; the umbilical cord is insulated; and the baby has more freedom of movement.

A common challenge in childbirth is when the membranes release before labor starts.  In medical terminology we call this premature rupture of membranes (PROM).

The literature tells us the longer the membranes are ruptured before birth, the more likely it is for the mother and baby to develop an infection. This is why hospitals and birth centers induce with pitocin (or Misoprostol) 24 hours after spontaneous rupture of membranes (SROM) if labor hasn’t started.  (Birth Centers transfer to a hospital for induction).  Homebirth midwives also recommend a variety of home therapies to naturally induce labor after the membranes release.

When the membranes release before the beginning of labor, the homebirth midwife and her client have concerns of increased risk of infection while waiting for labor to start.  Of course the expectant mother is informed and has the option to go to the hospital and induce labor- but she usually doesn’t want to!

So the homebirth midwife and her client are very careful to minimize the risks by monitoring both mother and baby and following precautions to decrease the likelihood of infection.

Then we wait… and wait…and wait some more.  It can feel like a long time.

diagram

According to the literature, 95% of women with PROM will start labor spontaneously within 72 hours.  I’ve never known an expectant mother in this situation to exceed 72 hours before labor finally started.

As a midwife, what gives me more patience and reassurance during this suspenseful time is the hope of a remaining, protective amniotic membrane.

The presence of an intact amnion is usually unknown since we avoid vaginal exams after SROM to limit infection.  We usually aren’t able to confirm the presence of the amniotic membrane until the first exam.

If it does remain intact, the amnion will release later during active labor or birth, often with a big, dramatic splash of amniotic fluid. Be ready! This can be a baptizing event. Or even more rare, the membrane remains intact and the baby is born in the caul.

I give thanks for our healthy mother and baby this Thanksgiving and all those strong amniotic membranes that stay intact until the very end. They give a nice sigh of relief for the homebirth midwives.

Stay tuned to learn how to grow a strong water bag!

Inspired by Adriana and Amos
Inspired by Adriana and Amos