Sometimes when labour starts, you need to head for the maternity ward straight away. Christine Hill explains when to get a move on

Most women get to the end of their pregnancy and just can’t wait to go into labour. Feeling heavy and bulky, tired and breathless, it’s time to have that baby out. If things get going gradually, you can hang on at home until the contractions get stronger and come at regular and shorter intervals. But there are two signs to watch for which mean you must head for hospital or call your midwife, if you’re planning a home birth.

The first is bleeding and the second is if your waters break

Bleeding

This is not to be confused with a ‘show’ – a plug of mucus sometimes streaked with watery blood which often signals the start of labour. If, by contrast, you lose fresh blood – the sort of deep red that comes out when you cut your finger – GO STRAIGHT TO HOSPITAL – EVEN IF YOU’RE PLANNING A HOME BIRTH. There’s a possibility that you may have an APH (antepartum haemorrhage). This occurs when part of the placenta becomes detached from the wall of the uterus. It’s a potential emergency because the baby may not be getting enough oxygen, so it needs to be checked as soon as possible. Don’t worry if it turns out to be a false alarm; no hospital will make you feel foolish for playing safe.

What happens when the waters break

Imagine there’s a balloon (the membranes) within the uterus, which is about a third full of water (the amniotic fluid). Your baby lies in the balloon, surrounded by the fluid. It’s slightly confusing to talk about the ‘waters going’ because, in fact, it’s not the waters that have gone, but the membrane that contains the waters. Hence the medical terminology, spontaneous rupture of membranes, or SRM for short.

Only 5% of labours begin with spontaneous breaking of waters with contractions following. More commonly, the waters break during labour. So if you think your waters have gone, you must go into hospital or call your midwife, even if you can’t feel any contractions.

There are two reasons for this

1. Although it is extremely rare (about 1 in 500 pregnancies) the baby’s cord may have dropped down and could be squashed between his head and your pelvis. This is called cord prolapse. Your midwife will make sure this hasn’t happened by monitoring the baby’s heart.
2. Once your waters have gone, there a risk of infection to you and your baby, so most obstetricians will want the baby delivered within the next 24 to 48 hours. The date and time that your waters break have to be registered on your notes. The midwife will probably test the fluid with litmus paper to make sure they have gone. If nothing else is happening, you might be sent home for a little while to see if contractions begin of their own accord, but you’ll be asked to take your temperature every four hours in order to check that you’re not getting an infection.

If you don’t start contractions spontaneously the hospital will induce labour

Although you may be disappointed to be induced, it is the best option for you both. Otherwise, when your baby is born, he may have to be given an intravenous course of antibiotics (not the best of starts) and it means you will have a longer stay in hospital.

How much water is there?

Some women report a positive flood when their waters break but, in practice, the quantity varies. It depends on the amount of fluid between the baby’s head and the cervix – the forewaters. If your baby has forewaters, you could lose as much as a litre of fluid – hence the deluge, and you certainly won’t be in any doubt as to what’s happened.

But if your baby is lying with its head on the cervix, you may only leak a little bit of fluid because this will act as a plug. In this case, it’s hard to know if your membranes have actually gone and you really are leaking amniotic fluid.

If you’re not sure, try this test

1. go to the loo and empty your bladder
2. pull up your pelvic floor muscles
3. with a tight pelvic floor and empty bladder, bear down

One other thing

The uterus will continue to make amniotic fluid, even if the membranes have ruptured. It’s a bit like the plug being taken out of a bath, while the taps are still running. This means that you’ll continue to lose fluid and feel damp the whole time. So even if you are leaking in dribs and drabs, don’t loiter at home. Head for the maternity ward for a check- up or call your midwife for advice if you’re planning a home birth.