This brings up to the question,"what at all is water breaking as far as pregnancy is concerned?"Do all water breaking means you are in labour? Does labour occur immediately after water breaking?
Most pregnant women are concerned about their pregnancy. They are concerned with when to give birth, their journey throughout the pregnancy and whether or not their pregnancy will yield a life baby. Simply put, the whole journey from conception to delivery is full of anxiety and it is only alleviated when you give birth to a life healthy baby.With pregnancy,it is likened to having your baby in a sac and the walls of the sac are the membranes commonly known as the amnion and chorion.You only start to see clear fluid leaking from your vagina when you have a break in the walls(membranes) of the sac.
In God's own sense,ideally you should see this water -like fluid when you are at term which is 37 completed weeks or just before labour or during labour.If you see this fluid before 37 weeks,then it means something is wrong which in this case is called premature rupture of membranes.
Karen was pregnant for the tenth time when I saw her and it was only the eighth pregnancy which resulted in a live healthy baby at 31 weeks.Unfortnately,she lost her first seven pregnancies as well as the ninth pregnancy. All the pregnancy losses were preceded by her water breaking.So it answers the question that not all water breaking means you're in labour.In Karen's case,I was particularly pitiqued at the trend of her pregnancy losses and that heightened my interest in her case.It becomes a challenge and your baby's chances of surviving outside the womb or uterus becomes drastically reduced if your water breaks before 28 weeks and between 28 and 37 completed weeks.A woman's body is powerful,unique and capable.Women are strong.These are some of the cases that you need to sympathise with your patient,encouraging and supporting her all way long.And I must put, a good support system is very crucial. Supportive partner and relatives are very needful.
Karen's tenth pregnancy was around 22 weeks and some days when I met her.In Ghana,based on the level of development in terms of our healthcare,age of viability of a pregnancy is 28 weeks.That is,at 28 weeks and beyond,in case there is a need to do delivery,your baby can survive outside the uterus.Karens baby wasn't yet at the age of viability so it was very alarming when her water broke and her cervix too was dilating.The cervix should ideally start dilating around the late third trimester of your pregnancy.It tells you that your baby is growing larger which is normal so the uterus has to open it's portal of exit which is the cervix in anticipation for a vaginal delivery.
Around 12 weeks of Karen's tenth pregnancy,she had a cervical cerclage. This is a short procedure in which the cervix is stitched to avoid it's opening or dilation before labour is due.I earlier stated that her 8 previous pregnancy losses were all preceded by her water breaking.This explains why her tenth pregnancy,in order to avoid such recurrence,a cervical cerclage was done.So it was really disturbing when her cervix was opening despite the cerclage being done.It was a pure classical case of inevitable abortion.Though at the hospital,ultrasound scans were taken and it was reported that the fluid around the baby was adequate yet she was still loosing the clear fluid everyday.Associated with it was some abdominal pain and some vaginal bleeding.
WHAT WOULD REALLY MAKE A PREGNANT WOMAN'S WATER TO BREAK BEFORE LABOUR?There are so many causes.It could be genital infections like bacterial vaginosis,multiple pregnancy,polyhydramnios(more fluid around your baby),previous history of water breaking before labour,cigarette and alcohol abuse in pregnancy,anaemia in pregnancy,bleeding in early pregnancy and most importantly cervical insufficiency(as in Karen's case).It is therefore imperative to see an obstetrician or your primary physician to treat genital infections if you have it and to avoid smoking and alcohol abuse in pregnancy.Most importantly,if you have a previous history of your water breaking in previous pregnancies,please do see your physician or obstetrician on time,ideally immediately you find out you're pregnant.
In the long run,Karen kept on loosing fluid everyday so the cerclage had to be removed and the baby delivered.Having to do a cerclage and remove it is an uncomfortable procedure.Whilst hers was removed,I was right beside her and I could see the pain in her eyes, the anxiety,the fears and the cries.Just imagine having getting pregnant for 10 times and only one child survived.I mean it is not easy.The changes your body has to go through with each pregnancy:the gaining of weight,vomitting,increased salivation,skin changes,loss of appetite,the abdominal pains and the cost with each pregnancy in terms of antenatal care visits are very uncomfortable.
Misoprostol was inserted into her vagina to cause abdominal contractions so she can deliver.She delivered a live baby at 23 weeks but the chances of survival of this baby is very minimal.As I stated earlier,the age around which babies can survive outside the uterus is 28 weeks(for Ghana).Regardless,the baby was given to the neonatologists for further care and management.We hope the baby survives.
This was Karen's story.A story that brought me to tears.A story that may make you question your faith.I still do remember her face with tears and the pain in her eyes.I remember the day after the delivery,I came to see her sleeping on her bed and even in her sleep,I could see she is emotionally and physically drained.Karen is a super hero, so are all women.
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Moms