Have you considered that labour pain could start before your water breaks? Are there ways to prepare for childbirth and the associated physical discomfort?

While breaking of the amniotic sac can signal labour, that doesn’t always happen. Every mother’s birthing experience is unique – those in labour may not necessarily experience a rupture (or waters breaking) first.

Experiencing childbirth can be a difficult process, with a lot of unknowns and plenty of questions to consider. This article will cover the question of whether labour pains can start before your water breaks, and how to best prepare for any physical discomfort that may come with it.

What is the definition of ‘waters breaking’?

The amnionic sac, a thin-walled, fluid-filled bag that keeps the baby safe and regulates its temperature, typically breaks at the on-set of labour, causing a “waters breaking” event.^1,2

When your waters break, it can start with either a small leak feeling like you wet yourself or strong rushing out of fluid gushing onto the floor.

It is typical for labour pains to begin without the breaking of waters, so it is critical to be aware of the indications and signs that may show up when labour begins. Contractions will start out mellow but get stronger as labour continues. Other signs of labour starting, involves alterations in discharge from the vagina, pain in the lower back area, and a bloody show. When going through any one of these symptoms, it is important to reach out to your healthcare provider or go directly to a hospital.

Every pregnancy and labour experience are different. The length of labour can range from a few hours to more than a day, so it is important to be mindful and stay patient during this process. If you have any questions or worries, make sure to contact your healthcare provider or hospital for help.

Prior to labour, it is beneficial to prepare a plan that outlines the steps needed to be taken when labour starts. An emergency bag should be packed. This may contain items such as water, snacks and items to keep you occupied during the process, as well as any pain relief options you may consider using, such as heat packs, Maternity TENS Machine or over-counter medication such as paracetamol or ibuprofen. 

Often, labour begins with the breaking of waters, but not necessarily.

Contractions of the uterus can start labour without the need to manually break the amniotic sac. If dilation and thinning of the cervix and baby’s head are deep in the pelvis, however, a small opening may be made by a health professional to help speed up delivery.

Sometimes, when the amniotic sac breaks well ahead of labour contractions, normally prior to the 37th week or pregnancy, this can be regarded as a condition called PROM (Premature rupture of the membranes). If this occurs, you should contact your doctor right away, as it can lead to problems such as infection if labour induction is not performed. 

Hence, what is the cause of labour to begin if it isn’t a rupture in the amniotic sac membranes?

What Triggers the Beginning of Labour?

Although the precise causes of labour are unclear, it is widely accepted that a combination of physical and hormonal changes initiate it. Oxytocin, Prostaglandins, and Relaxin are all hormones believed to be necessary for the onset.

As the baby develops and the uterus expands, it puts stress on the cervix, the entryway to the uterus. The pressure can cause thinning and widening of this cervix, which is necessary for birth. In addition, the cervix must shorten for delivery to occur.³

If your waters have not broken, how can you tell you are in labour?⁴ Here are a few signs to be aware of:

Contractions are abbreviated forms of words or phrases

Contractions are usually the first sign of labour, and they can vary in intensity. Your abdomen may become tight or harden in a wave-like motion – this will usually get more frequent and stronger as your labour progresses.

How do contractions feel?

During contractions, the uterus tightens and then relaxes – this can be likened to very strong menstrual cramps or the abdominal pain associated with Diarrhoea.

Near the end of pregnancy, Braxton Hicks contractions may be felt. These contractions are generally harmless and cause no discomfort.

As labour advances, your contractions will become stronger and longer. You may feel intense pain that radiates from your abdomen while they occur. After the contraction passes, the pain will lessen and hardness in your belly will disappear if you press on it.

The contractions help bring the baby out of the uterus by pushing it and widening the cervical opening.

It’s advised that you remain in the comfort of your home until contractions become regular, which is typically recommended by a midwife or doctor.

To relieve pain while you wait, try taking a warm bath or shower, using a heat pad,~ or using a Maternity TENS Machine at home.

Variations in vaginal discharge:

When labour is about to start, changes in vaginal discharge may indicate it; some women experience an increase in amount or a shift in colour or consistency of their discharge due to the cervix dilating. 

Pain in the lower back

When the baby’s head moves down into the pelvis, it can put pressure on the lower back that can be painful or uncomfortable.

Lower back pain is a common sign that labour is approaching. It may start as a dull ache but will become more severe and frequent as time goes on.

Numerous causes of lower back pain while giving birth exist, such as the baby’s head impacting nerves in the lower vertebrae, contractions pushing them down and hormones that relax ligaments in the pelvic area.

To treat lower back pain, solutions such as massage, heat and cold therapies, relaxation exercises, TENS therapy devices*, and medications like paracetamol or ibuprofen can be used. Always speak with your doctor or midwife to discuss pain relief options and include them in your birthing plan.

Bloody Show

When the cervix dilates, it may cause a loss of blood or mucus, called a “bloody show,” which is an indication that labour is near. Also called the “mucus plug, this pink jelly-like substance can fall out once the cervix is around 2cm dilated and can occur just as labour is beginning, or even up to a couple of weeks before.⁵ 

If you have any of the above symptoms, it’s important to contact your doctor or go to the hospital. It’s also important to remember that every woman’s labour experience is unique, and what is normal for one person may not be the same for another.

Labour can start without the rupture of the amniotic sac membrane and the exact cause is still unknown. Signs that labour has started including contractions, changes in vaginal discharge, lower back pain and bloody show, so it is essential to inform your healthcare provider or go to the hospital if you experience any of these.

Good luck in your birthing experience!  

*Always read the label and follow the directions for use. Do not use with any electronic medical devices e.g. pacemakers; prior to last 3 weeks of pregnancy; or on the abdomen at any stage of the pregnancy.

~Always read the label and follow the directions for use. Do not stick directly on skin.

Sources:

1. https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/water-breaking/art-20044142
2. https://www.hopkinsmedicine.org/health/wellness-and-prevention/anatomy-fetus-in-utero
3. https://www.yourhormones.info/topical-issues/hormones-of-pregnancy-and-labour/
4. https://www.thewomens.org.au/health-information/pregnancy-and-birth/labour-birth/stages-of-labour
5. https://www.nhs.uk/pregnancy/labour-and-birth/signs-of-labour/signs-that-labour-has-begun/