Identifying Different Leaks During Pregnancy
Not all my time at the hospital is spent delivering babies. Sometimes I'm on "pad patrol." That's nurse-speak for postpartum mother/baby care. Go ahead—guess what kind of pad I'm talking about. Sometimes I "do outpatients"—pregnant ladies who need medical attention but aren't necessarily in labor. A whole lot of outpatients come to the hospital with an Unidentified Foreign Leak. My job is to "Name That Leak."
Most of the time it's pee. I know what you're thinking: "How could they not know they've wet their pants?" They just can't, that's why. You try balancing a whole baby on your constantly full bladder while working a full time job on your feet and chasing a pack of screaming toddlers. You'd leak a little too. Believe me, most of these women have no idea they simply peed their pants or they'd never come in for an official diagnosis.
Sometimes the UFL is far more embarrassing. Whenever we get a "Leaker," we have to ask a few questions. One of those is: "When was the last time you had sex?" If the answer is: "About an hour ago and something yucky came out after. I think my water broke"; then my job is fairly straightforward—just some basic education. I know, I know, they ought to know the difference. We nurses think so too but—it's our job.
The big priority is determining whether a Leaker has actually broken her water bag (officially called Spontaneous Rupture of Membranes—SROM). How do we do that? By process of elimination and the use of a microscope.
First of all, we ask for the story. What happened when her undies got wet? If she describes an occasional squirt whenever she sneezes, it's probably pee. If she describes what we call "a positive shoe test"—a gush of fluid that runs down her legs and fills up her shoes—it's probably SROM. We ask, "Did you have to wear a pad to the hospital?" Yes? We want to see it. No? Are your clothes wet? Yes? It's sounding like SROM. No? It's probably pee (or something "yucky").
Once we get our hands on the aforementioned pad, we test it with a little piece of Nitrizine paper. That's a yellow test strip that turns bright blue in the presence of amniotic fluid. Unfortunately, it sometimes turns yellow in the presence of urine, blood and vaginal discharge too, so we use a positive Nitrizine test in conjunction with other information to "Name That Leak."
By this time, we've probably got our Leaker sitting in bed with a big blue Chux under her tushie. It's just like a puppy pad (an absorbent paper pad with a waterproof back). We'll check the Chux periodically for a puddle. If we see one, we'll Nitrizine it. What if our Leaker describes a small puddle but her pad and introitus (that's the very outside part of the vagina) are Nitrizine negative? She might still be leaking amniotic fluid, just not very much.
So now you're probably getting the idea that ruling out SROM isn't always easy. The next step is a sterile speculum exam. Oh yeah, baby, everybody loves that.
We get a speculum (that silly-looking, yet intimidating duck-billed instrument that opens your vagina enough so we can see your cervix). Using a sterile technique we look for pooling. Just like it sounds. We shine a bright light into the back of your vagina (yep, only that far—it only seems like we're looking at your tonsils) to see if there's a little pool of fluid. Yes? Probably SROM. No? Probably not.
RELATED: Vaginal Discharge During Pregnancy
Next step: we take a big sterile Q-tip, swab it around back there, then swipe it onto a couple of microscope slides. We then take the speculum out and Nitrizine any fluid that's on it. Nitrizine positive? Probably SROM. Nitrizine negative? Probably not.
Once we've got our slides we wait 15 minutes for them to completely dry. Then we head to the microscope and start looking. Amniotic fluid dries into very distinctive salt crystals that look like the fronds of a fern. We methodically scan every speck of the slides looking for ferns. If we see "ferning"—welcome to labor and delivery. Your water has broken and you're going to have your baby sometime in the relatively near future.
Most of the time, we don't see ferns and that means no SROM. We see all kinds of other stuff in there. Sometimes we even identify "yucky stuff." Guess what? That's what got you pregnant in the first place. We call the physician with our patient's story, Nitrizine, speculum and microscopic information (and of course, some fetal heart monitoring) and invite him to play "Name That Leak" with us. Most of the time, we send our Leaker home with the reassurance that she's just one of many who'll come in to our unit that week with a UFL.
We hope she'll have a sense of humor about it. We certainly will because not only will we see countless Leakers in our practice, most of us were Leakers too. Yeah, it's embarrassing and a tiny bit gross, but it's not fatal. Welcome to motherhood, where we leave our pride and dignity at the door.
On a side note—really just a personal request from all labor nurses to all pregnant mothers: When you lose your mucous plug; please don't bring it in to show us. We really, really, don't want to see it. No really, ladies, we don't. That's just gross.