Talk Birth

Unlike what you see in the movies, only a very small percentage of women have their water break spontaneously as the first sign of labor.  Most often, your water will break naturally while in labor, possibly during a strong contraction.  It may happen early on, it may happen towards the end, and in rare cases, the baby may actually be born in the bag of water.  Having your water broken artificially by an OB or midwife, also known as an amniotomy, is one of the most common medical interventions performed today.  A long, thin instrument with a hook on the end is inserted into the vagina, and through the cervix, to tear the amniotic membranes open.  The hope of the medical provider is to speed up your labor through this procedure.  But is it really working?  Is it really making labor faster?  Is it benefiting anyone?  Studies are saying no.

A study was performed on 4,893 women in 2007 aiming to compare the length of a woman’s labor who received an amniotomy versus a woman who did not.  There was no statistically significant difference in length of time found in the first or second stage of labor whether you had your water broken artificially or not. (Click here to read about this study)

Yet, there is evidence that amniotomies can lead to fetal distress, fetal heart rate complications, umbilical cord compression (because the baby’s cushioning against contractions is gone), and umbilical cord prolapse—which would all ultimately require an emergency c-section.  These risks are intensified if an amniotomy is performed before the mother is in active labor, the baby is not engaged, and/or the mother is not at full-term.  An amniotomy may also increase the risk of infection in the mother (especially if she is receiving vaginal exams after the water is broken).  In a hospital setting, once your bag of water is open, they usually have a time limit (sometimes 12 to 24 hours) for you to deliver before they will want to perform a c-section (this is due to the previously mentioned worry of infection).  So once an amniotomy is performed, labor almost becomes a “race to the finish line”—meaning there is a lot of pressure put on the mother to have the baby much faster then the baby may actually be ready to come.  This can lead to further medical interventions.

So why are they so commonly performed?  The most common reason is because providers see it as a quick and simple procedure that they hope will speed labor without needing to use chemical methods.  The belief is that the prostoglandins in the amniotic fluid will bathe the cervix, making contractions stronger and closer together.  Yet, studies are showing that even if amniotomies do increase the speed of labor, it is only by an hour or two at most.  A number that doesn’t sound significant enough to give an indication for this intervention.  Some nurses may want to use internal electronic fetal monitoring for a more accurate heart rate reading (where scalp electrodes are placed on the baby’s head).  This can only be done if the water is broken.  Internal fetal monitoring poses its own risks of infection to the mother and baby, and should only be used if the benefits truly outweigh the risks.  In other more severe cases, they may want to get a sample of the baby’s blood, or get a sample of the amniotic fluid due to a concern of presence of meconium.  In cases like these, there were probably already early concerns of fetal well-being during pregnancy, and before labor began.

The bottom line is, an amniotomy shouldn’t be routinely performed in a healthy labor just to speed things.  It should be saved for cases of real medical concerns.  Consider alternative methods to speeding up labor such as getting into upright birthing positions, moving around in labor, and relaxation techniques (such as hydrotherapy).