To Break or Not to Break Your Water

In some settings, it is still not unusual for a care provider to artificially break the mother's water if her sac is still intact when she arrives at the hospital. The rationale was "let's speed things up" and break the water to "get contractions going." Why spend more time laboring when we can potentially make it go faster? In fact, early research did show a small decrease in the length of labor when the care provider did an amniotomy, which prompted everyone to jump on the bandwagon and make that a part of the routine care mothers received while in labor.

Some mothers may not know that breaking the mother's water may be a part of their care provider's practices. Nor do the majority of mothers seem to be aware today that there are significant drawbacks to having your sac artificially broken during labor.

What Does the Research Tells about Breaking the Mother's Water?

A recent meta-analysis of over 14 studies with over 5,000 mothers during labor published in the Cochrane Review has shown that an amniotomy did not have any difference in the length of the first stage of labor. Nor did mothers show any difference in their own satisfaction of their labor whether or not their water was broken artificially. There was a slightly increased chance of a cesarean if the care providers performed an amniotomy, although researches found the results were not statistically significant. The authors of this review state that they "cannot recommend that amniotomy should be introduced routinely as part of standard labour management and care."

Is an Amniotomy Harmful?

Little is known about whether or not having your water broken will definitely be harmful in every case. However significant questions should be addressed. Based on the above findings, we may suspect that there is a slightly higher chance of a cesarean if your care provider does an amniotomy.

We also know that the amniotic sac provides a protective barrier for the baby and when that sac is broken, the likehihood of harmful bacteria entering the vagina and area surrounding the baby can result in infection. Research tells us that after a mother's water is broken for more than 24 hours, her risk of infection increases.

The amniotic fluid surrounding the baby acts as cushion, or a "shock absorber" from the intensity of labor contractions. It is not unusual to see a baby's heartrate drop shortly after the mother's water is broken as the baby tries to adjust to the loss of that cushioning.

New questions are arising about the need for amniotic fluid surrounding the baby, especially the tiny amount of fluid around the baby's head, that may play an important role in the rotation and descent of the baby. What do you do if your ring is too tight and gets stuck on your finger? You add slippery fluid to twist it off. The amniotic fluid around the baby's head serves the same purpose in helping the baby to wiggle into position and move down.

Where We Go from Here...

The bottom line is that the main reason for performing amniotomies (to speed up labor) has been disputed. Evidence points to the fact that the amniotic fluid serves many functions during labor and interfering with those functions will very likely interfere with labor. Mothers need to know that, just like other suggested interventions in labor, they have a choice. In order to make sure your choices are respected, be sure to have additional support such as a doula, as well as write your preferences down in a birth plan.

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