Labour is pretty aptly named; it can definitely feel like work. While every birth is unique, most women will agree it takes a good deal of endurance to work through their labour and give birth to their baby.
It’s not surprising then, that many women and providers would seek to make labour as short as possible, while still maintaining a safe birth experience.
One method that is thought to speed up labour is an amniotomy.
An amniotomy is when a small crochet hook-like instrument is used to rupture the bag of waters, known as the amniotic sac. The thought process is that the hormones released when this occurs might encourage labour to progress faster. Once the waters break, the baby might also move down a bit and possibly put more pressure on the cervix.
With those two effects in mind, amniotomy became a routine procedure in many birthing facilities in several countries. Instead of being reserved for situations where a baby needed to be born quickly, for medical reasons, it became routine practice, in the hope of speeding up labour for women who went into labour spontaneously.
But is it effective in speeding up labour? Are there any risks to performing an amniotomy?
Does Breaking The Waters Really Shorten Labour?
While routine amniotomy was quite common, there wasn’t a lot of evidence to support carrying it out for all labouring women. In fact, evidence shows it doesn’t shorten the first stage of labour.
A new Cochrane review of 15 studies found no evidence to support routine amniotomy to shorten labour for women who begin labour spontaneously. Neither is there any evidence that a shorter labour has health benefits for mother and baby.
The review involved a total of 5583 women and it concluded that routine amniotomy isn’t an evidence-based procedure.
One important thing that wasn’t addressed in any of these studies is whether or not amniotomy increased labour pain for women – something that many labouring women might want to know before consenting to an intervention.
Are There Potential Complications With An Amniotomy?
Every intervention has potential complications (risks). If a procedure is medically necessary, then the benefit of the procedure outweighs potential risks.
While rare, there are some serious potential complications associated with amniotomy. They include problems with the umbilical cord, such as a cord prolapse, or problems with baby’s heart rate.
If, for example, an assisted vaginal birth is needed because a baby is showing signs of distress, and an amniotomy becomes necessary, then the benefit is likely to outweigh possible risks. However, given there isn’t evidence to support routine amniotomy, in your particular situation it’s important to weigh up potential risks when deciding whether there are any benefits in choosing to have an amniotomy.
Does A Routine Amniotomy Increase The Risk Of C-Section?
The review of 15 studies found a possible increased risk of c-section birth when routine amniotomy is performed.
If there is a problem with baby’s heart rate, or with the umbilical cord, it’s likely that a c-section will be necessary. Having membranes ruptured can also increase the risk of infection. For this reason, many facilities have a time frame from when the waters break to when baby must be born, in the hope of reducing the risk of infection. If birth doesn’t occur vaginally within the time frame, a c-section may be performed.
A spontaneous rupture of membranes with minimal vaginal exams might carry less risk of infection than an amniotomy. In the case of an amniotomy, an object or the provider’s hand could introduce bacteria or push it toward the cervix and potentially increase the risk of infection.
Recommendations, procedures and birth norms definitely change over time. One advantage of recent changes in birth is that many professionals and labouring women now try to make evidence-based recommendations and choices. From this most recent Cochrane review, we can conclude that there isn’t evidence to support routine amniotomy.