What's the general rule in hospitals re: breaking waters? Or does it vary?

[sasha]

I just met up with my friend who's living in Shanghai, and met her gorgeous son to whom she gave birth about 7 weeks ago. She was telling me she got to hospital and was 3 cm, they gave her the epidural, and then broke her waters a few couple of hours later; baby was born about 5 hours after that. I didn't want to press her for details of why she had her waters broken (she's had a pretty traumatic pregnancy and some miscarriages before/between live births, so I just go with what she wants to talk about).


I'm just surprised they broke her waters... is it common? With both S and T, the waters didn't break till very late (ie soon before second stage), and there was never any discussion of breaking them earlier than that. My friend wasn't in labour for long (she'd only gone into labour earlier that day) and it was spontaneous onset, so I suppose perhaps they did it to speed things up a bit?

I wondered if it were different overseas, or if I've just never had the experience and that it's really quite common to have your waters broken, rather than having it happen by itself...

[trishalishous]

I know that Malaysia is HEAPS more interventionist ( and Italy too) although I havent delivered a child there.
In my regional WA hospital I was induced (gel) at midday, and there was no change (only 3 cm) at 6pm so I was left overnight for the ob to AROM the next morning.
I actually SROMed at midnight, and DD arrived at 930 am (traumatic labour)

[Traveller]

there is a school of thought that rupturing the membranes speeds up labour, therefore freeing up the labour bed sooner. However the most recent research has refuted this, so it is no longer common in many units to break the waters just for the sake of it.

Breaking the waters can stimulate contractions if they are weak or non existent though, hence it is used as part of the induction process. It may be that your friend was not yet in established labour, and they decided to break her waters to get her into labour. It is also used if labour has stalled (for example if a woman is stuck at 9cms, breaking the waters will bring the baby's head down onto the cervix and help it dilate that final cm). Or it could be that they are following guidelines based on older research. As a general rule though, if induction or augmention of labour with a drip is being considered, the waters will be broken first as the drugs are less effective if the membranes are still intact and sometimes breaking the waters will be enough on its own. But in a normal labour it is often not necessary.

[Snacks]

Am not going to repeat what Traveller said: I think as usual she's hit the nail.
Only wanted to mention that in both my labours I was asked during an internal if I wanted them to do it - it's not something they did without explaining/checking first. In my second labour we were discussing it and then she touched the membrane with her finger and it broke.

[onthefly]

I think it depends. With my first I was induced, so AROM was part of that.
With my second, it wasn't part of the plan, but our midwife suggested it as labour was not progressing very well (the idea being that it would put more pressure on the cervix). It certainly made the contractions more painful, really couldn't say for sure whether it sped things up.

[sasha]

Thanks for all your thoughts. She seemed so matter of fact about it, I didn't really want to say, "Uh... why?!!" Curiosity satisfied!