Article: Breaking Water Does Not Speed Delivery

Childbirth: Purposely Breaking Water Does Not Speed Delivery

By NICHOLAS BAKALAR
Published: October 30, 2007

A large review of studies suggests that a common procedure in labor, intentionally breaking the water, has no effect in reducing the labor time or assuring the baby?s health.

The procedure, sometimes called amniotomy, involves rupturing the amniotic membranes to speed contractions. The procedure has been in use for at least 250 years, although its popularity has varied.

The researchers reviewed 14 randomized controlled trials involving almost 5,000 women and found little evidence for any benefits. Amniotomy did not shorten the length of labor, decrease the need for the labor-stimulating drug oxytocin, decrease pain, reduce the number of instrument-aided births or lead to serious maternal injury or death.

The report, published Oct. 17 in The Cochrane Reviews, did find that the procedure might be associated with an increase in Caesarean sections and a reduced risk of a lower reading on the Apgar scale, which rates the baby?s condition at birth. But neither finding was statistically significant.

?We advise women whose labors are progressing normally to request their waters be left intact,? said the lead author, Dr. Rebecca Smyth, a research associate at the University of Liverpool. ?There is no evidence that leaving the waters intact causes any problems, and there is not sufficient evidence to suggest any benefit to either themselves or their baby.?

I always thought it did speed labour. Since I had such a fast labour for my first (4hours), I assumed this was why.
However my last two births were even shorter and they didn't pop until the last second, so probably had nothing to do with it in the end....

Mine were ruptured for DD1...it sped up the contractions..but not sure if it sped the labour itself up. It was 10 hours 25 mins.

DD2 ruptured not long before she was born on their own and labour was 6 hours 14 mins.

I always thought it made for a quick labour too!

I felt it did with DD as my labour was only 3hrs 54 mins.

My friend had her waters broken a few weeks ago when she was 10 days over & it did absolutely nothing, so I can believe that.

I wonder though if all these people that say it does shortern labour etc is because a lot of the time the waters are broken at the same time as the drip is put in & therefore the contractions are going to get more intense etc straight away??

It may start labour, but would you have had a fast labour anyway? We'll never know ;)

But I have heard it from the horse's mouth (an Ob) who admitted there is no proof it speeds up labour and that it's just what they 'think' (his words).

But I do know it can cause problems more than it it has benefits - not only infection, but cord prolapse if the baby is high, posterior babies seem harder to move once waters have broken, you are put on the clock having artifically ruptured membranes, you have to stay in hospital and they will get your labour going one way or the other, if you have a posterior baby and have a premature urge to push it just makes it worse (my poor sister) .... so many reasons to leave well alone! Membranes left alone often break just before pushing and I think this serves a good purpose.

Not that I necessarily agree with the practice, but I have seen it used with good results. I am interested that they looked at the overall length of labour, but they none of the studies looked at the time from amniotomy to establishment of labour. I've always seen it used in an attempt to start a labour that has been niggling in prelabour for a period of time...

The Cochrane review on Amniotomy has been around since October. Why is it news now? There is no evidence to support breaking waters to speed things up. Why mess with things that are there for a reason?

I suppose it has to be looked at *when* the amniotomy is performed. If done to establish labour, it can cause all sorts of problems as Kelly mentioned like the prolapse, infections, increased risk of c/s, lower apgar scores (although that article from last week was just saying they weren't good anyway LOL) etc. Plus there is a good chance amniotomy won't start labour if the body isn't ready for it, leading to the introduction of the drip and the cascade of interventions which may or may not follow.

But for an established labour, from my experiences it does a blimmin good job of bringing on 2nd stage. I've had 4 births, two were inductions led by an amniotomy, both involved synto drips and one almost ended in a failed induction and a c/s (and almost had a cord prolapse when the amniotomy was performed too). My two natural onset labours were at the hard and heavy contractions stage - full on active labour - when the amniotomy was performed and within minutes I was at pushing.

I know that there is the possibility that I would have broken my waters spontaneously at that point, or headed through transition and 2nd stage at that point anyway, but anecdotally I can say that the breaking of my waters was probably what brought my labours to an end.

I had been hoping on my last birth that I would have the opportunity to birth without an amniotomy, but needed an early induction for extremely high blood pressure. If I were to have another birth I would be trying my darndest not to have my waters broken artificially despite what I think it might do to the length of my labour. I would dearly love to have them break spontaneously. I have always loved the idea of having a baby in the caul too LOL......

I think that if performed before the onset of labour or in the earlier stages it stands a good chance of doing more harm than good though.

I had a 34 hr labour with my DS... we didnt know at the time, but 30hrs into it i was only 6cm dialted and the midwife broke my waters, his head was in an odd position, so when the waters were broken his head turned the way it should have been... contractions got way way way more intense, and labour was all over 4hrs later

so it could have jsut been the pressure from his head being in the correct position that hurried things up - or it could have the the waters being broken, or a mixture of both...

But i do believe that breaking the waters can speed up labour, but not as much as its made out to be...

Interesting. My waters never broke so in the end I let them be ruptured (I'd been 10cm for ages but with no urge to push) but it still took about 3 or 4 hours after that for Caty to be born. Still had no urge to push, but it was a relief that my belly wasn't so tight if that makes sense. But next time if it happens again I wont be letting them be ruptured. Lol, I was too scared to push with them intact as I thought it might hurt (errrr how stupid) and didnt' know I could birth with my waters unbroken (roll eyes now). I thought labour was a step 1, 2 then 3 procedure!

In hindsight, my midwives probably just didnt' want to be drenched with my waters when I was pushing (fair enough!).

I get the feeling AROM is one of those things that get done because "we can and it's what we're trained to do" - it's one of the tools in the sandpit and human nature wants to play. The art of birth is always to do less, not more, and it's always easier to do something than to do nothing but trust.

As the saying goes, "Don't just do something!! STAND there!!"

The labours I have witnessed in which AROM was not done, there was certainly no detriment to leaving the waters to break naturally. I've often heard women seduced into agreeing to AROM with "it will speed things up" but i think the waters, and the sac, are there for a purpose and are a useful shock-absorber.

There may be rare cases in which AROM can be a useful tool, but I think like most intervention, it's over-used because of the endemic "Failure to Wait."

Why should birth be rushed at all? Finances, scheduling and artificial timetables are some reasons why birth is often pushed or rushed.

If that's not what you want, then you need to be a very canny, careful consumer to make sure that you get what you want.

The first rule of successful & satisfying birthing? Location. Location. Location.

My experience birthing Eva actually goes against the grain of the study.
I was in established labour from about 10pm at night, and I was checked and found to be 4cm dilated at 4am.
5 hours later at 9am I was checked again, and found to be only 4.5cm. By this stage I was exhausted and teary, and beginning to lose strength, as I had been awake the whole night prior... I was at the RBWH Birth Centre, so they are quite against interventions, however my midwife did gently suggest to me that breaking my waters may speed things up, as she was worried about me. She also cautioned me that it may not help at all, and we went over the risks and such of prolapse - which I was quite worried about too.
And so after waiting a while, and weighing up the risks in my mind, I ended up asking her to break my waters, and they were broken at about 9.50am. Within 2 mins my contractions increased in length and intensity, and in less than 45 mins Eva entered the world. So in my case it certainly did speed up my labour as I went from 4.5cm dilated - to having given birth in less than 45mins! And the speed and intensity of it certainly took my breath away, but I am very glad I chose the option that I did, as the outcome was what I had hoped for.

However I agree that there are different circumstances for every birth... considering with my first - my waters were the first thing to go, and labour still didn't start!

My waters ruptured spontaneously at 3am. Contractions began slowly afterwards (i'd been sleeping and think i'd been having painless tightenings for a few hours before then). By 9.30am ctx were one in 10-12 for 40-50seconds. By midday ctx were one in 5 for 60. At 2.30pm 11.5 hours after the waters broke ctx were one in 3 for 90 and i was 2-3cm dilated and 50% effaced. I gave birth at 6.20pm with one push (after roaring to avoid pushing for nearly 3 hours). My waters rupturing early didn't make the time from then to birth particularly short, but equally my "real" labour was so short anyway, what difference would breaking the waters have made for me?

I think for SOME women in SOME situations it CAN help, but only an experienced midwife who KNOWS the woman is in a position to make that call. It can potentially do more harm than good and should therefore be undertaken with consideration and caution.

:

---

I think for SOME women in SOME situations it CAN help, but only an experienced midwife who KNOWS the woman is in a position to make that call. It can potentially do more harm than good and should therefore be undertaken with consideration and caution.

---

Totally agree there Bec!
(and yes my midwife did 'know' me, as I had been seeing her the entire pg. So I did trust her recommendation more for that reason too).

Having my waters broken saved me from emergency C/S! I was 5 cm dilated and exhaused in labour with Em. the MW checked me when i was asking for an epi (told u i was exhausted!) and broke my waters to see if that would help. My waters were menconum stained and within 5 minutes of my waters being broken, Em was out. so 5cm to born in 5 minutes. and just missed out on emergency C/S as Em was distressed. She took a bit of work to get breathing properly. With Sarah I was pushing and the waters were bulging out, and they feel strange! so they were broken so that her head could descend to where the water was blocking her. She too was in distress, with menconium staining but was fine. I dont know whether my third will have waters broken or not but we will cross that bridge when we come to it. I hope that they can be left intact, but it depends on the colour of the waters.

I went into labour at 1am in the morning. I turned up at the hospital at 2.30am to be told that I was 6 cm dialated and my waters where "bulging". To this point I was managin my labour extremely well and felt that all was progressing fine. The midwife told me that she would like my baby to be born soon because she was changing shifts. She offered to "speed" up the birth by breaking my waters!! She broke my waters and manually stretched my cervix .Within 3 mins my pain became unmanagable and the urge to push was impossible to ignore. Loren was born 10 mins later. I lost control of the birth, I tore really badly, bub feel on the bed and I ended up with a retained placenta and in surgery straight after birth. O

I don't know if breaking my waters contributed to all the above, but I think I would have had a better experience if all was left to progress naturally.

:

---

I went into labour at 1am in the morning. I turned up at the hospital at 2.30am to be told that I was 6 cm dialated and my waters where "bulging". To this point I was managin my labour extremely well and felt that all was progressing fine. The midwife told me that she would like my baby to be born soon because she was changing shifts. She offered to "speed" up the birth by breaking my waters!! She broke my waters and manually stretched my cervix .Within 3 mins my pain became unmanagable and the urge to push was impossible to ignore. Loren was born 10 mins later. I lost control of the birth, I tore really badly, bub feel on the bed and I ended up with a retained placenta and in surgery straight after birth. O

I don't know if breaking my waters contributed to all the above, but I think I would have had a better experience if all was left to progress naturally.

---

Bekz thanks for sharing that. I think your story shows another side to this question that's often not explored. I've been at a birth where a similar thing happened - mum agreed to her water being broken because she'd been up at the hospital all night with hindwater leak and nothing was happening - and everything went from nice and manageable to full on in 10 minutes flat. I literally saw her go from coping beautifully to screaming her head off because her baby just fell down on her cervix and she didn't have time to catch up. It was so much harder than it needed to be.

I think the fundamental question is really WHY do we think it's beneficial to speed labour up. Who does it benefit when a baby and a mother are doing well, and they're happy to just coast along on their own timetable. Just another symptom of the way society is I guess...why wait around for something when we don't have to.

That's why i think it's important that an experienced midwife who knows the woman needs to be making this sort of suggestion and not one who is "changing shift" and wants the birth over with. If the MUM is exhausted and wants things speeding up and the midwife agrees that her labour is one which is likely to benefit then and only then should AROM be considered. Doing it because you can is plain stupid.

My labour had no "padding" of waters and was not especially painful until i was instructed not to push. Even then, it wasn't so much more pain as the same pain (mild chinese-burning feeling at the cervix, no other pain) heightened with mild panic because it was so hard not to push when she was through the cervix already. Not every woman feels labour as more painful once the waters break, not every labour with accelerate dramatically. I have a friend who had AROM and felt much better for it (the pain over her bump during ctx lessened) but her labour then stalled and her ctx vanished for 40mins.

"First do no harm" - that means that the chance of benefit to the MOTHER and the BABY needs to be strong before ANY intervention is considered. Sadly many practitioners consider AROM a non-issue as interventions go because there are no drugs involved. I know of many women who had it done without even being consulted. Really there is nothing special or different about the female body in labour that warrants any treatment you wouldn't have given her in the 22nd week of pregnancy. Even if no professional ever LOOKS at the vagina (inside or out) the baby will still emerge from it in his or her own sweet time.

I truly do think that when you are in well-established labour, the water breaking will speed things up. With my first DD, my waters broke at home after about 2 hours of contractions. She was born 4.5 hours later. (not too bad for a first baby!) With my second, I laboured for 6 hours before my ob offered to break my water, if I wanted. I said sure! DD2 was born about 45 minutes later. With my third, I laboured for about 10 hours without "progressing" (stuck at 4cm). At about 6pm (I think!) my midwife agreed to break my water (I asked), and things became MUCH more intense from that point on. DD3 was born about 1.5 hours later.
In my experience, it definitely speeds things up. Whether it's a good idea or not is an entirely different question.

My dd was just about to pop, and my waters still had not broken. The MW took care of this, and DD was born about 5 minutes later.

15 hour labour.

I have no idea if it would have sped anythign up, but i do know that having it ruptered just before she said hello to the world made the process very wet and slimy - there was absolutely no pain when she came out, just felt like a big blob of jelly!