Artificially Breaking Your Water in Labor is Overrated - Here's Why

Picture this: you're in active labor (after six centimeters dilation) and working hard, but managing alright. Your water has not yet broken. You've been in labor for a while (8 hours since the start of early labor, but who's counting?) and there are moments when you wonder if you'll ever give birth. 

Then. 

Your doctor or midwife comes in, performs a cervical check with your permission, and says that you are 8cm and your bag of water is bulging. Then she says, after your last contraction, "If we break your water, we could move this right along and have a baby soon."

Oh the temptation! Oh the promises! With one simple, painless flick of an amnihook (the plastic tool used to snag the amniotic sac and break the water), you could be so much closer to having your baby, and more importantly, being done with this whole labor business. 

Except, that's not how artificially breaking your water (also known as an "amniotomy" or AROM - artificial rupture of membranes) in labor works. Your body is not a vending machine that pops out drinks for a dollar! 

Breaking your water in labor is considered an "intervention," which is just a jargon-y way of saying to interfere with or interrupt the normal flow and course of labor and birth. Sometimes, interventions are necessary. Like when labor and birth aren't "normal," (FYI: what is considered normal is a wide-ranging spectrum), or when there is a problem and intervention is necessary for the health and safety of parent and baby. The problem is, artificially breaking water is often done routinely during labor in the United States, whether or not speeding up labor is a concern. 

In the normal course of labor and birth, your bag of waters (technically called your membranes or amniotic sac) will break at some point in labor on their own if they haven't already done so before labor began. Less commonly, your baby could be born with the amniotic sac completely intact, which is known as being born "en caul." 

So what's the big deal? If breaking your water in labor will speed things along, where's the harm? 

First, let's make one thing clear: breaking your water in labor does not guarantee that your labor will speed up or that you will get to birth any quicker than if it were intact. In fact, some evidence shows that breaking your water in labor does not have an effect on shortening the length of labor.  

You might be thinking, "Yeah, but what if it could help? What's the harm in trying?" I'm glad you asked. These are risks and drawbacks to having your water artificially broken in labor:

• Increased labor pain
• More intense contractions
• Increased risk of infection
• Increased risk of additional interventions, including Pitocin, IV, external fetal monitoring (EFM), and c-section
• Increased need for IV pain medicine or epidural to cope with pain
• Increased possibility of a poorly positioned baby, which could increase pain, length of labor, and need for interventions or c-section
• Complication with baby's umbilical cord called "cord prolapse"
• Rare: problems with baby's heart rate, known as "fetal distress"

Of course, there are potential benefits to having your water manually broken, too. Keep in mind, however, that these benefits are not guarantees or even likelihoods, but rather, possibilities. 

• Potentially speed up labor
• May reduce need for c-section
• Allows for internal fetal monitoring (to get a more accurate read on baby's well being if variable/unstable readings are shown on external fetal monitors)
• Allows for intrauterine pressure catheter monitor (aka, IUPC to determine strength of your contractions, which can help you decide if further interventions are needed in a long labor)
• Detect meconium and determine if additional medical support is needed after birth

It's important to know, too, when breaking your water is contraindicated medically -- in other words, not a good idea at all due to the possibility of making birth less safe for you and baby. 

• Baby is presenting in an uncommon or more risky way other than head first, including breech, brow presentation, or face presentation
• Baby's head is not yet "engaged" in your pelvis
• Your cervix is not favorable for the procedure to make any change; it is still too thick, not very dilated, or not soft

If you are presented with the option to have your water broken in labor, consider the reasons presented, the status of your labor, and the trade offs you're willing to accept. In any case, it's important to talk with your OB or midwife about the potential risks and benefits of the procedure. If your provider fails to inform you, get your consent, or tells you there are no risks, you're not getting trustworthy care! 

It's important to go into labor and birth with a care provider you can trust to give you the best, evidence-based care. It also helps to know the right questions to ask if you are presented with a procedure, test, intervention, or any other decision-making point. A quality childbirth class, including Lamaze classes, spends time teaching you the right questions to ask to get the best care and make the safest and healthiest decisions for you and your baby. 

References

Cochrane. "Amniotomy for shortening spontaneous labor." June 18, 2013. https://www.cochrane.org/CD006167/PREG_amniotomy-for-shortening-spontaneous-labour

Lamaze International. "Artificial rupture of membranes." December 13, 2016. https://www.lamaze.org/RuptureOfMembranes

Verywell Family. "Breaking water to induce or augment labor." February 1, 2018. https://www.verywellfamily.com/how-is-breaking-the-water-amniotomy-induce-labor-2758961