Hang On to Your Bag: why you shouldn’t let anyone break your waters

The Artificial Rupture of Membranes (AROM) or “breaking the waters” is something that is often done in the hospital during the birth process to “speed up labour”. 

I have heard a hospital staff member justify doing this because “it releases the body’s own oxytocin therefore making the rest of the birth process more physiological”. 

Let me tell you, there is nothing “physiological” about a stranger sticking a crochet hook up your vagina and poking a hole in the amniotic sac where your baby resides.

Let’s go backwards a bit and talk about the role of the amniotic sac and fluid. During pregnancy, the amniotic sac protects the baby by

• Maintaining consistent temperature

• Cushioning any bumps to the belly

• Assisting in lung development (baby breathes amniotic fluid in and out of the lungs)

• Creating space for growth and muscle development

Now, what does the amniotic sac/fluid do during labour? Well contrary to popular belief, only about 10% of birthing humans will experience their waters breaking before labour starts. In fact, most waters stay intact until just before pushing. Nope, it’s not going to be like in the movies.

During a contraction, the fluid surrounding the baby helps to equalize the pressure rather than squeezing directly on the baby, umbilical cord, and placenta. If there is less fluid surrounding the baby, there is a decrease in the baby’s oxygen level each time the uterus contracts, brought on by the squeezing of the placenta (reducing oxygen supply), or the cord getting squished (reducing oxygen supply) and therefore a dip in heart rate. 

Dr. Rachel Reed goes into more detail about the amniotic sac here: https://midwifethinking.com/2015/09/16/in-defence-of-the-amniotic-sac/

Does artificially breaking the water really speed up a labour process? According to this Cochrane review: 

“Amniotomy (AROM) has been standard practice in recent years in many countries around the world. In some centres it is advocated and performed routinely in all women, and in many centres it is used for women whose labours have become prolonged…..

……The evidence showed no shortening of the length of first stage of labour and a possible increase in caesarean section. Routine amniotomy is not recommended as part of standard labour management and care.”

I witnessed a birth recently where the waters were broken, the baby had huge decels in heart rate, and then in an attempt to fix it, the hospital staff ATTEMPTED TO PUT WATER BACK IN via amnioinfusion. 

So let me get this straight - you broke her water, and then, realizing your mistake, tried to put the waters back in. Was this effective? Absolutely not. Keep in mind that just because a procedure is routine doesn’t mean that it’s helpful or evidence-based.

Hang on to your bag of waters, my friends.