One technique that has traditionally been used to induce or speed up labor is breaking the water. Technically, this is called amniotomy and is probably derived from the fact that it's actually the amniotic sac being broken.
Naturally Occurring Water Breaking
Research shows that a woman's water breaking is usually not the event you see in the movies - such as a women squealing excitedly that her water has broken with a baby being born a few minutes later. That's rarely a reality.
A Good Birth A Safe Birth by birth experts Diana Korte and Roberta Scaer notes that 95 percent of women with uncomplicated, unmedicated labors will still have the bag of water intact until very late during labor or even up until the birth. Having the amniotic sac still intact is a helpful benefit to both the mother and baby. The sac provides a nice soft cushion for the baby's head and umbilical cord. For the mother, the longer a bag stays intact the better her chances of avoiding infection as the bag of water directly protects against infections entering the birth canal.
If breaking the water occurs naturally, a mother will feel a gush of warm fluid or sometimes just a trickling of fluid. It rarely leads to a huge floor puddle.
Amniotomy is when a doctor or other care provider deliberately breaks a mother's amniotic sac. This is usually done to speed up labor or to induce, but it can also be done in order to attach a fetal monitor to the baby's head. Sometimes the bag is broken so the amniotic fluid can be tested for meconium.
Some of the pros to having the sac broken artificially include:
- If the amniotic fluid needs to be tested for meconium, breaking the water allows this to happen. Meconium is that first sticky baby poop which can be inhale by the baby, causing potential problems.
- By the time a woman is dilated 7 or more centimeter, it can possibly speed the last three centimeters of dilation. This is a painful stage, so making it go faster is a bonus to the mother.
There are many cons of amniotomy both for the mother and baby:
- Often, amniotomy is the start of labor and birth interventions. It's often done along with a Pitocin drip or other cervix stimulating drugs and an electronic fetal heart monitor.
- Research shows that women who have their water broken artificially have an increased chance of having a cesarean birth.
- Once the water is broken, there is no cushion for the baby's head and contractions become harder for the baby to handle.
- "The increased pressure differentials around the fetal head may lead to deformities of the skull." Human Labor and Birth 5th Edition, by Dr. Harry Oxorn. (Via Childbirth.org)
- A mother's risk of infection dramatically increases.
- Once the bulk of the water gushes out, the umbilical cord has a greater chance of being compressed and cutting off oxygen to the baby.
- It stops a woman's body from acting naturally and sometimes can take away the feeling of control from the mother.
Does Research Support Amniotomy?
There isn't much evidence to support the idea that amniotomy actually speeds up or induces labor. It's become more a habit of medical facilities than anything else. In fact a recent study reports that a review of previous amniotomy research shows that there is no reason to use amniotomy to induce or speed up labor. Mark Nichols, M.D., professor of obstetrics and gynecology at Oregon Health & Sciences University, questioned about the findings and noted "Most of us believe it works, so there will be a lot of skepticism about this."
Just this month, the Cochrane Systematic Review actually came out against routine water breaking. One Cochrane researcher talking about amniotomy notes "Women should be informed that it doesn't shorten the first or second stage of labour, it doesn't affect the woman's satisfaction with her childbirth experience, and doesn't result in the child being in better condition immediately after birth."
If you search around journals, medical texts, and more sources you'll see a lot of theories about how breaking the amniotic sac is beneficial to inducing labor or speeding labor but there isn't a lot of hard evidence.
Alternatives to Artificially Breaking the Water
There really is no need to say "an alternative to amniotomy" because it very rarely is necessary in the first place. If you know the pros and cons, it's fine to want medical interventions if it makes your labor the labor you want. It's also fine to want a labor that's not full of medical interventions.
If inducing labor is your goal than following are some great articles that can help.
- Natural Induction of Labor
- Walking and Labor Induction
- Herbs for Labor Induction
- Self Induction of Labor