Having your water broken?

[Snowflake777]

I had my water broken last time (I can't remember when, exactly, but it was in the final stretch of labour) and didn't really think anything of it.

If it should happen again, is there any reason I should refuse it? Can anyone tell me what the risks/benefits are?

[Comtessa]

Some good reasons to refuse having your water broken would be:

• it removes the "cushion" around the baby which can (depending on stage of labor) a) make contractions feel a LOT stronger and more painful, and b) settle baby into an unfavorable position that might be harder for her/him to get out of without the extra room generated by the amniotic fluid;
• if baby is floating high in the pelvis, there is a risk of cord prolapse from AROM, which means an immediate emergency C-section;
• once your membranes are ruptured, you are "on the clock" to get the baby out -- usually 24 hours -- which means that everyone's anxiety about "hurrying your labor" gets suddenly much higher and the pressure to deliver quickly is more intense. 

All of that being said, however, AROM isn't always bad.  If it's fairly late in labor, baby is in a good position and well-engaged in the pelvis, then the risk factors are much lower.  It can shorten labor by an average of 40 minutes (I don't remember where I read that, but I'm fairly certain that's the right number).  And if your labor progress is slow, it's one of the least invasive interventions that they can try to speed it up.  IMO, it makes sense to try AROM first, if there's concern that your labor isn't moving quickly enough (i.e., you're running out of steam and getting dehydrated, or something like that), and the next thing they would suggest is a major intervention. 

My HB MW broke my water when I was at 10 cm and trying to push, but was so tired that the contractions weren't strong enough to help me get the baby out.  AROM was the last-ditch effort to get the baby out at home before we transferred to the hospital. 

On the other hand, if you and baby are handling labor just fine, if there's no problem with labor progress, and all is well, then there's no reason to break your water.  Sometimes they just do it 'cause it's what they do, KWIM?  It puts one more thing under the control of the HCP and out of the control of nature (they hate it when your water breaks unpredictably).  So if there's good reason to do it and the risks are low, IMO it's not a big deal, but if there's no reason to intervene, like with most things in birth, better to leave well enough alone.

[Snowflake777]

Wonderful answer, thank you so much for taking the time to explain Comtessa!

[AFWife]

My HB MW broke my water...but my sac was crazy thick (like, she could grab at it and FEEL it through the gloves...it took several tries to actually break it) I was 9.5cm with the bag bulging down through my cervix. I'd been in labor something like 18 hours. (It was easy until the final 2 though) She said, "We can keep going like this and have a baby in a few hours or we can break your water and have a baby right now. It's your choice, I'm good either way." I said, "Do it" and had a baby 20mins later.

[msmiranda]

Originally Posted by AFWife 

My HB MW broke my water...but my sac was crazy thick (like, she could grab at it and FEEL it through the gloves...it took several tries to actually break it) I was 9.5cm with the bag bulging down through my cervix. I'd been in labor something like 18 hours. (It was easy until the final 2 though) She said, "We can keep going like this and have a baby in a few hours or we can break your water and have a baby right now. It's your choice, I'm good either way." I said, "Do it" and had a baby 20mins later.

I had something similar happen to me during my first birth -- my water hadn't broken and it was impeding the process of pushing him out.  The midwives knew I was nearing the end of my rope physically and mentally and wanted to get him out ASAP, so I had no problem with them breaking it, although they didn't get a chance because just as she was reaching for the hook thing, it broke spontaneously and drenched her scrubs! :)

So for me, I would be okay with it during pushing or perhaps as a last-ditch attempt to help pick up a labor stalled at 8-10cm, but probably not any earlier than that, for the reasons Comtessa stated above.
 

[AFWife]

Originally Posted by msmiranda 

I had something similar happen to me during my first birth -- my water hadn't broken and it was impeding the process of pushing him out.  The midwives knew I was nearing the end of my rope physically and mentally and wanted to get him out ASAP, so I had no problem with them breaking it, although they didn't get a chance because just as she was reaching for the hook thing, it broke spontaneously and drenched her scrubs! :)

So for me, I would be okay with it during pushing or perhaps as a last-ditch attempt to help pick up a labor stalled at 8-10cm, but probably not any earlier than that, for the reasons Comtessa stated above.
 

I also appreciated being given a CHOICE (read: control) in the situation. My MIL has said more than once about her second birth how they "had to" break her water because it hadn't broken on its own...

[goldenwillow]

Originally Posted by Comtessa 

On the other hand, if you and baby are handling labor just fine, if there's no problem with labor progress, and all is well, then there's no reason to break your water.  Sometimes they just do it 'cause it's what they do, KWIM?  It puts one more thing under the control of the HCP and out of the control of nature (they hate it when your water breaks unpredictably).  So if there's good reason to do it and the risks are low, IMO it's not a big deal, but if there's no reason to intervene, like with most things in birth, better to leave well enough alone.

All well said. 

My water didn't break until I was just about ready to push.  It actually freaked me out.  Then it was really on and DS came about 20 mins later.

[Jaimee]

I was at a FSBC with my first and was told I could have my water broken to check for meconium or I could transfer to the hospital for monitoring b/c the baby's heart rate was a little too high.  Obviously, I chose to have my water broken and of course there was no meconium at all.  But after that the contractions came on hard and fast and they were extremely difficult to integrate.  I had been laboring nicely, comfortably and was already at 8cm.  But after breaking my water I started to lose my focus and my body started to get out of my control.  In hindsight, I was furious that my water "had" to be broken in order to avoid the hospital and it is one of the key reasons I opted for a home birth with my second.

Now, if I were in a situation where I was exhausted and needed to get things moving along, I would definitely chose having my water broken over pitocin or an epi.  Otherwise, I would leave my water intact as long as possible.  I actually just had a friend birth her son in the caul!  Pretty amazing!

[Snowflake777]

Thank you all for the responses.

I have no regrets having my water broken with DD - labor was progressing slowly and I was beyond exhausted (I'd been in labor for 24 hours, and awake for 36+ hours when DD was born), and it did speed things up. I wasn't pressured into it, my midwife asked if I wanted to. Still, it's good to be informed about the pros & cons this time around.

[*MamaJen*]

You've gotten some good responses already, but in general, I think the key thing to remember is that AROM is an intervention, and all interventions have possible risks and benefits. If AROM is used judiciously, it can be a good thing; if it's used routinely, it's probably a bad thing.