Wednesday, November 24, 2010

Repost: NYT article on the risks of Artificial Rupture of the Membranes

This is a repost of a New York Times article from 2007 I recently read thanks to another doula. 


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 [2007] 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.”

A comment: This is very interesting to read seeing as I have yet to attend a hospital birth where amniotomy (AROM) wasn't seen as necessary, or at least strongly suggested. I've even spoken with some family members who, even after given birth a few times, didn't know that the bag of waters could break on their own because a doctor has always done it for them!

Not only may there be some risks to AROM being a standard procedure, but there are many instances where keeping the bag intact can help a great deal. If the baby is not in an ideal position, keeping her in the amniotic sac can help to have her gently adjust to a more ideal position and ease back labor. It is also less painful for the mother to have the bags intact because it adds a bit of a buffer between baby and pelvis. Not to mention the decrease in chances of infection when the bag is still present.

As with any procedure in birth, it is wise to educate yourself and to talk to your care provider about the risks, benefits, and alternatives. In the end, it's your decision! If there is no medical necessity for a procedure-standard as it may be-you can always say you'd rather not have it done. In the case of AROM, the alternative is so simple: Just wait! 

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