Amniotomy? No thank you!

I am glad to see more attention being given to the problem of artificial rupture of membranes (AROM), also known as amniotomy.  I am encouraged to see this because I believe AROM is what lead to my unnecesarean.

Authors’ conclusions (Cochrane Review, July 13, 2007)

On the basis of the findings of this review, we cannot recommend that amniotomy should be introduced routinely as part of standard labour management and care. We do recommend that the evidence presented in this review should be made available to women offered an amniotomy and may be useful as a foundation for discussion and any resulting decisions made between women and their caregivers.

[Click here to read the review abstract.]

A few articles in the press that piqued my interest:

Childbirth: purposely breaking water does not speed deliveryNew York Times
“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.”

In labor, breaking a woman’s water may be futileLos Angeles Times
“The hormones in the amniotic fluid have been thought to stimulate contractions, but not only does an amniotomy fail to speed up and strengthen labor, it also fails to improve a woman’s satisfaction with the birth experience, an analysis by the Cochrane Review found. Nor does it result in the baby being in better condition after birth.”

Don’t ‘Break the Waters’ During Labor Without Good Clinical Reason, Concludes Cochrane ReviewScience Daily
“This Cochrane Systematic Review found that breaking the waters may be associated with a slightly (non-significantly) higher rate of Caesarean section. Breaking the waters may cause changes in the baby’s heart rate.”

Breaking waters not needed in routine birthsGlobe & Mail
“Yet many medical centres perform amniotomy for routine deliveries. One Toronto hospital does it for 80 per cent of the births under its roof.”
[The “annoying cough” begins a new brief and is not related to this discussion.]

Review Finds That “Breaking the Water” Does Not Speed or Help With LaborHealth Behavior News Service
“However, several American doctors said the findings are unlikely to change the way obstetricians help women give birth in the United States. “Most of us believe it works, so there will be a lot skepticism about this,” said Mark Nichols, M.D., professor of obstetrics and gynecology at Oregon Health & Sciences University.”

The Cochrane Group is an international independent non-profit organization whose goal is to help people like you and me make better-informed decisions about healthcare and interventions.  Archie Cochrane was a British epidemiologist and is the organization’s namesake.  The Cochrane Collaboration was founded in 1993.

In Born in the USA, Marsden Wagner hails the Cochrane Library as “a frequently updated, highly respected electronic library of reviews of the scientific evidence on different obstetric practices”.  Know that doctors (such as Mark Nichols, the man quoted in the Health Behavior News Service bulletin) don’t always practice evidence-based care.  They often “follow the crowd” (ACOG) or repeat unnecessary procedures just because “they work”.  My response to that style of practice is that it is unethical, unfounded, reckless, irresponsible, subversive, and the list of negative modifiers could go on and on for hours.  We all know that cesareans “work”, for instance, but that does not mean that even a significant minority (30% of all live births for example) should be undergoing this procedure.  “It works” is not acceptable.

Something else you should know about the Cochrane group is that several members produced a textbook called A Guide to Effective Care in Pregnancy and Childbirth.  You can download this book  for free from Childbirth Connection.  This is an amazing resource!


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