Photo from Birthing Way: http://www.birthingway.com/caul.htm
Artificial rupture of membranes (ARM) aka ‘breaking the waters’ is a common intervention during birth. However, an ARM should not be carried out without a good understanding of how the amniotic sac and fluid function in labour. Women need to be fully informed of the risks associated this intervention before agreeing to alter their labour in this way. This post will discuss how the ‘waters’ work in labour and the implications of breaking them.
Anatomy and physiology
By the end of pregnancy the baby is surrounded by around 500-1000mls of Fluid. This is mostly made up of amniotic fluid secreted by the amniotic sac (the membranes). The baby also contributes urine and respiratory tract secretions into the fluid. The amniotic fluid is constantly being produced and renewed – Baby swallows the fluid; it is passed through the gut into the baby’s circulation; then sent out through the placenta. This process continues even if the amniotic membranes have broken. So, even when the waters have ‘gone’ there is still some fluid present ie. there is no such thing as a ‘dry labour’.
The amniotic membrane is adhered to the chorion – another membrane between the amniotic membrane and the uterus. These membranes look like one, but you can tease them apart after birth.
During pregnancy
The amniotic sac protects and prepares baby by:
- Cushioning any bumps to the abdomen.
- Maintaining a constant temperature.
- Allowing movement to aid muscle development.
- Creating space for growth.
- Protecting against infection – the membranes provide a barrier + the fluid contains antimicrobial peptides.
- Assisting lung development – baby breathes fluid in and out of the lungs.
- Taste and smell – the smell of amniotic fluid has been found to have a calming effect on newborns (Varendia et al. 1998).
After 40 weeks gestation around 20% of baby’s will pass meconium into their amniotic fluid as the bowels reach maturity and begin to work. This is perfectly normal and is not a sign of distress. This meconium is diluted and processed with the amniotic fluid as described above.
During labour
Around 80-90% of women start their labour with their membranes intact. This is probably because the amniotic sac plays an important role in the physiology of a natural birth.
General fluid pressure
During a contraction the pressure is equalised throughout the fluid rather than directly squeezing the baby, placenta and umbilical cord. This protects the baby and his/her oxygen supply from the effects of the powerful uterine contractions. When the membranes have ruptured the placenta and baby get compressed during a contraction. Most babies can cope well with this, but the experience of birth for the baby is probably not as pleasant. When the placenta is compressed blood circulation is interrupted reducing the oxygen supply to baby. In addition, the umbilical cord may be in a position where it gets squashed between baby and uterus with contractions. When this happens the baby’s heart rate will dip during a contraction in response to the reduced blood flow. A healthy baby can cope with this intermittent reduction in oxygen supply for hours (it’s a bit like holding your breath for 30 seconds every few minutes). However, this is probably not so great to do for an extended period of time.
Forewaters
The sac of amniotic fluid is describes as having two sections – the forewaters (in front of baby’s head) and the hind waters (behind baby’s head). A ‘hind water leak’ refers to a tear in the the amniotic membranes behind the baby’s head. Often this is experienced by the woman as an occasional light trickle as the fluid has to run down the outside of the sac and past baby’s head to get out.
During labour forewaters are formed as the lower segment of the uterus stretches and the chorion (the external membrane) detaches from it. The well flexed baby’s head fits into the cervix and cuts off the fluid in front of the head from the fluid behind (hind waters). Pressure from contractions cause the forewaters to bulge downwards into the dilating cervix and eventually through into the vagina. This protects the forewaters from the high pressure applied to the hind waters during a contraction and keeps the membranes intact. The forewaters transmit pressure evenly over the cervix which aids further dilatation. When the baby is in an OP position the head may not flex as well to block off the hind waters = pressure is able to move into the forewaters and they may rupture. Early rupture of membranes if often a feature of an OP labour.
Lubrication
The forewaters usually break when the cervix is almost fully open and the membranes are bulging so far into the vagina that they burst. This ‘fluid burst’ lubricates the vaginal and perineum to facilitate movement of the baby and stretching of the tissues.
Born in the caul
If is fairly common for a baby to be born in the amniotic sac when labour is left to unfold without interference. I have some beautiful photos of this but don’t have permission from the parents to share them online – so if you want to see them you will have to come and study Midwifery at USC. However, I have found photos on Navelgazing Midwife’s blog and photos on the Birthing Way website.
Historically being born in the caul was considered good luck for the baby. It was also believed that a baby who was born in the caul would be protected from drowning. Midwives used to dry out amniotic membranes and sell them to sailors as a talisman to protect them from drowning. Very enterprising!
Artificial rupture of membranes (ARM) aka amniotomy
Breaking the membranes with an amni-hook is a common intervention during labour. It is usually the second step in the induction process, and also done in an attempt to speed up spontaneous labour. In an induced labour, intact membranes can prevent the artificially created contractions from getting into an effective pattern. There is also the theoretical risk of an induced contraction (that is too strong) forcing amniotic fluid through the membranes/placenta and into the blood system causing an amniotic embolism and maternal death. So an ARM is recommended before a syntocinon/pitocin infusion is started (although this may not be a worldwide practice).
In a spontaneous labour the rationale for an ARM is that once the forewaters have gone the hard baby’s head will apply direct pressure to the cervix and open it quicker. However, a cochrane review of the available research states that “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 for normally progressing labours or in labours which have become prolonged.”
There are also risks associated with an ARM:
- It may increase contraction intensity and pain which can result in the woman feeling unable to cope and choosing an epidural… intervention rollercoaster begins.
- The baby may become distressed due to compression of the placenta, baby and/or cord (as described above).
- Fok et al (2005) found amniotomy altered fetal vascular blood flow, suggesting there is a fetal stress response following an ARM.
- The umbilical cord may be swept down by the waters and either past the baby’s head or wedged next to the baby’s head. This is called a ‘cord prolapse’ and is an emergency situation. The compression of the cord interrupts or stops the supply of oxygen to the baby and the baby must be born asap by c-section. The only cord prolapse I have been involved with happened after an ARM (not done by me - honest!). The outcome for the woman was a live baby born by emergency c-section. Her previous 2 babies had been vaginal births.
- If there is a blood vessel running through the membranes (see picture below) and the amni-hook ruptures the vessel the baby will lose blood volume fast – another emergency situation.
- There is a slight increase in the risk of infection but mostly for the mother (not baby). This risk is minimal if nothing is put into the vagina during labour (ie. hands, instruments etc.).
Summary
The amniotic sac and fluid play an important role in facilitating birth and protecting the baby. There is no evidence that rupturing this sac will reduce the length of labour. While every intervention has it’s place including ARM, midwives need to carefully consider the risks before offering it to women. Also women must be fully informed of the risks before choosing an ARM during their labour.
Update: Lisa Barrett shares film of a beautiful caul birth here.
A beautiful post Rachel. You have done the ‘waters’ credit. A great resource for students and childbearing women. Thanks.
Great clear blog post.
Thanks for visiting!
Thank you for the very informative post!!
This article is VERY informative! This is one of the reasons I will stay home as long as possible before going to the hospital to birth my 4th baby! Really wish I could have had a homebirth this time!
Hi Taci, have you looked into homebirth in your local area? There are quite a few public hospital group practice midwives that are doing homebirth now as well as the independent midwives. Wishing you a beautiful birth for your babe x
Great post! I’d love to hear your take on PROM, too.
Watch this space…
great post! How many times do we see membranes artificially ruptured to “speed” a labour up!
I once knew a girl who had a c-section due to blood being in the waters when they broke them. I wonder now if they had knicked a blood vessel in the membranes. Nothing was wrong with the baby for the blood to be in the water. This is very interesting and informative. Thank You!
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I think this is an awesome blog post. I too know a woman who had to have an “emergency c-section” BECAUSE of having her water broken. She was only 3 cm and already on pitocin when they did it. This was my sister in law. My mother in law told me “they are going to break her water now”. Immediately, I knew she was going to have c-section. They broke her water, then about 3 minutes after they broke it, they were rushed into surgery because the baby’s heart rate was going extremely high, then extremely low. I am so grateful you wrote this blog because I can now show it to other pregnant women, so they know the true risks of having their water broken.
Beautiful work that clearly demonstrates that ‘…the less we do, the more we give”. We need to stop doing and let women birth. Thank you Rachel.
Now why aren’t doctors taught this is school? No one is ever going to break my water again! Thanks so much Rachel!
Are you saying that they always break the waters before they induce someone? (Or that they should?) Because I know my sister was induced and they didn’t break her waters until delivery . . . she had contractions 3 mins apart for hours, they forgot about her, finally remembered, broke her waters, found the baby posterior, used forceps and got him out. (I am having a homebirth!)
The waters must be broken before a syntocinon/pitocin drip is started. It sounds like your sister had been given the prostaglandin gel (or tablet) to ripen her cervix ready for the drip. That can be enough to kick start labour on it’s own if the body Is ready. I really hope they didn’t start a drip and forget about her with intact membranes.
I am a labor Doula and I’ve seen quite a few mom’s who have had a pitocin drip with intact membranes… I hadn’t realized that was the theory for Amniotic fluid embolism.
I have also heard so many times from women, “They had to break my water”, or some variation, of “my water wouldn’t break on it’s own, so the Dr. had to break it”. They have no idea that this is not ‘normal’! It drives me crazy!
I loved this post. Tons of good information.
I do question who it is that sets out the AROM before induction with pitocin though… as I would say definitely more than half, of the people I know who’ve been induced or augmented with pitocin have had intact membranes. In fact not rupturing them is a common choice so as not to start the “clock” of 18 or 24 hours before baby “must” be delivered because of infection. This is people both online and in my own city… I’m in Canada but the women I talk to are from all over this country as well as the US and a few from other countries as well.
Is there an official recommendation somewhere?
Hi Alison
AROM before syntocinon (pitocin) is the standard practice in the UK and here in Australia. The recommendation comes from the respective Obstetric Colleges and is reflected in hospital guidelines/policies for induction. I have even seen women have a c-section because their cervix would not open enough to have an AROM with prostaglandin treatment. I think the theoretical danger of fluid embolism is fairly unlikely. The recommendation seems to be based on the fact that syntocinon is not very effective on it’s own and if you have decided to induce you need to do it the best way. Remember when you are inducing labour you are saying the baby is in danger if it stays in the uterus therefore you need to make sure induction is successful. You can spot intact membranes during an induction by the CTG trace – it is classic. The contraction pattern is all over the place and uncoordinated and the cervix does not dilate well. Usually this prompts a vaginal examination and once an AROM is performed the contractions coordinate and labour progresses. Remember ‘progress’ is important when we are medically managing labour.
Also the prolonged rupture of membranes requiring antibiotics is rubbish and I will be posting on this phenomena at some point.
I am guessing that in the US and Canada the practice is different and maybe pitocin is being routinely used without AROM?
“I am guessing that in the US and Canada the practice is different and maybe pitocin is being routinely used without AROM?”
yes, i know that happens often around here (southern us). as soon as i walked into the hospital and was checked the nurse came back in with a bag of pitocin the ob had ordred for me. :-/
after 2 days of labor i asked my ob to break my waters and my baby was born within the hour.
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This is such a “lightbulb” post for me. I delivered my twin boys vaginally and have always thought I had a fairly “normal” labour, all things considered, but the more I read, the more I can see the effects that my induction had on the outcome.
I was induced at 37+5, with ARM & syntocin (I think you guys in the northern hemisphere call it pitocin? I am in Australia). After 10.5 hours of labor, with an epidural that was administered by staff choice at 4cm (I was borderline PE, BP was skyrocketing and I had agreed to have one put in at “the latest possible stage” in case my second twin needed manual repositioning as they were mono-di and sharing a placenta), I gave birth to two relatively healthy boys. My firstborn had gone into distress during my labor and was delivered in a rush by forceps, suctioned and then spent 48 hours in SCN on light O2 and for observation. My secondborn was pushed out 7 minutes later with ventouse assistance and was screaming beautifully.
I now believe my firstborn went into distress because:
- My syntocin kept being pushed up because one of the newer midwives was not satisfied I was “in labor” because my ECG patterns weren’t to her liking (until the head of mid came down and told her to look at ME not the ECG and that I was laboring just fine, thank you!)
- This increased the intensity and frequency of my contractions artificially fast
- AND I now know, that having had my waters broken on Twin 1′s amniotic sac, my poor baby was feeling the full pelt of each contraction.
It explains to me also, why Twin 2 came through the same labor so much better, with his amniotic sac intact right up until I was pushing him out, he would have been much better equipped to deal with my contractions than his brother.
I had always thought ARM was a relatively “minor” intervention and blamed the synto solely for Twin 1′s distress, but I can see now that the ARM was also a big part of it.
Lovely, informative article. Thanks so much – I’ll be sharing it!
Why must you never start a pitocin drip with intact membranes? I know I was on a drip for about 2-3 hours prior to ARM with my 2nd pregnancy…
Hi FoxyKate
See the reply to Alison below.
I wish I’d had this information before I had my second child. My doctor was “allowing me” (his word, not mine) to continue to labor naturally even though I’d been in labor “so long” (his words). I’d been in active labor for 13 hours, no where near as long as my first child (total labor time 27 1/2 hours). At the 8 hour mark my doctor told me I’d been in labor too long and the only way he’d let me continue naturally was if I agreed to him doing the ARM. Otherwise, he said (threatened) he was going to start me on pitocin.
With my first I’d labored for 20 hours at home, went to the hospital and labored the last 7 1/2 hours and had a successful vaginal birth.
This was the SAME doctor and suddenly 13 hours was too long. He broke my water, I was at 5cm and 100% effaced. My son was born 9 hours later.
So I never felt that the ARM sped my labor along…still over 20 hours of labor. And luckily I still had a successful vaginal delivery, but it has always been my belief that the difference in my doctor’s attitude was that the first time I remained open to an epidural if I needed one, the second one I had made it very clear I would not get one. Also, with my first I stayed in my bed nearly the whole time I was in the hospital (since I labored so long at home)…with my second I used the tub, and frequently went outside to take a walk around the maternity center. I also used the birthing ball and various relaxation cd’s and techniques. I honestly feel they didn’t like that I was going about laboring “my way” and just wanted me to hurry up and “be done.”
Great post!
You said at the end that every intervention has its place ,I am just curious what reasons you WOULD consider ARM to be a prudent intervention
Ohh difficult question Christine. I guess if a woman is aware of the risks and still want me to do it, I would. Some women who have birthed babies before are adamant that they want this intervention and who am I to argue? For some women it does speed up labour. I would probably suggest they try to do it themselves first – with their finger. Definitely for an induction of labour – if you are going to intervene and manage labour you need to do it the most effective way.
The last time I did it was at a homebirth (which I am always extremely reluctant to do). This mother was having a VBAC (OP) and had ‘stalled’ at 7-8cm which was what happened in her previous birth. Normally this is not a problem, but psychologically it was for her. We worked through it and she wanted to try an AROM hoping to bring baby’s head further into the pelvis to rotate. We did and she birthed – probably made no difference at all but she felt good about it. Interesting the membranes were the thickest I have ever seen – you could hardly see through them.
Thanks for sharing this. I’ve had 2 water births and during my second had a AROM. I was 8cm and delivered <15mins later with no complications and babe was completely healthy. I think I would do it again (at that later point) but this is really great information to have for that kind of decision.
Thank you so much!
I think I marveled more at the hands-off approach of the midwife than the birth itself. My third child was born this way – odd feeling – like he was wrapped in cling-film! I remember making out his ear as I waited for his shoulders to follow.
It is always inspiring to see footage free of fear and inhibition.
Thank you for this clip!
Rachel asked me for some comments, so here goes –
Nice article. I agree with some of the commenters that amniotomy is not required prior to starting pitocin. Amniotic fluid embolism is a super rare complication without clinically significant association to any particular intervention.
From an OB’s perspective –
* While some infants deliver en caul, the vast majority will spontaneously rupture prior to or during labor, so its hard to look at this intervention as being so significant. There are many papers that show amniotomy alone to be an effective induction method. We don’t use this a lot now because we have pitocin and cervical ripening agents, but it does work. I was once on a mission trip and saw a woman at 38 weeks with severe pre-eclampsia. We had no pitocin, no IV pumps, and no cervical ripening agent. We ruptured her membranes at about 10 PM and came back in the morning and the midwife had delivered her.
* AROM as a method of speeding up a labor is one of those things were the ‘data’ doesn’t seem to match up to what we see in practice. Cochrane says it doesn’t help, but I’ve seen a zillion labors that seemed stalled until amniotomy was done, and then suddenly the mother is rapidly progressing. I think it clearly helps in some cases, though those cases may be outliers. We have to remember that large studies statistically remove outliers. They do not say that the intervention does nothing in every case, they just say that in aggregate we cannot identify an effect.
* AROM does lead to cord prolapse in some rare cases, though for that to happen the cord likely needs to be presenting. It also increases the likelihood of cord compression during labor (whether it happens naturally or via AROM) for the reasons you mention.
* Regarding vasa previa (the vessels running through the membranes that you mention) – this is always talked about, but its hard to imagine somebody AROMing through vessels unless they are being pretty slack in their assessment. Vessels in the membranes, if they are in the strike zone of the open cervix, are going to be very palpable, given that they pulsate with the fetus’ heartbeat. If one felt these vessels typically we would go for a cesarean. In reality, this diagnosis is usually made postpartum, when the vessels are seen in the already delivered placenta. I’ve seen many placentas where the rupture, whether by AROM or SROM (spontaneous ROM) ripped right along the vasa previa. This is not surprising as the tear is going to go along the path of least resistance, and the vessels are going to provide more resistance than blank amniotic membrane.
* There was a time that inductions started with AROM, or it was done as soon as the cervix was open far enough to admit an amnihook. While I don’t have a huge anti-AROM feeling in my practice, this was a little extreme. It led to a high level of amniotic infection and probably increased cesarean rates as a result. Given our ability to get somebody into labor without AROM with other medications, this practice doesn’t make sense at this point.
* AROM is required for internal monitoring, which in some cases is a good idea.
* >> This risk (of infection) is minimal if nothing is put into the vagina during labour – This is a VERY good point. AROM does stimulate labor in inductions, but it is critical that if it is going to be employed that the doc or midwife not do a million cervical exams after AROM. I teach my residents that once they AROM, they should just wait until mom needs to push to check her again, unless there is some really good reason. There is little reason to do routine exams on a ruptured patient unless she is a way way way off the labor curve. AROM with or without pit and no exams seems to help labor along. AROM with lots of subsequent exams seems to cause infection.
* Overall, AROM is a useful thing with some potential downsides. I don’t subscribe to it being a fundamentally bad thing. It happens naturally in every labor at some point. Having it happen at the end of an amnihook rather than some natural shearing force in labor is not so different.
—
* When this happens (cord compression) the baby’s heart rate will dip during a contraction in response to the reduced blood flow.
Just a little physiology lesson here. This is partially right, but probably not why you think. The reason the heart rate drops is _not_ because of reduced blood flow _to_ the baby. It drops because of reduced blood flow _away_ from the baby. About 50% of fetal cardiac output goes out through the cord. If the cord is compressed, the afterload (blood pressure the fetal heart must pump against) shoots up. Little receptors in the fetal aorta and carotids sense the increased pressure and tell the fetal heart to slow down to return pressure to normal. This happens very fast (within a few heartbeats), which is why variable decellerations are so quick up and down. If the cord is compressed 100%, you will have about a halving of the fetal heart rate. Some worry that a variable deceleration could go down to 0 beats a minute, but this can never happen physiologically. As complete cord compression increases afterload by a factor of 2, the heart rate is divided by a factor of 2 to keep blood pressure the same. There is no reason for it to go lower.
Upshot of this is that the variable deceleration one sees with cord compression is a not a pathologic event. Its a healthy fetal response to cord compression.
Thanks for your input Nicholas.
There seems to be a different approach re. pitocin and ARM between Obs in different countries. As induction is outside the midwives scope of practice or expertise it is always good to hear the perspective of those responsible for the management of induction. Thanks for the physiology lesson – I kept the information simple but you have provided a more in-depth explanation. A variable deceleration is not pathological and is actually normal in the circumstance of cord compression. But over time more abnormal heart rate patterns can begin to develop.
As for AROM being the same as natural rupture – natural rupture usually takes place quite late on in the labour. I also agree that AROM does appear to speed labour up for some women despite the research. Then again we could head into the ‘adequate progress’ argument if we’re not careful ; )
Thanks again for your comment. It is only when midwives and obstetricians share respect and knowledge that women get the best care.
Thanks so much for this post. My labor progressed very well, and quickly, (4cm @6am, 9cm and pushing @9am) and so because I was ready to push, but my waters hadn’t broken yet so the nurse tried and couldn’t and the doctor had to come in and do it with his tool. Contractions stopped after he did that and they wanted to put me on the drip, even though I was 10cm! Fortunately contractions were going strong again before the drip got there. I had NO IDEA that wasn’t necessary!!! I’m going with a midwife, home birth next time around, for many reasons besides this one. Thanks so much for the great information!!
Adrienne
Thank you so much for this wonderfully clear post. Putting it in my Sunday Surf
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Loved it!! Thanks!!
I discovered your site through a friend and LOVE the info I am finding here! I am 6 months pregnant w/ my 3rd and have progressed from my 1st being an epidural @ 3cm, ARM, suctioned out after 17 1/2 hours of labor 9lb 2oz baby who was then placed into NICU (for 5 days) after 6 hours b/c the breathing didn’t calm down. 2nd was ‘au naturale’, I got to the hospital 2 hours before the baby was born & had a great DR/nursing staff! Also 9lb 2oz who stayed in the room w/ me & was extremely healthy. Now I would *love* to have a homebirth but my hubby is not okay w/ the idea b/c we live 40 mins away from the closest hospital, I’m not going to push him b/c my last experience was not ‘horrible’. I am hoping for another good labor & delivery but that I can also wait as long as possible before we head to the hospital!! I will continue reading up on what you have to say on here – it makes me feel like I can be more informed this time around!!
Good luck with the next birth Jai. Don’t leave it too long before heading to hospital!
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This a great blog. ARM seems to becoming routine in hospitals now. On the show “One Born Every Minute” when they were waiting for some poor woman to dilate enough so they could rupture her membranes, the woman asked the midwife “do you have to break someone’s waters”, the midwife responded “yes all the time”. My jaw nearly hit the floor.
It’s become so routine, that women generally accept it without questioning the implications or realising that it is in fact an intervention. I’m going to be giving this to mums that come on my classes as an example of why it’s important to ask the right questions every time they are offered an intervention. Thanks!
Women really need this information before they are in labour. Keep encouraging women to take hold of their power and ask for answers.
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Hi is this a australian site?
i was wondering if anyone could help me, my mother went on to be a midwife
That is after she gave birth and then sold me in a private adoption, this private adoption was “hell” for me, as they had a natural son and I was his “toy” nothing more I was told this regularly
Anyway I found my tru mother a few years back and after a 2min conversation where she wanted to know about my tru father ????(not me or my children) I dont know the man, told me to go away, when I found out sheis a midwife It nearly killed me!
She respect others births but not her & mine! do anyone know anyone like this Can you midwives give me a clue !
thanks
This is an Australian site. I am sorry about your traumatic adoption experience. I can’t give you any answers about your mother – only she can know her reasons. I hope you can find peace with the past.
Rx
With my 4th baby and 3 previous very satisfying births, I got to a stage where I felt I wanted to push but did not have the right feeling down there -can’t really explain it better than that, except to say, something didn’t feel right. I asked my midwife to examine me and ARM me if possible. She VE’d me and stated that she felt something that she thought was lumpy near the head and didn’t feel comfortable to ARM me – I was 7cm & at the spines. She got the Dr and she was unable to feel this and so progressed with the ARM. I went to the toilet and sat there for over an hour when I felt the urge to stand & balance on my (R) leg and shake my (L) leg just like a dog does for about 15 min. I told my midwife that I needed to dislodge something and there was nothing on view until suddenly I felt what ever it was move out of the way and out came the baby’s head with a mighty whosh. I truly believe that his little hand was in the way & that my body was telling me to shake it free so he could be born – it was an amazing birth and I felt so intune with my body like it was speaking to me from within – I just needed to listen. My midwife asked me later was I happy with the decision to have the ARM and I was completely happy because it was my decision, that was right for me at that point in time. I believe my baby was low enough but that feeling was not right because his little hand was in the way
This is such an interesting post! It reminded me of the funny thing that happened when my daughter was born at home last summer. I had a beautiful water birth; my midwife was marvelously hands-off. I was very calm and comfortable as I labored in the water, and reached down to feel my baby’s head as it was crowning. At first I totally freaked out, because I felt a very strange ridge on the top of her head — I imagined I was birthing a Klingon! “What IS that?!” I squealed. “Just the membrane, it’s okay,” my midwife replied calmly. Apparently it had sort of scrunched up right at the top of her head as my daughter moved down. Moments later I was holding my daughter and she was beautiful and perfect — NOT a Klingon. We all had a good chuckle!
Hi again
thanks for your concern, seeings how this is an Aussie Site, someone might know her, give me an insight into what type of person would do this to their 1st born child She lives in Glen Iris in Melbourne and is now called June Ogrodnik, i would alos like to know medical stuff, but after trying and being hung up on, not willing to go there again,,,,kind of pretend shes dead to me!!! Anyone know June Ogrodnik
Thanks ever so much
Thank you so much for this. A year and a half later, I am in emotional recovery from a home birth turned “emergency” c-section and all that entailed. Your essay is illuminating and validating of my intuition. I had felt that my amniotic sac was strong and I had an intuition that my baby might be born in the caul. Due to prolonged labor where we were already considering transport to the hospital, my midwives suggested that we break the waters because it would expedite labor and because if we transported the hosptial would do that anyway. I really didn’t want to. I checked in with myself and felt the answer was ‘no’ and I checked in with my baby to ask permission and I’m not sure I got it, but I did consent to have the waters broken. And that in itself was Grief to me. It took a great deal of effort for the midwives to break the sac. They said it was a very strong one. Reflecting on that now, I see more how the sac didn’t want to be broken because it was meant to serve and protect. (And, sure enough, the labor picked up a bit and in my experience it became unbearable and a cascade of interventions happened but labor still didn’t speed up “enough” and so now my baby was unprotected by the caul and developed respiratory distress and needed resucitation after birth by c-section and spent 4 days in the NICU and bonding and breastfeeding were drastically affected. (Abbreviated story.) My regrets at not honoring my intuition are huge. Reading your essay helps me understand more physiologically and spiritually why it mattered to hold those waters as sacred and keep them undisturbed. I would welcome a response. Blessings to you.
I am pleased my post validated your intuition. I hope it helps you come to terms with how your birth journey went. It can help to debrief face-to-face with someone who can listen to your story and feelings. Do you have access to this? Every birth is unique and we learn important lessons about ourselves through our birth journeys – even those that did not go to plan. x
I gave birth to my first baby in January at 42w exactly following an induction.
My edd was adjusted at my 12w scan from 1/1/11 to 22/12/10, I came up with my original due date from lmp and extended cycle length whereas the scan edd agreed with lmp and normal cycle length. So when I gave birth on 5/1/11 I was 2 weeks over hospital dates, but only 4 days over my own. I was co-erred into an induction by my midwives, I always wanted a natural water birth in my local midwifery led unit (birth centre) and really wanted to avoid induction cos I was dreading the intervention roller coaster! But I was told that if I went to t+14 I would be allowed to go to the midwife unit I may as well have the induction, wasn’t overly happy about it, but I dd it anyway.
At my sweep at t+10 I was 2cm with membranes bulging, but cervix still really long. When I got to hospital 3 days later I was 3cm with a favorable cervix and so didn’t need the prostin. Was told my waters would be broken then placed on the drip. It wasn’t explained why the arm was necessary.
I was taken along to labour ward at 8.30am and she wanted to do the arm immediately I told her to wait until my partner arrived as I wanted him with me and he was due at 9, I fought to get her to wait. So she put me on the ctg and left me for 20 mins, and came back at ten to and told me that she was doing the arm right then as it needed doing, my partner was still 10 minutes away. I could not get her to wait and she proceeded.
It was the most painful thng I have ever experienced, I was crying and she was in there fo ages, when she finished there was blood on her Hand and my waters wer still only trickling. Was told it was difficult as the membranes were tight to baby’s head. Partner arrived after it had happened and was really upset that he wasn’t there for me. IN hindsight I am very glad he did not see it as I know he would have been horrified.
I then hadvto fight to be allowed to go for a walk to allow contractions to start naturally before being placed on the drip, I was allowed an hour and that was it. I am si thankful for that hour as i was able t walk down the 6 floors to outside for some fresh air and private time with my partner!
The drip was horrid, they doubled my dosage every 30 minutes instead of 60minutes. The ctg machine was not picking up my contractions even though they were horrid, ended up that the midwife had to physically record them by looking at my pulse and behavior. Within 3 hours I wax contracting for 60seconds every 75seconds and begging for an epidural, I was already flat on my back because pethidine was a bad idea, it did not agree with me at all. I was only 6cm by this point. They turned the drip off for the epidural and I went from screaming madwoman while the drip was on to blissful calm while it was off, didn’t even flinch as the epidural went in.
By 7pm I was fully dilated, was then told to rest for 2 hours before. Could start pushing so that baby could descend. Drip was lowered so I could nap. At half 8 the consultant registrar started making noise about intervention if pushing didn work so I was checked again and baby had descended and I was allowed to push. Pushed for an hour and nothing. Suddenly the room filled with people, baby was twisted and I needed forceps and possible c section. To be honest I’m not really sure wha happened, i was out of it. A consent form was shoved in front of me and I could barely see where to sign.
Rushed to theatre, massive epidural top up and was directed when to push as I couldn’t feel anything. Baby was born with keilands forceps just before midnight, luckily I had a ver experienced registrar, otherwise I would have had a c section.
It was very traumatic, recovery was horrid and as I was trying to breast feed, the only pain releif available was paracetamol and ibuprofen.
It took 4 days to get breastfeeding established as a resul of the birth trauma to baby and the combination of a tongue tie also.
I have read so much since then and am much more educated, next time I am resolutely avoiding induction and any possible interventions unless they are truly necessary
Than you for taking the time to share your story. It is a very familiar one unfortunately. Routine induction for post-dates needs to stop. I hope your next birth is a healing experience for you.
Hi, just found your site from reddit. It’s not an article I would normally read, but I loved your perspective on it. Thank you for making a blog post worth reading!
Thanks for this post. I’ve recently come to realize how significant this seemingly small intervention can be.
One more risk is that once the waters have been broken, a hospital will not allow the mother to leave. It starts the arbitrary “clock” – some hospitals set it at 12 hours, some at 18, some at 24 – where once the waters have been released the baby must be born by that time or a cesarean will be done. (Based on the faulty belief that length of time since BOW broken leads to increased risk of infection.) As you noted, mom’s risk of infection is low as long as no fingers or instruments are inserted in the vagina, but how could they EVER keep from fiddlin down there!
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Thank you for all your wonderful articles. I am wondering what your opinion is on my situation. I am preparing for a VBAC (currently 18 weeks) but have been given till 10 days post dates before I will be induced via catheter and then AROM. As I am considered “high risk” of uterine rupture (not really if you read the stats but nonetheless) so cannot be induced via other methods. My only other option is a booked caesarean and I am definitely not going there again (1st baby was breech and I wish I knew what I know now). I am not interested in a home birth and am attending a clinic specifically for women wanting a VBAC so feel like I am I the right place but I still don’t want to be “on the clock” or poked and prodded continuously.
10 day post dates! Wow. VBAC women often go post dates (in my experience) probably due to anxiety and the pressure of ‘not going post dates’. I can’t give you any advice except get informed and remember that you don’t have to have anything done to you that you don’t want. Trust your instincts and your body.
Thanks. My previous Obs wouldn’t give me past 40 weeks and then straight to a booked caesar. A supposed VBAC friendly Obs would only give me till 41 weeks then a booked caesar. The main public teaching hospital will give me 10 days so that’s where I’m going.
Great blog entry! My question is about the meconium; my first they let me go to the beginning of 41 weeks. I was seeing a specialist at the time to keep an eye on my sons growth bc during the 20 sono they found to anomalies that they thought meant down syndrome. At 41 weeks they did a sono and my specialist realized he couldnt see my amniotic fluid (because there was meconium). My body was closed for business at the time, they gave me cervidil (sp) to get my cervix going, Praise God right as they were getting ready to hook me up to pitocin my water broke. 8 hours later I had a perfect, healthy baby boy! So my question is was he in any real danger from the meconium, because they made it seem as though he was in major danger?! Thank you
All I can say is that he was not in danger from the meconium alone. It can only be harmful if inhaled – which he would only do if he became stressed. It is interesting that the plan was induction which is know to increase the chance of the baby becoming stressed ie. would make the meconium more dangerous. Luckily you got yourself into labour without it. By the way ‘they’ don’t ‘let’ you go… remember it is your body and you call the shots. ‘They’ can give you information and should only give you recommendations if they want to take responsibility for you following those recommendations. No one can make you do anything. Enjoy your boy
Thanks for the info. I find it funny “the let me go” he was my first and that was almost 4 years ago. To be honest I was the woman that just wanted to go in and do what they told me and get my epideral and just wait for it to happen while being told what to do. Now after two kids, having had a spinal headache (that lasted 24 days-blood patch didnt work) with my 2nd. I have informed myself as to my options and I research everything almost to a fault (drives people crazy)
Anyways, with my 3rd (whenever happens) I have a whole different outlook and game plan. I would like a homebirth but if that wont work for us for whatever reason I will definately choose a birth center of the hospital and no pain meds this time. With meds I have push both of my babies out in just under 30 mins with 1 -2 stitches. So Im just thinking if I was actually in complete control just imagine what I could do.
Thank you for what you do informing women of their options. I didnt have access to the internet with my first and with my second I just didnt do enough research however. Now I am not the same woman or mother I was when I had my first 4 years ago.
Thank you sharing this information. It was very well done and informative that even I ( a women wanting to study soon) can understand it. Thank you again!!! The body is truly just amazing and with out a doubt the best made machine!!! Thank you again!!!!
Had first son in the hospital , my water had started leaking on its own and i was already having mild contractions (I could barely feel them) They gave me pitocin but did not do anything else…pretty much forgot about me and left me in my throw up for a hour with such painful unnatural contractions. I should have never let them give me anything but 1st time did not know any better.
My other 3 boys I had at home with a wonderful midwife. A very low stress natural delivery and much less painful. My 2nd and 4th babys would have been born in the “sac” but I could not handle the pressure. Once my 2nd had been crowning for about 3 contractions and after me climbing up the bed… i asked my midwife to break my water and it was good to feel that warm water come out and by the next contraction the baby just slide right out with almost no pain at all. My 4th.. well he was crowning and i could not ever feel it but remembering how much it hurt with trying to push with the sac intact, I asked her to break it after the next contraction and it was almost as if breaking the water at that point made him slide out on his own. That was a wonderful soothing feeling at that point in labor.
Thank you for the info I always love reading this stuff… even though we are done having babies
Random question but…Why is it that doctors worry so much if women go passed 42 weeks? Has it ever happened to where a mom really just doesn’t go into labor? I went 42 weeks with my last baby and through i was never going to go and he came out perfectly fine and look at a perfect “term” Why is it such a “big risk” to go to long?
Hi Kristen. Thanks for sharing your birth stories and re. your question… There is a theory that the placenta shuts down after 41 weeks. There is no evidence to support this. Babies are more at risk after 42 weeks but this may be associated with what is done to them to get them out. I’m pretty sure that before inductions women didn’t remain pregnant forever – labour would happen at some point. Our culture is very caught up on times and dates
In the book “Husband-Coached Childbirth” Dr Bradley cites a patient of his who was pregnant for a year. When the baby was born, he was a perfect at-term baby and the placenta was fine as well. He just needed that extra time. It’s important to remember that “term” is based on a bell-curve. The majority of women give brith between 37 and 42 weeks, but there are always others who give birth earlier or later than that. It’s not necessarliy dangerous – at least not as dangerous as most doctors would have you believe. My favorite quote from the book is “any doctor who thinks he knows when a baby is going to be born is going to fool himself into picking a green apple”.
My second birth ended in a transfer from home birth to hospital, because the midwife suspected that the baby has compressed the cord (baby’s heart rate was lower than usual and sometimes decelerated fast without contractions) and she wanted me to be in the hospital when the water breaks, because then the cord could get really compressed when the protection of water is lost. When I got to the hospital I was fully dilated, waters still intact. At the hospital the first thing they did was break the waters (well… actually they spent an hour asking me routine questions before even checking baby’s heartbeat, but that’s another story). And just after that the doctor started screaming – “get the monitor on, the cord is prolapsing!!!” Then she tried to get the cord back and the nurse tried to find a monitor that would pick up something. First one didn’t pick up anything so for 5 minutes I thought my baby is gone… At the same time nurses were shaving me for a CS and I even signed a consent. The next monitor they found picked up the baby’s heartbeat, the doctor managed to get the cord back behind my baby’s head and I managed to get a fairly routine hospital vaginal delivery (episiotomy, pitocin, immediate cord clamping, pulling on the cord to get placenta out, lost 2 liters of blood, manual revision of the uterus, antibiotics to save me from possible infection).
After this experience I am thinking that nature is clever. The cord was compressed so this time the waters would not break even at full dilation (my first birth started with rupture of membranes). And the waters probably would not have broken up until the last moment (I had 1,5 liters of waters so I doubt I could have managed birth in caul, but who knows) giving my baby the best chance of survival. I was surprised that the doctor was so shocked at the cord prolapse. When I transferred the homebirth midwife did tell hospital midwife all the reasons for transferring and we did suspect that something like this could happen if the waters broke before baby’s head was low enough. But probably the doctor was just arrogant and decided to ignore the thoughts and intuitions of a homebirth midwife. My intuition says that my baby would have been ok at home as well, but I am not a risk taker. If my midwife was not comfortable with the situation – I knew we had to transfer. Most important thing – both me and the baby are dong good – my son was doing excellent despite the circumstances. And now I have even deeper respect for the way birth works.
What is your take on the situation?
I agree with you – birth works in mysterious ways and we often don’t understand what is happening until afterwards.
Hi, thanks for your informative website. So, I am 37 6/7 days pregnant, had contractions 3 min apart, painful, for 5 hours, went to the hospital, confirmed contractions, dilated to 3 cm, 60 % effaced…after all the checking was done, I walked around for an hour, had an iv placed…declined epidural…and suddenly the contractions stopped. I was told I needed AROM by the nurse, I declined ( had AROM with my first, felt like it led to pitocin and the word csection being thrown about – which I refused and had vaginal delivery) and was discharged after being told to come back when I was ready to cooperate. I now have no clue when to go back to the hospital. I am afraid to go back because I think they think I am playing games. But I really dont want to give birth at home – I don’t know how to do that. Should I have let them do the AROM? I do have contractions now, but irregular, maybe 30 min apart at times.
I have been offline and moving house… I assume you have had your baby now and would love to know how it went.
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So I am wondering if maybe this is why my baby’s cord broke right after he was born. They broke my water and I was already at a ten….it hurt so horribly after that and I was so exhausted that I got an epidural so I could sleep for 2 hours before pushing baby out. When he came out the cord just burst. I was planning on waiting for it to stop pulsing before cutting the cord but those plans went out the window, and he got taken away from me right after he was placed in my arms. I was too exhausted to fight
Thank you so much for this post! I’m thrilled to learn more about the amniotic sac. I really suspect that my first baby would have been born in the caul. I was dilated to 10 and ready to push and she the sac was still intact. They broke it and she was born a little while later.
How does being born in the caul affect the baby’s first breaths? I’m 35 wks with my second baby and will be birthing with midwives this time. They’re very much supportive of my birth choices, but I want to be sure I understand what those all entail.
I’m so glad to have found your blog!
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Hi, I`m happy to find this page. I gave birth to my firth child 3 month ago and she was born in caul. It was spontanous 10 hours long labour on due date, not in water, with no pain relief. It was a wonderful experience and I hope for more like that. I`m just wondering if there is anything I can do for it! I`ve done a small research on the Internet and found that in many cases, when babies were born in caul, the mother was labouring and giving birth standing (like myself)… Maybe it helps, i will try it again:)
Oh, and I had a wonderful, very young midwife with me there, she was really superb with letting me do all the labour and birth in my way with the very minimum examinations and instructions.
Wow, amazing blog structure! How long have you been blogging for? you made running a blog glance easy. The full look of your web site is excellent, let alone the content!
Just a quick note to say I’m enjoying your blog very much and all the info on it. Also, the salemmidwife blog at wordpress.com was deleted, but I was able to see the in-the-caul pics at the first site. Neat photo with the blood vessel in the caul. Learning new things every day!
Thanks Becky. I have removed the link
I just wanted to say how valuable this blog article is. AROM for labour augmentation is such a common intervention in the UK and I make this compulsory reading for all mums in my classes and have done since you wrote it. You have a great way of writing a blog that is accessible, knowledgable and informative without dumbing down. Thank you!
Thank you
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Hi, thankyou for this information would you be able to tell me is there anyway any part of the waters could stay intact after the birth? after my 3rd pregancy i had a very quick delivery and 2 days after giving birth i had a very large gush of water, which i was told over the phone that no this was urine, but you can feel what area it comes out from and it definatly came out my vagina, is this possible?
thanks sam
I’ve never heard of this before. The bag of membranes that contains the amniotic fluid is part of the placenta. So, if your placenta was out – the membranes would also be out and any fluid they had contained. I really don’t know what the gush of water was… weird. Maybe someone else on here can come up with an explanation?
Thank you for the info. I was looking exactly for this. I just had a hospital water birth and when I was 8 cm, and after 8 hours of labor midwife offered to break the waters for me. I don’t know why I agreed to it, since I felt that I didn’t really need it, but she convinced me that it’s a good idea and that it will speed things up for me. After she broke the water, things did start to progress very quickly and way more intense. 10 mins later I started to push and in 20 more minutes I gave birth. The baby came out a little blue and the midwives though she was in distress and cut the cord right away (which I didn’t want to be done) and took her and put an oxygen mask. I strongly believe that breaking the waters was not needed in my case and even may have lead to the baby’s distress. I wish all the midwives were as informed as you are!!!