What does Tom Cruise Have to do with Breaking My Water?

Pregnant women and their partners settle into their seats as I announce we are going to watch a movie. The lights go down as the movie starts up, and we see our heroine navigating a convertible, wind having its way with her hair, along a curvy road with a cliff below.  What, you didn't see this movie in your childbirth class?  Are you ready to know what in the world that clip from a Hollywood blockbuster has to do with birth? 

An iatrogenic effect is a care-giver caused illness or issue. So, our leading lady was out for a Sunday drive, enjoying herself, when Cruise's character begins the chase. During this pursuit she almost slams into a truck, spins-out, and ends up perilously perched on a precipice. But wait, what happens next? She is rescued by none other than the person who put her in danger to begin with. Will she walk away from this incident blaming him for the accident, or will she remember him as the person who saved her life? 

It is not unusual to hear women share, "Thank goodness we were in the hospital! They saved my life! They saved my baby's life!" In casual conversation this makes birth sound very scary. With  knowledge of the potential risks of a specific intervention and keenly-tuned ears, frequently one can pick up on the events that may have turned that situation into an emergency. For example, let's look at an intervention that happens hundreds of times daily in hospitals the country over: artificial rupture of membranes (AROM, or breaking the water). 

The most common reason to break the water is to "speed-up labor." In some situations, AROM is done to more accurately monitor the baby's heart rate  and the contraction strength via internal instruments. It can absolutely be a part of the epidural routine (give epidural--->break water--->insert internal monitors--->begin pitocin). Let's look at it alone, though -- just having the water broken.

It seems harmless enough, right? No IV or medications required. The only instrument involved is an amnihook. By simple insertion, the hook tears the amniotic sac and the water is broken. The baby here is almost ready for birth -- see the cervix is wide open as the bag bulges over the baby's head? A baby this low is less likely to have an issue than a baby who isn't in such a snug-to-the-cervix position. Sometimes as the water flows out, baby's cord sweeps down a bit and becomes pinched between baby and the uterine wall. The baby's heart rate drops, and mom would be given oxygen and rolled into different positions to try and ease that pinching pressure off the cord. If there is a side she can lie on where baby looks good, then mom holds that position; if baby doesn't like the lack of fluid and continues to have heart decelerations, sometimes this can require immediate action -- a cesarean birth. 

In a situation like this, it is unlikely the woman would be told AROM contributed to baby's decels.  Assessing mom and baby's immediate needs and working to resolve the issue is where the focus needs to be. In the midst of the crisis and machines and noises and scrub-donned staff, the family is terrified. When mom and baby are finally safely reunited, and the collective sigh of relief is made, often it's the medical establishment that gets the award and eternal praise for navigating everyone through this dangerous situation. Tom Cruise reached through the car hanging off the cliff and pulled the heroine to safety.

Here are some facts about AROM:

• Amniotomy does not shorten labor length and is associated with increase risk of cesarean birth (Lee et al. 2010; Fok 2005; Goffinet 1997) 
• AROM increases risk of infection (Busowski et al. 1995)
• Stalled or slow labors often respond to position changes, movement, and hydration (Lawrence et al. 2009)
• Pain levels can increase, most likely due to the loss of the cushion of fluid (Barrett et al. 1992; Lupton 1992; Inch 1985) 

Of course interventions have their place, it would be irresponsible to say they are never needed. There is also overwhelming evidence that shows us, when mom and baby are doing okay, it's best to support their unique labor by allowing them to work together in their own time.

Click here to learn more about the risks of interventions, why they might be needed, and how to keep labor as normal as possible in the midst of an intervention. And to see more of the video clips I use -- stay tuned! 

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