Myth-conceptions: "My water wouldn't break on its own..."

If I had a dollar for every time I've heard that one. Here's the thing: while your water will likely break on its own sometime during labor (if not one of the 10% whose water breaks pre-labor), your baby can possibly be born with the amniotic sac intact, and that's perfectly fine! It's OK to break the amniotic sac after the birth and peel it back from baby's face if your water hasn't broken on its own before that. It's called being born "in the caul," and it's considered to be good luck in many cultures. Maybe that's because of the many important ways that the amniotic sac and amniotic fluid protect the baby.

I always advocate for true informed consent. Before moms are given the option to have their water broken artificially (also called amniotomy, or AROM--artifical rupture of membranes), are they warned of the potential risks? Are they informed that the amniotic sac functions to protect the baby from infection so long as it is intact? Are they told that every time something is inserted into mother's vagina during labor, it increases her risk of infection as well (including vaginal exams), especially after AROM? What about the risk of cord prolapse from AROM, which necessitates an immediate emergency cesarean? What about the increased pressure on the baby from each contraction, now that the somewhat protective cushion of amniotic fluid and amniotic sac is removed before its time, which can contribute to fetal distress or non-reassuring heart tones?

Here is an informative blog describing the function and importance of the amniotic sac during labor. A fascinating read (if you're fascinated by the same stuff that I am.)

Are moms informed that the research (specifically Cochrane review, at this link) concludes, "Evidence does not support the routine breaking the waters for women in spontaneous labour... There is little evidence that a shorter labour has benefits for the mother or the baby. There are a number of potential important but rare risks associated with amniotomy, including problems with the umbilical cord or the baby's heart rate... 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." That ought to be proof enough that America's routine obstetrical practices are far from evidence-based.

When we have well established, accredited resources stating the risks of AROM (without any benefits), why is it still occurring routinely? "Routine artificial rupture of membranes increases the likelihood of intrauterine infection because it eliminates the physical barrier (the amniotic sac) between the baby and the mother's vaginal flora. This study suggests an additional mechanism for the prevention of infection when the membranes remain intact: A baby bathed in amniotic fluid benefits from antimicrobial proteins that are found in the fluid and in vernix caseosa." We're all still speaking English, right?

So, why have I heard literally dozens of women tell me some variation of the following? "My water could never break on its own. My OB had to break my water for me with all four of my births." Gah! The frustration! People, I assure you that at some point before you hold your baby in your arms, the amniotic sac will tear on its own! I can promise you that!

I've seen lots of awesome birth photos online of births in the caul, and in the future, I'll bookmark photos like that here. For now, here are a few "in the caul" photo or video links.

awesome (graphic) waterbirth with amniotic sac intact on YouTube

graphic homebirth in the caul, water breaks immediately after birth, mom delivers on hands & knees

This one's my favorite. Incredible (graphic) photo series birth story. You can see vernix floating in the amniotic sac surrounding baby's face after the head is born, while the amniotic sac is still intact. Note that the cord is wrapped around baby's neck, which is not an emergency, as I posted in my previous blog.

Oh and before I forget, can we once and for all dispel the myth of the dry birth? There is NO SUCH THING as a dry birth. Seriously. Amniotic fluid is replenished continually after the amniotic sac is broken (whether naturally or artificially) and this is one of the reasons why it's so important for momma to remain well hydrated (by oral fluid intake) during labor.

I once heard a mom describe how her birth was painful and difficult because it was a dry birth. She stated that since there was "no fluid" it made her baby's descent full of friction. I politely explained to her what I just told you ("There's no such thing as dry birth, amniotic fluid is continually replenished, etc."). I kid you not, she blinked twice, then continued with her story about dry birth. Folks, I'm not making this stuff up. There were, no doubt, many factors that contributed to that birth being painful and difficult, and those factors are beyond the scope of today's discussion. What I'd like to impart is that it is *strong, effective contractions* that bring a baby down and out. They do not ride out on a log flume of amniotic fluid.

The final trigger for today's topic was this morning when I read Tiffani Amber Thiessen's birth story on People.com. You know, Kelly Kapowski on Saved By the Bell. I'm sorry that she and her daughter had a difficult experience, but I'm deeply saddened by the fact that there was no informed consent, and I'm saddened even more that she is perpetuating birth myths. Tiffani clearly had no understanding of what she agreed to, which is obvious from her statements:

"“First my water didn’t break; they had to do it for me. Then the baby wasn’t descending, because the cord was wrapped around her neck,” the White Collar star — who ultimately delivered via c-section after 30 hours of labor — tells PEOPLE.

"“Once she was finally out, I didn’t even get to hold her before they whisked her away… The whole thing was very surreal.”"

Can we discuss this bit by bit? Not to tear her apart or make fun or anything of the sort, but to hopefully prevent iatrogenic birth catastrophes that are utterly avoidable? If we can learn from others' mistakes and prevent suffering, that's a worthwhile discussion, in my humble opinion.

I realize that I don't have Tiffani's medical charts in front of me, but I can say without any hesitation that "they" did NOT "HAVE" to break her water "for her." See the above reference links.

The cord is wrapped around the baby's neck in approximately 30% of all births and is not an emergency or a problem in and of itself, as we established as well. True cord problems are extremely rare, and while it's possible that Tiffani was one of those rare percent of women, odds are against it.

The fact that the preventable problems with her birth led to some sort of complications with the baby is a sad but common situation. See CIMS Fact Sheet on cesarean risks for full details.

Would Tiffani Thiessen have made the same decisions had she been well informed of the potential risks involved with the interventions she chose? Maybe, maybe not, but I don't want for people to hear such a well-publicized birth story and believe that women need to be rescued from the amniotic sac that's holding their baby captive. I want to make sure that my blog readers don't fall for the same Myth-conceptions.