During pregnancy, the amniotic sac has many roles. It holds the fluid that protects the baby, provides cushioning and allows him or her to move freely for much of the pregnancy. The fluid contains important electrolytes, proteins, and more for the growing baby; it also gives the baby a way to breathe and swallow in utero. But this amazing, protective bubble plays possibly an even greater role during childbirth!
I think Rachel at Midwife Thinking says it best:
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 for an extended period of time, or if the baby is already compromised through prematurity or a poorly functioning placenta.
Eventually the force of the contraction and the movement of the baby will rupture the sac as the baby’s body is born. You don’t need to worry about the sac holding the baby back. A baby and uterus are stronger than the membranes.
Despite this wonderful truth, many membranes have “help” rupturing (this was true with both my first and second births, and neither were necessary).
Artificial Rupture of Membranes (AROM) or Amniotomy
Most women do not have their water break spontaneously at the onset of labor (only 10-20% do), but many have it artificially broken by a doctor or midwife at some point. According to Wikipedia, there are four main reasons for performing an amniotomy:
- To induce labor or augment uterine activity.
- To enable the doctor or midwife to monitor the baby’s heartbeat internally.
- To check the color of the fluid.
- To avoid having the baby aspirate the contents of the amniotic sac at the moment of birth.
While these may be necessary for some, there is (at least) one major issue with AROM: it often leads to more interventions. It rarely, if ever, stands alone and results in a med-free, natural birth. Once a woman’s water has broken, she is on the clock; most doctors will give 24-48 hours before they will insist her baby(ies) be delivered. If her labor stalls or “fails to progress”, she is likely to be given the man-made version of oxytocin (pitocin or syntocinon) to cause contractions, but these artificially-induced contractions are no joke! She is likely to need an epidural to cope with the pain. Also, after hours of these contractions, the baby may struggle with a repeated drop in heart rate. If she still fails to progress, is unable to effectively push, or the baby’s heart rate continues to drop, they may start discussing the need for a cesarean.
Born in the Caul
Many women have their water broken during labor because they are under the impression that it needs to be broken and/or it might not do it on its own, but that’s just not the case. It is normal for a woman to have her water break as she is pushing (this happened to me with my third) but there are even some babies who are born en caul, which means with all of the amniotic sac still intact. My friend, Kerry, from Winding Road teamed up with me today and has posted her story, in which she gives birth to her daughter in the caul. Check out her great post. :)
Because so few babies are born this way, there have always been beliefs on the significance of it. Some say that a child born this way may have special intuitive powers, be destined to be a midwife, have extraordinary luck or never die by drowning.¹ In medieval times the appearance of a caul on a newborn baby was seen as a sign of good luck. It was considered an omen that the child was destined for greatness.²
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Whether our babies are born in the caul or our water breaks at some point during labor, I know one thing: we need a lot fewer interventions and a lot more trusting to let our bodies do what they are designed to do.
Image credit – David Roseborough