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If your water hasn't already broken on its own and your labor isn't progressing well, your practitioner may rupture the amniotic sac or "bag of waters" that surround your baby. This is done to try to augment your labor, or stimulate more effective contractions.
The procedure is known as amniotomy, and has been used for a long time. But experts continue to debate its risks and benefits.
On the pro side, having an amniotomy may:
- make labor shorter
- reduce your chances of needing Pitocin (a synthetic version of the hormone that stimulates contractions).
- make contractions more effective, causing your cervix to dilate so your labor can progress
On the con side, amniotomy:
- increases your risk of infection
- removes protection the intact amniotic sac provides against umbilical cord compression during and even between contractions. (Umbilical cord compression can cause your baby's heart rate to slow down, which may, in some cases, lead to a c-section).
- will likely cause more painful contractions than you have been having.
How is an amniotomy done?
Your practitioner can break your amniotic sac by inserting a slim, plastic hooked instrument through your vagina and dilated cervix. This should cause no more discomfort than a regular vaginal exam.
This procedure allows the amniotic fluid to flow out of the uterus through the cervix. The fluid contains hormones like prostaglandins that usually lead to stronger contractions. And with the buffer of fluid around the baby gone, the baby's head can now press on the cervix and cause it to dilate faster.
Why might my provider break my water artificially?
Your practitioner may choose to perform an amniotomy because the longer your labor is allowed to go on without making progress, the greater the chance that you'll be exhausted when it's time to push, or that you'll end up with a c-section.
Your practitioner will consider whether amniotomy is a good choice for you based on factors such as how much your cervix is dilated, how low the baby is in your pelvis, whether you need internal fetal monitoring, and your risk of infection.
If your labor is progressing well and your baby is doing fine, you probably don't need an amniotomy until you're very close to delivering. Some practitioners even deliver the baby in the sac.
However, you may need an amniotomy earlier in the labor process if your provider is unable to monitor your baby with the amniotic sac intact