The most often cited reason for doing an AROM is progress. When labor is slow or arrested many times breaking your waters is suggested as a safe way to speed things up. One time I had a client who was laboring very well and making adequate progress and then the doctor came in 5 minutes before her shift was up and suggested breaking her waters since according to her, it had cut her own labor time nearly in half. I couldn't believe such blatant misinformation! In this case there was no medical indication, simply a desire to speed an already well progressing labor. My client agreed (as who wouldn't when promised a speedy delivery?!) The unfortunate result was that the contractions intensified, causing pain my client could not keep up with prompting her to request a narcotic for the pain, which then led to her being confined to the bed, which slowed her progress down considerably and as far as I could see only increased her frustration and discomfort. A veritable snowball of interventions that began with in my opinion an unnecessary AROM.
Another example of AROM used to speed up labor is from my own first birth. My first birth was long but not atypically so. I was going on a good 18 hours of labor with steady progress but not yet complete dilation. My mood was tense and tired. When my midwife suggested that breaking my waters might speed up my labor, I latched onto that fact with all the hope and expectation of a dying woman being offered a cure. My husband tried to remind me of what we had learned in our Bradley childbirth classes, but I was not convinced. Anything that might mean an end to my pain was very very welcome. In my case I was close enough to complete dilation that it did not cause any very severe increase in pain nor necessitate my requiring any other intervention. What did happen was that I ended up feeling as if I had failed somehow in my attempt to birth. I felt like I needed the help of my midwives in order to give birth and that my body just wasn't able to get the job done.
With my third I again accepted an AROM although I can no longer remember why (which bothers me a bit...) but anyway I was laboring well although contractions were incredibly intense. My son's heartbeat stayed steady throughout labor but after the AROM there were significant decelerations to the point that my midwives gave me oxygen and told me to get up on the bed (I had been on the birth stool). A significant side-effect of AROM is that cord compression is more likely to occur causing fetal distress. Without the bulgy bag of waters for protection the baby is less protected and more subjected to the rigors and stresses of labor. Since my son could no longer tolerate the contractions and pushing as well, I had to be up on the bed and slow things down in order to proceed safely. If I had left my bag of waters intact would labor have continued as steadily but with less distress for my son? It's possible...
My third and final example is from a birth where the baby was actually born in the sack. It was my client's first birth, and everything was progressing steadily and normally. The doctors were very gentle and patient, encouraging my client and remaining calm and steady throughout. An ideal situation! Whenever my client complained of pain or wondered when labor was going to end, instead of offering to "do something" i.e. break her waters to speed things up, offer pain medication, the nurses and I instead offered words of encouragement and gently helped her breathe through her contractions. The baby's heartbeat never faltered and when pushing time came, my client pushed slowly and steadily with each contraction. We all expected the bag of waters to break explosively on any or all of us there assisting but it never did, and in the end the baby was born, beautifully and gently with the bag intact.
Expecting labor (especially a first labor) to be slow and steady and allowing for pushing to be slow and steady as well is key. Avoiding stress for mother and baby is also key when aiming for a natural childbirth. Looking back, I think what I needed most towards the end of my first labor was encouragement that I was doing well and that all was proceeding normally. To me, my labor seemed abnormally slow and painful. I wanted/expected the AROM to be my miracle pill, dropping my baby out of me quickly. That didn't happen and afterwards I still remember feeling that there had been something wrong or abnormal about my labor and my experience of pain.
Birth is difficult but shouldn't be scary. When a laboring woman expresses pain or fear the best thing her caregivers can do for her is give her a sense of her own power to birth. How this is done varies woman to woman. Some need words of encouragement and praise. Others need to do something, so suggesting position changes can be really helpful. Others like touch, so massage or counter-pressure can give them the boost they need to keep going. Offering to break their waters or offering any other intervention even when needed should be done carefully and considerately since it carries with it the implicit observation that whatever the woman is doing it is not working. And equally importantly, breaking the waters should not be touted as a safe effective way to speed up labor. It can speed things up but it is not always safe or the most effective way to do so. The potential risks should be adequately explained and it should be suggested only after other methods have been tried.
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