One More for the "Leave Birth Alone" Files

October 31, 2007

The Cochrane Collaboration has released a new systematic review on amniotomy (artificially breaking the waters, or “artificial rupture of membranes”) for speeding up labor which concludes that the current evidence does not support the practice. It is important to note that this paper is not a new randomized controlled trial (the “gold standard” for evidence in medicine), but compiles the findings from fourteen studies of a total of 4,893 women, and presents a recommendation on the practice based on a review of these previous works. The Cochrane Collaboration, however, is regarded as one of the most reliable sources of systematic reviews, which allow the comparison of evidence from multiple studies and provide a “big picture” view of the topic.

Amniotomy is often used because it is believed to shorten the duration labor, or speed it along when it has become “prolonged.” The authors of the Cochrane review concluded that:

“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.”

Regarding c-section, the reviewers found no statistically significant difference in cesarean rates, but because the finding was nearly significant, they indicated that they could not say with certainty that rates are not increased when amniotomy is performed.

The reviewers found that amniotomy appeared to make no difference in length of the first stage of labor, maternal satisfaction with the childbirth experience, use of pain relief, oxytocin usage, postpartum hemorrhage, or maternal or perinatal morbidity or mortality (serious complications or death). As such, their final recommendation was as follows:

“Implications for practice: On the basis of the findings of this review, we do not recommend that amniotomy be introduced routinely as part of standard labour management and care. We do recommend that the evidence presented in this review should be made available to women offered an amniotomy and may be useful as a foundation for discussion and any resulting decisions made between women and their caregivers. It may be useful to provide information to women as part of their antenatal education.”

The full-text of the paper is not available without a subscription, but a brief summary is available, as is a short piece in the New York Times.

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