Growing up, I assumed all women went into labor either in a fancy restaurant or standing in line at the grocery store. I believed this because Hollywood movies, for whatever insane reason they have, ALWAYS portray the start of labor with some overly dramatic water breaking scene in a public place. It’s enough to make any woman in her 9th month stay locked in her bedroom. In reality, Hollywood is dead wrong. Research shows that just 1 in 10 woman experience a dramatic gush of amniotic fluid before labor starts. Usually your water will break with a trickle, not gushing effect, and after you’ve already been in labor for a while. That said, I was one of those rare mamas-to-be whose water did break before I went into labor. Not good news for me, because health care professionals panic if your water breaks before labor starts. My midwife and the nurses at the hospital where I gave birth told me that if labor didn’t start on its own soon, they’d induce, a common practice in America, mainly due to fear of potential complications such as infection and placental abruption. Luckily, new research shows that this older train of thought may not even be helpful, which in turn can help you avoid an overly painful labor.
Researchers agree that preterm rupture of membranes (water breaking) affects just 1% to 5% of all pregnancies but they disagree about how to manage it. The American College of Obstetricians and Gynecologists recommends inducing labor when your water breaks while other societies take a more conservative approach, allowing a mother-to-be more time to go into labor naturally. Now a new multicenter Dutch randomized trial finds that the American approach might be wrong. To explore the debate researchers performed the PPROMEXIL trial, a randomized trial conducted at 60 Dutch hospitals that included 532 women. All of the women experienced their water breaking before labor started, at some point between weeks 34 and 37 of gestation. The women were randomly assigned induction of labor with either prostaglandin or oxytocin or received no induction and instead had their pregnancy monitored. Women in the monitor group stayed monitored until they had a spontaneous delivery or until 37 weeks’ gestation, when labor was induced according to national guidelines. Overall, the women who were not induced experienced a longer pregnancy (by three days on average) and experienced no more ill effects, such as higher cesarean delivery, neonatal sepsis, or respiratory distress syndrome rates than the induced group of women. Although the researchers feel this issue needs more study, overall, induction of labor did not appear to substantially improve the outcome for either the woman or her baby compared to labor starting naturally.
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