Yes, even though AROM has no significant health benefits, and in some cases can increase infection risk, we ALWAYS do it. We don’t want these poor doctors, midwives, or nurses to be inconvenienced and grossed out by having to witness a normal biological function proceeding normally!

I had my last one in the caul on my side because the OB knew not to break the water on an OP baby…THANK GOD. She turned at the last moment and came out with an intact bag at least to her waist…maybe further. It was a blessings because though they made me push so long she had no cone head.

I thought being in the caul reduced the chances of the baby getting GBS- if they don’t take their first breath by the vagina and anus, they can’t breathe it in and come down with it.

Obviously, cosmetics are a very lame reason for breaking the bag, but I’ve always thought that breaking the water at the last minute was a precaution in case there was thick mec that needed to be suctioned on the perineum. In fact, at home births I’ve seen midwives break it a little earlier than the last possible second, so we could transfer for mec if needed.

The only reason I can really think to break the bag before the head is born is because sometimes the membranes are really tough and hard to remove from the baby’s face if they aren’t broken nearby. Two births I’ve attended as an apprentice the midwife and I have struggled to break through very tough membranes as baby is being born. We got them off though. And I thought it looked really cool.

Caren, I was at a birth were the mom had SROM 40 hrs prior to birth, and yet we were still suprised by mec after the head was born–the head acted as a cork and held the mec back.

Knitted, in my case my water broke 31 hours before my daughter was born, but the mec didn’t show up till just before I began pushing, and the extent of it wasn’t clear till after baby was out (and was green from head to toe).

My HBAC baby came out en caul, and he was a nice “big one”! A tad over 10 lbs in fact, no sugar issues. My father was also a 10 lb baby. It did make it easier by far. AROM is yet another commonplace intervention that is there because people who didn’t know any better “have always done it this way”, like many obstetric traditions, such as lithotomy position, etc etc. It increases the pain dramatically, and thereby raises “compliance” when epidurals might have been resisted otherwise. Besides, it increases the risk of malpresentation and infection, both of which increase revenues to hospitals for surgeries and NICU stays. So why would they quit? Crime pays for them.

breaking the water doesn’t always help with dignosing MecAsp. My first was born with clear fluids when my water broke, no mec show during crowing/birthing, no mec on the baby, no mec in the afterbirth or visible in/on the placenta. Yet he had a severe MecAsp which required (among other things) 3 plus weeks of breathing intervention and ECMO.

Breaking the waters won’t reduce the risk of mec aspiration. It’s been drinking it for weeks anyway, and the intact baag is a sterile environment. When the waters go, it is only the forewaters anyway- the little bubble in front of the head. The rest is held behind the baby, leaking with each contraction, but is only released as the baby is born. We don’t routinely suck anyway- there is a risk that the vocal cords will spasm if you do. Our baby resus guidelines actually say that unless there is mec you can easily extract, either with suction or a finger, then just get on any bag the baby. It is better to get the baby breathing, and worry about aspiration later than to waste time suctioning a flat baby. If there is GBS, then the danger has occurred before the baby is born, because it has been smeared with it during descent. Where and how it takes its first breath won’t affect things. If it is going to be infected the major route is through the skin anyway, via a trauma during birth. GBS lives quite happily in our throats and on our skin, and it is transient. Sometimes it’s there and sometimes not. Occasionally it gets a fit in its head and gives you tonsillitis, but it isn’t a real nightmare until it gets into your blood.
On a different note, people born en caul will never die at sea, so the legend goes. They will also have the gift of second sight. Long ago, sailors would carry talismans made of membrane to protect them.
Andy

I don’t think it should be done routinely, but…

My second baby was almost born en caul. As the forebag (itself the size of the baby’s head) was out, my midwife (CPM) had a flash of intuition that she should break it. Good thing she listened to that… Baby had the cord around her neck and both shoulders. I think she mistook her placenta for a backpack!

… So I can’t say I’m entirely against it, either.