Amniotomy - which translates into artificially rupturing the membranes - is one of the most routinely offered interventions when giving birth. This is sometimes noted as an AROM. Your membranes are the amniotic sac, a fluid-filled bag, otherwise known as your water. The sac surrounds and protects your baby. Your waters break naturally usually just before giving birth, but around 10% of women will have their waters break before labor begins.
If you are having an induction of labor or if there is a slowing of your labor, your midwife or obstetrician may discuss with you having an AROM to help progress the labor. This should include discussion around the risks and benefits of breaking your waters and you need to consent. The membranes can be ruptured using a specialized tool, such as an amnihook or they may be ruptured by the examiners’ finger. This should include discussion around the risks and benefits of breaking your waters and you need to consent.
How is your water broken by a midwife or obstetrician?
Breaking your water is when the midwife or doctor ruptures the membranes of the amniotic sac. This is typically done through a so-called amnio hook or with a scalp electrode. The amnio hook looks like a crochet hook and is used during a vaginal exam.
The amnihook is gently put against the membranes to allow a hole to be created, allowing the amniotic fluid, or waters, to be broken. This hook is protected by your healthcare provider, so as not to cause any trauma to you or the baby. This can still be uncomfortable. Before breaking your water, your healthcare provider will touch your stomach to assess the baby’s position. This way, she/he can sense the child’s head and confirm that the head is facing downward and is low.
Amnio hook is typically used for amniotomy when your healthcare provider is considering helping along with your labor. A scalp electrode is used when It is necessary to continuously listen to your baby’s heartbeat. This procedure is done if it has been difficult to monitor your baby’s heart rate and there has been a concern highlighted already that they need to continuously listen to the baby’s heart. The electrode remains attached to the baby’s scalp until just before the birth. It can cause some slight bleeding and bruising the baby’s scalp. But neither the woman nor the child feels any pain during the procedure. The vaginal inspection on the other hand can feel a bit uncomfortable.
Your consent is needed
The evidence behind amniotomy suggests that this is not supposed to be done as a standard procedure during labor. However, some healthcare providers feel that breaking your waters can shorten the length of labor and/or can aid if there is a delay in progression of labor. Therefore, it is important that you, as a pregnant woman, always receive information about interventions being performed and that you give your consent to these procedures beforehand. Knowing that the pain can fluctuate in strength and intensity after your waters are broken can also be valuable, so you should be offered pain relief before the procedure starts.
Why Wait with Amniotomy?
Keeping the membranes intact for as long as possible can be advantageous for the baby, partly as to decrease the risk for infections and make the baby’s journey through the pelvic bone as gentle as possible. If you wish to wait with amniotomy or want a more proactive treatment of the pregnancy, it may be a good idea to write it down as part of your birth plan or when discussing induction of labor - something like this:
“I wish to wait to rupture the membranes while giving birth. If there is a medical reason for doing otherwise, I wish you to ask for my consent and explain to me why it needs to be done.”
“I wish to minimize intervention while I’m giving birth, and if there is a risk of prolonged labor, I wish to discuss the alternative of amniotomy beforehand."
Sources:
- Smyth RM, Alldred SK, Markham C. Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev. 2013 Jan 31;(1):CD006167. doi: 10.1002/14651858.CD006167.pub3. Update in: Cochrane Database Syst Rev. 2013;(6):CD006167. PMID: 23440804.
- Socialstyrelsen (2011)