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What does "artificial rupture of the membrane" mean?

What does

Artificial rupture of membranes should you or shouldn't you...

What is this membrane we speak of???  Your baby is encased inside of a sac filled with amniotic fluid to feed and cushion your baby as it grows and develops within you. 

How do you rupture said membrane???  Artificial rupture of membranes (AROM) is when your care provider "breaks your water" with a crochet-like hook.  Rupturing the membranes is thought to release chemicals and hormones that stimulate contractions. 

Usually your water will spontaneously rupture by itself while laboring.  Typically around transition or the pushing stage of labor.  Only 10% of pregnancies start by the water breaking without any contractions.

Artificially rupturing your membrane is considered a birth intervention and can lead to more interventions as your labor progresses, if you decide to have your waters broken, make sure you are far enough along (7-9cm). 

 

Here is a list of pros and cons as well as some questions you can ask your care provider to make sure AROM is right for you in your labor.  

Pros:
  • Might help a stalled labor progress
  • May reduce need for c-section
  • Allows for internal fetal monitoring (to get a more accurate read on baby's well being if variable/unstable readings are shown on external fetal monitors)
  • Allows for intrauterine pressure catheter monitor (to determine strength of your contractions, which can help you decide if further interventions are needed in a long labor)
  • Detect meconium and determine if additional medical support is needed after birth.
Cons:
  • Increased labor pain
  • More intense contractions
  • Increased risk of infection
  • Increased risk of additional interventions, including Pitocin, IV, external fetal monitoring, and c-section
  • Increased need for IV pain medicine or epidural to cope with pain
  • Increased possibility of a poorly positioned baby, which could increase pain, length of labor, and need for interventions or c-section
  • Complication with baby's umbilical cord called "cord prolapse"
  • Rare: problems with baby's heart rate, known as "fetal distress"Potentially speed up labor 

 In a review of studies of over 8,800 women, they found that artificially rupturing the membranes doesn't really do anything.

Authors' conclusions:  "On the basis of the findings of this review, we cannot recommend that amniotomy should be introduced routinely as part of standard labour management and care. We 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."

https://www.cochrane.org/CD006167/PREG_amniotomy-for-shortening-spontaneous-labour

 

If you are presented with the option to have your water broken in labor, consider the reasons presented, the status of your labor, and the trade offs you're willing to accept.  It's important to talk with your care provider about the potential risks and benefits of the procedure. 

Questions to Ask

Before agreeing to have your waters broken, there are a few questions you will want to ask your doctor or midwife:

  • Are there other interventions that may be needed because of this?
  • Will I be able to walk around after my water is broken?
  • Will I need extra monitoring?
  • How would breaking my water change labor for me?
  • What are my alternatives?
  • Do I have time to decide what I want to do?

Do your own research!! Being informed will help you to make the best choice for you in your labor.  Knowing your options and any risk or benefits can help you feel in control of your birthing experience, which will help you have a positive one!!!

 

Stripping of membranes or stretch and sweep

This procedure is used to induce labor. 

This usually happens at one of your last maternity appointment, during one of your vaginal checks.  Your care provider insert their finger up your vagina towards your cervix. They take their finger and they sweep around to separate the membrane that surrounds your baby from the lower part of your uterus by your cervix.

This is thought to irritate your uterus into contracting and getting your labor started. 

Stripping  membranes will only help if your cervix is ready.  

be aware that stripping your membranes 

  • Can be very painful.
  • Can cause your uterus to become really irritable and contract irregularly.
  • 10% chance that your water will break

If your are presented with the option to strip your membranes to get your labor started, asking questions about your cervix will help you know if stripping your membranes will be effective.

  • how dilated are you?
  • how effaced?
  • what is the consistency of your cervix (soft or hard)?

You have so many great options with it comes to your amniotic sac.  Learning more will help you make good decisions. 





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