Approximately 10 percent of women will have their water break before the onset of labor. That means the other 90 percent will face the choice of an amniotomy (artificial breaking of the amniotic sac) or having their membranes rupture on their own (spontaneous rupture of the membrane, or SPOM).
Why do I bring this subject up? One of my doula friends, Nikita, recently attended a birth where there was great debate regarding if and when the mother should have her membranes ruptured by her doctor. After much time and discussion, the client opted for this procedure. She was fortunate enough to have a well-educated birth doula with her to explain the pros and cons of such an intervention. For those forging forward on their own, here is a breakdown of why you may or may not want an amniotomy.
What is an amniotomy?
Also known as an AROM, this is a procedure done to artificially rupture the membranes or “break the water.” This should not be attempted by anyone other than your care provider. To do this, your care provider will insert an amniotic hook (it looks like a crocheting needle) into the vagina to perforate the amniotic sac.
Why is this procedure done?
There are a few reasons why a care provider may choose to rupture the mother’s membranes:
*It enables the provider to insert an Internal Fetal Monitor if he or she does not feel that the External Fetal Monitor is giving an accurate reading.
*If there is concern about fetal distress, this allows the provider to view the amniotic fluid to see if there is meconium (a thick, tar-like substance that lines the unborn baby’s intestines).
*To progress dilation: Without the pool of fluid surrounding the baby, it is believed the baby can descend deeper into the pelvis and apply more direct pressure onto the cervix, thereby increasing dilation.
*It may help move labor along by stimulating stronger uterine contractions. If this is the case, it is also important to consider the timetable the care provider is using to judge the need to “speed things along.” The World Health Organization defines first-time moms in labor for more than 18 hours as being in prolonged labor. If the mother has only been in labor for six or eight hours, there may not be a need to push her faster than her body is ready to move.
I have advised my doula clients to use an AROM in two different scenarios. One scenario is when the care provider gives the laboring mother two options: starting Pitocin or breaking the water. Depending on where the mom is in labor, breaking the water can be a good way to avoid the use of Pitocin and help move the mother into a more consistent labor pattern. (While the use of Pitocin and an amniotomy are both interventions, Pitocin tends to require the need for more immediate interventions.)
To read the full article at New York Family Magazine click here.
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