Monthly Archives: November 2012

The Amniotomy Question: Examining the Pros and Cons of Rupturing Membranes

Standard

Abstract: The culture of birth establishes practices and embraces rituals. Currently there is a movement toward midwifery and away from hospital births as women and professions question the value of some practices and interventions common in hospital births. Amniotomy is a well-established practice that is accepted as an intervention to help women in their birth process, with the hope that it will shorten labor. There is little research regarding the psychological implication of amniotomy on the infant. This paper explores the pros and cons of amniotomy, its role as a ritual for birth attendants and the possible psychological effects on the infant.


Artificial rupturing of the amniotic membranes (AROM), or amni-otomy, is a common and even routine practice in the North American culture of birth. Amniotomy is accepted as a useful means to get labor going again if it has become stuck (1). Throughout gestation, the amniotic fluid is an integral component of the baby’s environment. The baby learns to move in this fluid, breathes it into his lungs and swallows it in preparation for sustaining life outside of the womb. At the time of birth, amniotic fluid functions as a cushion for the baby during contractions and passage down the birth canal (2). The decision to rupture the membranes or to wait for spontaneous rupture is an important part of the birth plan. But with amniotomy having become such a common practice, and so accepted within the realm of natural childbirth, this decision is often overlooked.

When the doctor or midwife makes the decision to rupture the amniotic membranes, it is done by inserting an amnio hook into the birth canal to snag and break the membrane. In deciding to break the amniotic membrane, the hope is that the baby’s head will push against the cervix, helping to open the cervix and shorten labor. Some studies (3–6) have found that amniotomy to shorten labor is not helpful because it shortens it by only one or two hours. One study (7) found that amniotomy increased the pain of labor and interfered with the onset of maternal affection immediately after birth because many women felt that their body’s process had been disturbed (8). In some women however, especially multiparas, amniotomy during the second stage of labor is reported to alleviate pain (9).

References:

  1. Goer, H. 1999. The Thinking Woman’s Guide to a Better Birth. New York: The Berkeley Publishing Group.
  2. Simkin, P. 2001. The Birth Partner, 2nd ed. Boston: The Harvard Common Press.
  3. Davis-Floyd, R, and CF Sargent, eds. 1997. Childbirth and Authoritative Knowledge: Cross-cultural Perspectives. 3rd ed. Berkeley and San Francisco: University of California Press.
  4. Enkin, M, et al. 2000. A Guide to Effective Care in Pregnancy and Childbirth, 3rd ed. New York: Oxford Press.
  5. May, KA, and LP Mahlmeister, eds. 1994. Maternal & Neonatal Nursing, 3rd ed. Pennsylvania: JB Lippincott Company.
  6. Wagner, M. 2006. Born in the USA. Berkley, CA: University of California Press.
  7. Robson, KM, and R Kumar. 1980. Delayed Onset of Maternal Affection. Br J Psychiatry 136: 347–53.
  8. Mayes, M. 1996. Mayes Midwifery, 12th ed. Oxford: Baillière Tindall.
  9. Brenda. 2001. Artificial rupture of membranes: breaking the waters. Message posted to UK Midwifery Archives at http://www.radmid.demon.co.uk/arm.htm. Accessed 2 Jun 2010.

Verna Oberg Excerpted from “The Amniotomy Question: Examining the Pros and Cons of Rupturing Membranes,” Midwifery Today, Issue 95 View table of contents / Order the back issue