What is Artificial Rupture of Membranes?

This topic is one that comes up a lot in discussion with my clients prenatally as well as during labors. So, what is Artificial Rupture of Membranes (AROM)? The more commonly known term is “breaking the water.” This is when the amniotic sac is intentionally ruptured with an amnihook by an obstetric provider during labor. An amnihook is a thin, plastic tool with a hook shape at one end. Some providers use a special glove with a hook on the finger. The procedure itself is painless but some may experience discomfort by their providers hands holding open he cervix similar to a cervical exam.

Why is AROM used in obstetrical settings?

Obstetric providers often recommend AROM to "speed up labor" or as a routine step in a medical labor induction. It is an intervention that works in a couple of different ways. Often, when the amniotic sac ruptures, whether spontaneously or artificially, the body experiences a rise in oxytocin levels bringing on more and stronger contractions. Secondarily, when the amniotic fluid is no longer present in the uterus, there is no longer a cushion between baby’s head and the cervix. This can allow the head to put more pressure on the cervix and therefore lead to faster dilation.

So, does this method work to speed up labor? The jury is still out. In a spontaneous labor for a first-time birther, the evidence does not show that AROM is an effective tool in shortening labor. With a medical induction, it is one tool, of many, that can be used to progress labor. It is not a "necessity" as part of an induction process. As with everything, it is important to take a look at the benefits and risks of all labor induction methods/tools and decide what you are comfortable with and what you aren’t.

“It also does not have any benefit in shortening labor if it’s your first time giving birth and you have a spontaneous or non-induced labor.” - Evidence Based Birth

AROM comes with some serious risks.

Some obstetric providers tend to gloss over risks or deem them “highly unlikely” to happen. So, let’s talk about them...

• Increased risk of infection – Once the waters are ruptures, you are at an increased risk of developing an infection. Moreover, regardless of indications of infections, most providers want to see delivery within 24 hours of rupture. This puts your labor on a pretty short timeline, especially for first time birthers where labor can normally take longer. After the 24-hour mark, some providers may want to introduce more interventions and some may suggest a cesarean at that point. It is important to understand where your provider stands on this so that you know what to expect if you do consent to AROM.

• Fetal distress – This is usually deemed “rare” but one I often see in labors where AROM has been performed. The amniotic fluid acts as a cushion between baby, the cord and the inside of the uterus. It plays an important role in protecting your baby against the stress of contractions. When you no longer have that cushion, it is easier for the cord to become squished between the baby and uterus. There is also less “wiggle-room” for baby to relieve the squished cord through movement. A compromised cord can decrease the amount of oxygen baby receives and cause a decline in the baby’s heart rate. Sometimes this can be helped with frequent position changes, but there are times when unresolved fetal distress leads to an emergency cesarean.

• Cord Prolapse – This is a rare but severe complication when the cord slips past baby’s head and enters the cervix first. This will result in an immediate cesarean.

• Another big factor to consider is that labor pains will intensify quickly after the water is broken, whether spontaneously or artificially. For those wishing to have an un-medicated birth, this can make labor more challenging to cope through and be another benefit to avoiding AROM.

When should I have my water broken?

There is rarely a circumstance in which anyone should have their water broken. If mom and baby are healthy, labor should be left to progress naturally.

Of course, there are always exceptions in labor and sometimes AROM may be a good choice or deemed beneficial, for example, to place an internal monitor on baby’s head to get a more accurate reading of fetal heart rate.

It is extremely important to look at options and potential interventions prenatally so that you understand the risks and benefits going into your labor. It is also important to be fluid in your plan, ask challenging questions to your provider and consider alternatives during labor if the need arises for an intervention. Start with “is this a TRUE NEED to keep myself and baby safe? Or is this a WANT as an attempt to speed up the labor process?” and go from there, next discussing other options or alternatives.

What if my labor is progressing slowly or stalls?

Sometimes a stall in labor is a natural occurrence to allow mom to rest and refuel. This should always be considered as a first step in a spontaneous labor that slows or stops. Staying upright and mobile, frequent positional changes, and submerging in a warm tub of water are just a few ways to encourage labor to progress efficiently. Natural methods to restart labor, such as stimulating contractions through use of nipple stimulation with a breast pump can also be considered.

Sometimes, a stall of labor is caused by an imbalance in the soft tissues of the pelvis and breaking the water will only further the issue by making it harder for baby to maneuver as necessary. Consider having a doula that is trained and knowledgeable on tissue releases, balancing techniques and positions that can be used to help keep labor progressing and address stalls, as necessary. Body Ready Method (BRM) Pro’s are specifically trained in this.

**Hint: I am one 😉 If you'd like to chat or check my availability, you can book a call with me.

I also offer Early Induction and Labor Stall Body Balancing Sessions for local families that are not clients of mine. Get more info on that here --- > https://doulakm.com/prenatal-body-balancing

However, if you are not local to Cincinnati or Dayton, Ohio… You can find a BRM Pro doula near you here --- > https://bodyreadymethod.com/birth-pro/

When it comes to your birth, you have choices. My recommendation is to not take that lightly and make sure you are informed BEFORE you consent.

XOXO,

Katie – CBD, BRM Pro, HBHD