As Ani DiFranco once noted, “Birth is the epicenter of women’s power.” All the while, not every birth is controllable, no matter how much you plan ahead. For this reason, mothers-to-be should be knowledgeable about the different ways to either speed up or intentionally induce the process of labor.
Commonly used by healthcare providers in the industry, amniotomy is a form of labor intervention. This recommended practice of artificially “breaking one’s water” has a deep history for obstetricians and midwives. Known also as the artificial rupture of the membranes (AROM), the use of amniotomy in modern society varies around the world.
For women who do not experience spontaneous rupture, purposefully breaking the amniotic sac can stimulate the labor process or assist with progress. How? Let’s examine the ins and outs of this procedure by uncovering the reasons why doctors may break your water artificially.
What Is the Amniotic Sac?
In utero, the fetus develops in a thin-walled bag of membranes known as the amniotic sac. The amniotic sac starts developing at conception, then forms in its entirety during the first month of pregnancy. Traditionally filled with fluid—which increases in volume throughout the stages of pregnancy—this important sac and its fluid serve numerous functions. The main goal is to protect the growing baby in the uterus from any sources of physical harm or external danger.
The Function of Amniotic Fluid
The majority of amniotic fluid surrounding a fetus is water, with the other small percentage being other vital components, such as fetal urine, hormones, nutrients, and antibodies. These combined elements are fully responsible for protecting the fetus with a warm, safe, and comfortable liquid environment.
Before the stages of childbirth, the fluids of the amniotic sac help by providing cushioning against outside pressures, controlling temperature, preventing infection, supporting the umbilical cord, developing the lungs and digestive system, and developing bones and muscles.
The rupturing of these protective membranes is a clear sign a baby is ready to exit the womb and enter the outside world. However, if the amniotic sac does not rupture on its own and a care provider sees the need to begin labor, they can decide to artificially start the process by rupturing the sac with a specialized tool. As previously mentioned, amniotomy is a prevalent induction method for kickstarting contractions.
The Basics of an Amniotomy
Induction is relatively common in the context of labor and childbirth. Sometimes physicians perform induction methods for medical reasons, and other times the choice can be elective. Generally, labor induction through the artificial rupturing of the membranes isn’t warranted unless medically necessary.
Moms-to-be may or may not desire labor intervention, including that of amniotomy. Nonetheless, certain situations call for the release of fluid from the amniotic sac to facilitate healthy vaginal delivery. Performed by an experienced care provider—with special surgical tools—amniotomy is a common enough procedure to safely help labor begin or progress. However, several risks and complications are possible when deliberately creating a hole in the amniotic sac.
The Risks of Artificial Rupture of Membranes
Serious complications from this procedure are rare. For this reason, physicians can advise artificially rupturing the membranes for the sake of the mother and baby. If performed early or incorrectly, the risks to be aware of include the following: umbilical cord prolapse, intrauterine infection, intrapartum chorioamnionitis, irregular fetal heartbeat, vasa previa, or maternal blood loss.
If advised when the time for labor comes, ask your care provider to thoroughly explain the procedure, the involved risks, and any alternative intervention options. A trained and experienced obstetric practitioner will not proceed with the process if any conditions are present that oppose amniotomy.
Reasons Why Practitioners Perform Amniotomies
A doctor will decide to artificially rupture the membranes to start uterus contractions when the time is right; they will use the Bishop score to evaluate if the cervix is ready—aka dilated and thinned—for labor induction. Medical professionals only complete the procedure if the cervix looks suitable and the head of the baby has moved into an engaged position. If so, most women will go into labor hours after the amniotic sac breaks.
So, what are the reasons why doctors may break your water artificially? Remember, water breaking before childbirth is a different experience for everyone, even for those who have had multiple pregnancies. Expectant mothers might undergo an amniotomy during their birthing experience for the following reasons.
To Initially Induce Labor
The best labor induction method depends on the favorability of the cervix. After a vaginal exam, the Bishop score calculates the likeliness of any labor-inducing success, including the artificial breaking of the membranes. Physicians perform an amniotomy to begin a vaginal delivery by jumpstarting and intensifying contractions of the uterus. AROM is usable in conjunction with labor-stimulating methods.
To Augment Stalled Labor
On the other hand, doctors may break your water to speed up or augment the labor process—labor can stall or slow for several hours at a time during some birthing experiences. This intervention approach can help a laboring mother move into a more consistent pattern or even lessen the possible need for a Cesarean birth.
For Internal Fetal Monitoring
To closely monitor the health and safety of a fetus during childbirth, an obstetrician or midwife may turn to the intervention technique of amniotomy. Breaking your water allows for internal fetal monitoring that places a monitor on the head of the baby. This monitoring device measures and records fetal heartbeat during extended or high-risk labor.
To Identify Signs of Fetal Distress
Last but not least, your care provider may choose to artificially rupture the amniotic sac to see if any signs of fetal distress are visible. Doctors often look at the amniotic fluid to determine whether a baby has passed meconium—their first bowel movement. Having this knowledge helps a healthcare team plan the next best steps appropriately. Fetal distress calls for immediate action, such as C-sections.
The Specialty Tools Involved
An amniotomy is a procedure that involves inserting a specialized tool through the cervix to break the amniotic sac. Practitioners can choose from various medical-grade amniotic hooks to successfully reach up and rupture the membranes. The right hook and a steady technique allow the bag to tear correctly and unleash the amniotic fluids. You may feel some discomfort, but note that breaking your water is on an equal pain level to traditional vaginal exams.
All things considered, this procedure is not suitable for all laboring mothers. Yet, in the right circumstances or situations, amniotomy can be powerfully beneficial for the health of mom and baby. Speak with a medical professional or personal healthcare provider for further details or advice.