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Amniotomy FAQ


This Frequently Asked Questions (FAQ) article is composed of facts from medical journals, studies, childbirth books, other childbirth resources, and from personal opinion. If you have anything to add, or have a question about anything, please feel free to write me.

Robin Elise Weiss, ICCE, CD(DONA), NACA
http://pregnancy.about.com


Table of Contents:


What is an amniotomy?

Amniotomy is the artificial rupture of the amniotic sac with a tool called the amniohook (a long crochet type hook, with a pricked end) or an amnicot (a glove with a small pricked end on one finger). One of these will be placed inside the vagina, where the caregiver will rupture the amniotic sac or membrane.

When is amniotomy done?

Amniotomy is done either to induce labor or at some point during labor, depending on your practitioner's protocols. Some practioners believe that everyone needs an amniotomy and some do not believe in the routine use of amniotomy.

Why is amniotomy performed?

Amniotomy is said to be done for three reasons:

  • To induce or augment labor.
  • To check for meconium (baby's first stool).
  • To place the internal fetal monitor on your baby's scalp.

Does amniotomy physically hurt me?

Most women have different opinions on this. Some women hardly notice and others seem to really mind the pain it causes. What appears to be the major factor in whether or not it is a painful procedure is the condition of the cervix at the time the amniotomy is performed.

Does amniotomy have any disadvantages?

Amniotomy has several disadvantages.

  • This is the only cushion your baby's head has.
  • "The increased pressure differentials around the fetal head may lead to deformities of the skull." Human Labor and Birth 5th Edition, by Dr. Harry Oxorn.
  • "The reduction in the amount of amniotic fluid may increase compression of the umbilical cord." Which would show as fetal distress during labor. Human Labor and Birth 5th Edition, by Dr. Harry Oxorn
  • This increases the possibility of a cord prolapse.
  • This increases the likelihood of infection (from vaginal exams and probes placed into the vagina.
  • Most practioner's will start the cesarean clock once the amniotomy is performed.
  • This may cause your practioner to restrict you to bed.
  • This may cause your practioner to restrict your use of the tub or bath.

Does amniotomy have any advantages?

When used properly, the advantages can outweigh the disadvantages.

  • It enables the condition of amniotic fluid to be viewed. Conception, Pregnancy, and Birth by Dr. Miriam Stoppard
  • It can possibly, if done late in labor, such as a stalled late first stage (approximately 7 cms), speed dilatation. Human Labor and Birth

Are there alternatives to amniotomy?

There have always been ways to start a labor that isn't or augment a labor that appears to be lagging. Some of them can be done by you, and some are done by the practioners.

Induction Techniques:

  • Time. Some women take longer than others. Monitoring the baby (fetal movement counts, etc.) will give you a good idea of the baby's health and whether or not you have time to play with.
  • Prostaglandins and Oxytocin These can be found at home by deep penetrating intercourse with no condom (Semen contains Prostaglandins.). Female orgasms release oxytocin. Rolling the nipples increases the oxytocin levels. At the hospital or practioner's office, your choices are Prostaglandins suppositories (to ripen the cervix) or an oxtocin (Pitocin) drip.

Augmentation Techniques:

  • Movement: Changing position and walking or moving around helps to speed labor. Try and figure out if your labor is really stalled or if it's just progressing at it's own naturally slow pace. If the baby is taking it's time to mold or move to a certain position it can appear that labor has stalled or slowed, when certain postures may help the baby move.
  • Relaxation: Take a bath or a shower, do some relaxation techniques. Is there something bothering you about labor or the birth? Are you afraid or uncomfortable?
  • Prostaglandins and Oxytocin: Rolling the nipples increases the oxytocin levels. Your choices are Prostaglandins suppositories (to ripen the cervix) or an oxtocin (Pitocin) drip.

Research on Amniotomy

Fetal Heart Tone abnormalities are more likely in the healthy, term fetus after amniotomy. If the ability to cope with stress is already compromised, adverse effects on Fetal Heart Tones are likely to be more common and more severe.

  • Fraser WD et al. Effect of early amniotomy on the risk of dystocia in nulliparous women. N Engl J Med 1993;22;328(16):1145-1149.

  • Kariniemi V. Effects of amniotomy on fetal heart rate variability during labor. Am J Obstet Gynecol 1983;147(8):975-976.

  • Barrett JF et al. Randomized trial of amnitomy in labour versus the intention to leave membranes intact until the second stage. Br J Obstet Gynaecol 1992;99(1):5-9.

  • Garite TJ et al. The influence of elective amniotomy on fetal heart rate patterns and the course of labor in term patients: a randomized study. Am J Obstet Gynecol 1993;168(6 Pt 1):1827-1832.

Amniotomy may have little or no effect on labor length or have effect only in some subgroup.

  • Fraser WD et al. Effects of early amniotomy on the risk of dystocia in nulliparous women. N Engl J Med 1993;22;328(16):1145-1149.

  • Seitchik J, Holden AE and Castillio M. Amniotomy and the use of oxytocin in labor in nulliparous women. Am J Obstet Gynecol 1985;153(8):848-854.

  • Rosen, MG and Peisner DB. Effect of amniotic membrane rupture on length of labor. Obstet Gynecol 1987;70(4):604-607.

  • Fraser WD et al. A randomized controlled trial of early amniotomy. Br J Obstet Gynaecol 1991;98(1):84-91.

  • Barrett JF et al. Randomized trial of amniotomy in labour versus the intention to leave the membranes intact until second stage. Br J Obstet Gynaecol 1992;99(1):5-9.

Amniotomy may cause umbilical cord prolapse.

  • Levy H et al. Umbilical cord prolapse. Obstet Gynecol 1984;64(4):499-502.

Amniotomy does not reduce the cesarean rate, even among nulliparas, the most likely subgroup to experience dystocia.

  • Fraser WD et al. Effects of early amniotomy on the risk of dystocia in nulliparous women. N Engl J Med 1993;22;328(16):1145-1149.

  • Fraser WD et al. A randomized controlled trial of early amniotomy. Br J Obstet Gynaecol 1991;98(1):84-91.

  • Barrett JF et al. Randomized trial of amniotomy in labour versus the intention to leave the membranes intact until second stage. Br J Obstet Gynaecol 1992;99(1):5-9.

  • Garite TJ et al. The influence of elective amniotomy on fetal heart rate patterns and the course of labor in term patients: a randomized study. Am J Obstet J Gynecol 1993;168(6 Pt 1):1827-1832.

Personal Opinions on Amniotomy

Carol:

"I had my water broken after 8 hours of labor "to get things going faster". I was under the impression that my labor was doing just fine. I had not stopped once I started (unlike my first baby) and I had just started getting the urge to push. I was completely unmedicated. I was checked when I told them the urge was starting. I was almost completely dilated. Apparently I had a very small "lip" on one side still. So they broke my water, like I said earlier, "to get things moving faster". This was at 4:11am. One contraction later my daughter was born at 4:16am! I had been waiting at home for my husband to arrive from a two week business trip with my contractions 3 minutes apart. I was almost 4 weeks early and he had no idea anything was happening until he stepped out of the cab. :) If I had known that she would be born 5 minutes after my water broke I would not have waited for him to get home."

Margaret:

"For my first child, I had PROM (waters broke on their own at 36 weeks). For my second, I arrived at the birth center at 4-5 cm with my bag of waters bulging. The midwife asked if I wanted them broken. I knew things could hurt a lot more afterwards, but that it could also speed things up a lot. I thought about it for about 15 minutes, and after I was assured that I could still go in the jacuzzi, I said OK. It didn't hurt at all for the actual procedure, and though the contractions changed in character, they didn't really hurt any more than before. I went immediately into the jacuzzi, and stayed there for 1/2 hour. another hour or so later, and I was fully dilated. The pushing stage only lasted 13 minutes. On the whole, I was pleased with my decision to have my membranes ruptured."

Chrissie:

"My water was broken when I went in for an induced labor (Hannah was 10 days late). The Dr. tried to break the waters at 8 ish (am) but it didn't work, she started the pitocin. At 12ish the midwife came in - I'd been in serious labor since 11ish she examined me and said the bag of water s was "big and bulgie", so she broke it - worked about an hour later i was pushing - hannah arrived at 2:34."

Lynn:

"I had my membranes ruptured to try and start labor. It did start the labor but they still had to give me the pitocin. I was about ten days late so that was why they decided to try and start labor. I was in labor with the pitocin for about seven hours. (Not hard labor mind you.) They finally had to do a c-section because my daughter instead of descending, actually retreated."

Amanda:

"My labor was augmented by breaking the waters. After which they told me that the baby's head was really high, and I would kill the baby if I got out of bed with a cord prolapse. I really feel that this lead to every other intervention that I received, including forceps and episiotomy. Not to mention the fear of thinking my baby was dying! I found out later that they knew the baby was high up, so it was really their fault that I was in any danger, but my doc said that had he been there he never would have broken my water. I would do everything differently if I could."



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