Artificial Rupture of Membranes
spamelita on Nov 14 2007 at 3:49 pm | Filed under: research
From the Cochrane Reviews comes this review of research that finds AROM (artificial rupture of membranes) does not hasten labor or ensure baby’s well-being.
The researchers reviewed 14 randomized controlled trials involving almost 5,000 women and found little evidence for any benefits. Amniotomy did not shorten the length of labor, decrease the need for the labor-stimulating drug oxytocin, decrease pain, reduce the number of instrument-aided births or lead to serious maternal injury or death.
Anecdotally, there have been situations where I know rupture of membranes - both spontaneous (on their own) or artificial - has made a birth happen more quickly. I think it’s safe to say we all know of times where late AROM has picked up a slow labor at the end of dilation. Whether or not it’s supporting the natural process of labor (it’s not), there are times where I’ve seen it work.
However, we also know that this information is not a surprise to many providers. I think the biggest disadvantage is when it’s used to induce prior to 4-5cm (having seen AROM at 1-2cm for induction it seems to shows the least amount of effectiveness) or when labor is moving forward, but not to the appreciation of provider and/or mother. This review only pulled instances where labor had begun spontaneously and AROM was not used for induction.
In my opinion,this is where looking at evidence-based research is key: as providers, we carry alot of anecdotal experience. The important thing for me is that we don’t allow those experiences become the truth for us. Giving full informed choice (including research like this) is important for each woman - including that our own experience includes an amount of women that a study this size would consider insignificant.
Thoughts?
I KNOW that the AROM was the number one thing that was the worse about my intensel intervention-filled birth of my 2nd baby.
I was induced randomly, then tied up to every hose and tube there is. Then they break the water and WHOOSH! he comes down and jams all crooked-y, starting the badness. Freaky pain, need for epidurals that dont work, narcotics to “calm me down a little”, then futile purple-pushing on the acynclitic head until I give up and get my first section. yay. not.
AROM is bad and to be avoided unless late in labor there is a very informed Mama and some compelling evidence that it will help a true stalled labor after change of position, etc is all involved and tried.
Sigh.
I hate the AROM–plus it puts you on their clock with their obsession with the “infection” and the 12 hour rule. Letting hem break your water early in labor is a big big way to try and get a c/sec because now you are on their clock that says if you dont birth in 12 hours (some hospitals 24) then you get sectioned.
ARGGGGGGGG
I agree that AROMing too soon can have effects on the labor. Myself in my first labor they broke my water at 3 cm and that locked in his malposition(he was asynclitic). I personally believe that AROM is done far too much.
I think it’s dangerous to AROM grand multipara’s because the baby is often floating (at least mine have since like baby 3 and I had baby 6 just two months ago). I actually was begging for the OB to break my water, but I think he knew I was OP and hadn’t informed the nurse (who was annoying and bad and the reason I just wanted the birth over with). Anyway, if he had broken my water, my OP baby could have gotten stuck that way. I had already pushed for an hour and a half…so if he had broken it, how long would they “let” me push before calling for a c-section since baby had decels early on? Also, what about cord prolapse? Since I had intact waters, I was able to move once nursie found out I was a mom with an OP positioned baby inside. Baby was able to turn. And besides, it’s cool to know my baby was born in her bag of waters. From what they said, I believe the whole bag was intact when she came out. Cool.
I was present for much of my sister’s (induced) labour and delivery (invited, of course =)) and they ruptured her membranes at 11:00 when she was only 1 cm … without telling her what they were doing. The OB said she was “checking her” and stuck the hook up while my sister scooted up the bed and away and kept asking “what are you doing?” after about 4 tries and just as many “please tell me what you’re doing”s the doctor finally said, “trying to break your water”. She didn’t think she broke it, but 3 mins later it was fully ruptured. That was at 11:00 am. She got the epidural at 11:30 am because the pain was so intense (hello! no build up!)and didn’t deliver her baby until 10:55 that night. I’m soooo sure that AROM sped up her delivery *sarcasm dripping*
Whoa. The comment right above mine terrifies me.
Thanks for the link to the article. I like what you’ve sadi, I’m going to address it at my place and add a similar experience I just had!
LP
I had a homebirth. I had thought my water broke the day before, but maybe it was just a leak that closed up. Anyway, I pushed for a little over an hour. Toward the end my midwife and her assistant were watching as I pushed and holding towels up to their faces because they were afraid that the water was going to break. We all laughed about this. After more than an hour, my midwife offered to break the waters and I agreed because I wasn’t making any progress. My 10 lb 4 oz son was born about 10 minutes later.
I would never agree to AROM early in labor or with the baby high up, but I really think it helped me get him out before I became exhausted.
I was happy to see this review, because my anecdotal experience has shown this. But like you, I have seen on occasion when AROM during transition labor made things go like a bullet. I can say that almost all woman who have been AROM’ed get an epidural within the following hour because they just were not psychologically ready to have that intense change in their contractions.
But my question is: will this review of the literature reach the masses? I haven’t seen any changes in AROM practices with the MDs I work with, nor have I cared for a woman who said she didn’t want her water broken because the data shows its not helpful.