Artificial Rupture of Membranes (Amniotomy) During Pregnancy – Need, Procedure & Risks

When it’s time for your baby to arrive, your body will give you different signs to let you know that you’re ready for labour. One such sign is water breaking or amniotic sac rupturing. But the last leg of pregnancy may not be easy for all women and you may find yourself asking a doctor to induce the labour. Your doctor may consider rupturing the sac artificially in order to speed up the labour. The method used to speed up labour is known as amniotomy. This procedure is used in several hospitals. Read on to know when doctors may consider this procedure, whether or not there are any associated risks involved in doing so, and more.

What Is Meant By Amniotomy?

Amniotomy or artificial rupture of membranes is a procedure that is performed to rupture or break the water sac of a pregnant woman. This water sac or amniotic fluid is the liquid that protects and surrounds the baby in the pregnant woman’s uterus for nine months and as it breaks it releases hormones, which helps in sending signals to the brain for beginning or intensifying the labour. Approximately 10 per cent of pregnant women experience this phenomenon naturally, however, in some cases, the doctor or midwife may recommend doing it artificially, for the labour to progress. In simple words, amniotomy definition can be summed as ‘artificial rupturing of the amniotic sac’.

When Is It Performed?

Before amniotomy is considered as an option, your doctor will assess how much your cervix has opened up or dilated, how thin has the cervix is (effacement), how low the baby is in your cervix (fetal station) and various other such factors. After assessing all such factors, the doctor will calculate the likelihood of the procedure being successful. Some doctors may do so by Bishop’s score (or cervix score which is done to check if labour induction will be required) for amniotomy, where points are assigned to dilation, effacement, fetal station, consistency and position and based on the points the decision to conduct or not to conduct the procedure is taken.

Why Is It Performed?

Here are some reasons when your doctor may consider inducing labour via amniotomy.

1. To Start Labor

Artificial rupturing of the membrane is a great way of inducing or starting the labour, especially if the cervix is favourable too.

2. For Augmentation of Labor

Amniotomy is a great way of speeding up the labour. But that may not be feasible in all cases, however, it may reduce the chances cesarean delivery.

3. For Foetal Monitoring

Amniotomy can be performed if your baby is in need of close fetal monitoring. This is usually done in cases when the labour is prolonged or it’s a high-risk delivery.

Other Procedures That Can Be Performed Along With Amniotomy

Here are some other procedures that can be performed along with amniotomy:

1. IV Oxytocin Drip

An IV oxytocin drip is a medication used for uterine contractions.

2. Cervical Ripening

Your doctor will perform this technique for softening and dilating the cervix. This will prepare the cervix for vaginal delivery.

3. Stimulating the Nipples

This procedure will help the body release natural oxytocin, which will be beneficial in stimulating contractions.

4. Stripping the Membrane

This procedure involves gently separating the amniotic sac from the uterus, which helps the body to release hormones to start the contractions.

Healthcare Providers Who Perform the Artificial Rupture of Membranes

Here are some healthcare providers that can perform amniotomy:

1. Midwives

These are the healthcare providers who offer prenatal, labour, and delivery care. However, certified professional midwives or CPM or Certified nurse-midwives CNM are the ones who usually perform amniotomy in some cases.

2. Family Medicine Doctor

These are the healthcare providers that provide help and assistance to adults, children and also may provide assistance during labour and childbirth.

3. OB/GYN Obstetrician/ Gynecologists

These are the healthcare providers who specialize in health care issues of women, pregnancy, labour, and childbirth.

Tips to Prepare for Amniotomy

Here’s how you can prepare well for an amniotomy:

• Start taking any medication that may be prescribed by your healthcare practitioner.
• Talk to your doctor in detail about your medical history, which includes telling about any OTC medications, vitamins, herbal medicines, etc. that you may be taking.
• Talk to your doctor about any decrease in fetal movement, vaginal discharge, contractions, cramps, bleeding, etc.

Questions to Ask Doctor About Amniotomy

Apart from helping your doctor by preparing for the procedure, you may also ask some questions that may help ease your worries:

• Why is this procedure considered and whether or not are there any other options that you may consider?
• How long can the procedure take?
• Will I be prescribed any medicines before and after the procedure?
• What will happen when the sac gets ruptured?
• Are there any risks for my baby or me, in case I do not go in for the procedure?

Procedure of Amniotomy

The amniotomy procedure is performed in the labour room and does not take much time. Here is how the procedure is usually performed:

• You will be made to lie down on your back with your legs parted and bend.
• Your healthcare provider will use amniotomy equipment that includes a small hook or a gloved finger with a hook on its head, which will be inserted through your vagina and cervix to reach the uterus.
• This hook will pull the sac until it ruptures it.
• You will feel water coming out from your vagina.
• Your healthcare provider may check the fluid for any traces of meconium or fetal stool.
• If required, a device will be attached to monitor your baby’s heartbeat.

What to Expect After the Procedure

Your health practitioner and the care team will take the utmost care while performing the procedure as your comfort is of utmost importance. You are likely to wonder how will you feel after artificial rupturing of membranes. Well, you will feel warm down there as warm water will flow down from your vagina. You may also feel some pain in your lower back and may experience pain similar to that of menstrual cramps. It is normal to feel a slight discomfort in your cervix because of the amniotomy hook but pain during amniotomy is unusual. You should talk to your healthcare provider about the same.

You may notice that your contractions may become more intense after the procedure. If your contractions become intense, it’s a sign that amniotomy was successful. You can follow breathing techniques that you may have learned in your childbirth classes. If contractions intensify and you are unable to bear the pain, you can talk to your healthcare provider for pain-relieving options.

Risks and Complications

Here are some risks and complications that may arise after amniotomy:

• It may lead to vaginal bleeding.
• It may cause injury to the baby.
• It may cause infection to the mother or the baby.
• It may lead to umbilical cord prolapse, which may cut off the baby’s blood supply and lead to emergency cesarean delivery.
• It may lead to foetal distress.
• If the baby’s head is not fixed in the cervix, this procedure may sometimes lead to fetal malposition and thus cause complications in delivery.

How to Lower These Risks

Here are some effective ways of reducing the chances of any risks:

• Inform your doctor about any increase in pain or bleeding that you may register.
• Take prescribed medicines as suggested.
• Talk to your care team about the extent and type of your contractions that you may be experiencing.
• Follow a healthy diet and exercise as suggested by your healthcare team.
• Make sure that you get all the required prenatal care.

When Amniotomy Should Not Be Performed

Amniotomy is a fairly safe procedure, however, it may not be an ideal choice for intensifying or starting labour for all women. Your doctor may be able to establish the same during your second or third-trimester ultrasound scan or while performing a vaginal exam that this procedure may not be a safe bet for you. Here are some instances that your doctor may advise against this procedure:

1. If Baby’s Head is Not Fixed

In case the baby’s head is in zero station or floating, this means that it is not fixed or engaged in the cervix. Under such a situation, your doctor may advise you against this procedure.

2. If the Baby is in the Breech Position

If the baby is in a breech position that includes brow presentation or face presentation or in any other such malpresentation, your doctor may not recommend the procedure.

3. Vasa Previa

Vasa Previa is a condition when the blood vessels from the umbilical cord or placenta pass over the cervix beneath the foetus. This condition is usually detected during the routine ultrasound scans. In the case of vasa previa, the doctor may advise against amniotomy.

Amniotomy or artificial rupturing of membranes, like other medical procedures, has its own set of pros and cons. It is important that you discuss the drawbacks and benefits with your doctor before you consider this procedure to bring on (or to speed up) the labour.

Also Read: 

Low Amniotic Fluid while Pregnant
Baby Born with Amniotic Sac
Ways to Increase and Decrease Amniotic Fluid during Pregnancy