ARM, (Artificial rupture of the membranes) simply means breaking the membranes that surround the baby and releasing the amniotic fluid before it breaks naturally itself.
This is performed with the use of a long sharp hook similar to a crochet hook that is inserted through your vagina and cervix and used to make a small nick in the membranes allowing the waters to escape. You will be required to lay on your back with your legs open while this procedure is preformed.
ARM’s are used to either help start labour before it is ready to started itself, or speed up a labour that is not moving fast enough for either the care provider or the mother.
The ARM is a simple procedure to perform but it doesn’t come with out a number of significant problems that can affect both you and your baby.
Reasons given to perform an ARM
- To assist in the induction for labour, usually performed in conjunction with an oxytocin drip.
- To speed up a labour that has slowed down.
- To check the presence of meconium (baby poo) in the amniotic fluid, that may indicate foetal distress.
- So forceps or vacuum can be used
- So an internal monitor can be screwed into your unborn baby’s head.
- Some research shows that it may reduce the length of your labour
- May help your baby’s head descend further down into the birth canal.
- Has the potential to increase the chances of your baby becoming distressed in labour.
- If the baby’s head is not well down the first rush of amniotic fluid may bring the cord down and deprive the baby of oxygen.
- As the cushion of fluid between the baby’s head and the cervix is removed, this can cause strong contractions as the baby’s head now has direct pressure on the cervix. This may cause intense contractions and extra pain and discomfort, which may lead to an increased use of pain-relieving drugs.
- The extra pressure on the baby’s head may cause distress to the baby, which will result in further interventions.
- Can cause infection so most obstetricians believe that once the membranes are ruptured the baby needs to be out within 24 hours, some as little as 12 hours. This means that you may require a caesarean simply because someone decided to rupture your membranes
- May result in a longer, more painful labour, as the baby might not be able to move into the optimal position before dropping further into the birth canal.
- If you have your waters broken too early and your labour naturally stops, then you will require an induction or caesarean due to the fear of infection.
The research shows that approximately 70% of women will still have their waters intake at the beginning of the pushing stage if an ARM hasn’t been performed.
Regardless of whether your labour is progressing slowly or not, some caregivers like to routinely rupture the membranes at some stage during your labour. Sometimes this is purely out of habit or because of the pressure they feel from time frames and policies written for litigation purposes.
Performing an ARM routinely is not supported for medical reasons. If your baby’s heart rate is normal, and you are happy with your labour you may wish to question this procedure.
“Looking back I went into the hospital to early in my labour. Soon after I arrived my labour started to really slow down so the midwife offered to break my waters to speed things up. Unfortunately this didn’t work and my labour stopped, because I had had my waters broken I couldn’t go home and wait for my proper labour to start. I was induced and ended up needing a caesarean.” – Sarah
“I decided to leave the hospital in the middle of my labour because the obstetrician on duty was instructing my midwife over the phone to speed up my labour by breaking my waters. This was only because I had reach my time limit set by the hospital. Both my baby and I were fine and I didn’t want unnecessary intervention performed because I had read all about the cascade of intervention. I decided to go home and then return to the hospital as my time allowed to birth my baby started again. 3 hours after returning to the hospital I had a beautiful water birth free of any intervention.” – Jennifer
“A women can be labouring beautifully with no signs of maternal or foetal distress, but if we break her waters and find meconium, then we need to treat her like a high risk pregnancy and strap her to the continual foetal monitor.” – Midwife
“Somewhere around 4am I started to push. I was still obsessed with breaking my waters with my contractions as I knew they hadn’t broken yet and I was sure they where stopping my baby from moving down at a quicker pace. At 4.40am Val recommended that I try to feel the babies head with my fingers to see how close she was. I reached down and could feel the big hard bag of the waters just inside with my finger. I remember feeling very angry that it was there and hadn’t broken yet which I verbalized. Val recommended that I try and break it with my finger on the next contraction, which I tried to do, but it wouldn’t break. I then tried again and this time it broke.” – Jen’s Birth Story