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What to Know About Amniotomy and the Artificial Rupture of Membranes

Your doctor might recommend this procedure to speed things up during labor. Here’s the lowdown on what it entails.
ByDani Wolfe, Contributing Writer|Updated June 29, 2023
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pregnant woman lying in hospital bed while in labor
Image: christinarosepix | Shutterstock

Sometimes, baby just won’t come out fast enough during labor. That’s when your doctor might recommend an amniotomy in order to speed things along. Amniotomy, aka artificial rupture of the membranes, is basically when the doctor artificially breaks your water in order to encourage you to dilate faster, monitor baby more closely or reduce risk to you and baby. Ahead, read up on what else you should know about amniotomy—including how it’s performed and potential risks.

AROM: What Is Amniotomy?

Amniotomy, commonly referred to as artificial rupture of membranes (AROM), is a procedure that has been performed for at least a few hundred years in which a medical professional intentionally breaks your amniotic sac to help progress labor. For some people, the amniotic sac breaks naturally as contractions progress, notes the Cleveland Clinic. Your water could also break spontaneously, known as premature rupture of membranes (PROM). But if your amniotic sac doesn’t break despite you being in labor, your doctor might recommend the amniotomy procedure, which could cause your uterus to contract and dilate your cervix—bringing you one step closer to meeting baby.

Reasons Your Doctor May Perform Amniotomy

There are several reasons your doctor might recommend an amniotomy during labor. “[Amniotomy] is done to augment the labor process, and is usually recommended when we need to monitor baby’s heart rate and uterine activity,” explains Anna Cabeca, DO, FACOG, an ob-gyn, sexual health expert and founder of The Girlfriend Doctor. “When a woman isn’t dilated as expected while going through contractions but the water hasn’t broken yet, and we fear that the baby and/or Mom’s safety are at risk, or that the baby’s neck could get stuck in the umbilical cord, we artificially rupture the membranes.”

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How Is Amniotomy Performed?

During the amniotomy procedure, your provider will first check your cervix to see how far you’ve dilated, as well as make sure baby is low in the pelvis and pressed against the cervix, according to the Cleveland Clinic. Next, the provider will insert an amnihook—a thin, plastic tool that Cabeca says resembles a crochet hook—into your vagina. They will then use the amnihook to puncture your amniotic sac.

What Does Amniotomy Feel Like?

Cabeca says that amniotomy is generally a painless procedure, although the Cleveland Clinic notes that if you haven’t taken any pain medication, you might feel slight discomfort when the doctor inserts the amnihook. However, once the sac is ruptured, your uterine contractions will likely get much stronger and more intense, adds Cabeca.

What Are the Risks of Amniotomy?

In rare circumstances, there can be complications due to amniotomy. “This procedure has to be done carefully, and we need to cautiously evaluate the necessity and the timing,” says Cabeca. Potential issues include:

  • Umbilical cord prolapse. An umbilical cord prolapse is when the umbilical cord drops through the vagina before baby, which can cut off baby’s oxygen supply, according to the Cleveland Clinic. “This is typically a medical emergency that requires quick action on the part of the provider to hold the baby’s head up off of the cord while others are prepping for an emergency cesarean,” says P. Fadwah Halaby, ARNP, CNM, a nurse practitioner with a specialty in midwifery in Palm Beach, Florida.
  • Chorioamnionitis. Cabeca says amniotomy can increase your risk of this infection of the membranes and tissues surrounding the fetus, which is associated with chronic lung disease in baby, according to research.
  • Neonatal sepsis. This infection in baby’s bloodstream has a higher chance of happening as more time passes between the start of an induction and amniotomy, according to a 2022 study published in the American Journal of Obstetrics and Gynecology.
  • C-section. Amniotomy can increase your chances of having a c-section if baby is in breech position after your provider breaks your water, notes the Cleveland Clinic.

Rare complications aside, the role of AROM in pregnancy is to speed up labor, so you might be wondering: How fast will labor progress—or begin—after my doctor performs an amniotomy? “This is unique to each individual,” says Halaby. “It isn’t a guarantee that amniotomy will result in labor.” One systematic review published in the American Journal of Obstetrics and Gynecology MFM notes that early amniotomy during induction of labor could speed up delivery by an average of 3.6 hours.

At the end of the day, your healthcare provider will help you make the decision that’s right for you—so you can focus on what’s to come.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

Sources

Anna Cabeca, DO, FACOG, is an ob-gyn, sexual health expert and founder of The Girlfriend Doctor. She received her doctor or osteopathic medicine in gynecology and obstetrics from the Emory University School of Medicine.

P. Fadwah Halaby, ARNP, CNM, is a highly experienced nurse practitioner with a specialty in midwifery in Palm Beach, Florida.

StatPearls, Amniotomy, April 2023

Cleveland Clinic, Amniotomy, October 2022

Reviews in Obstetrics and Gynecology, Contemporary Diagnosis and Management of Preterm Premature Rupture of Membranes, 2008

Cochrane Database of Systematic Reviews, Amniotomy for Shortening Spontaneous Labour, June 2013

StatPearls, Chorioamnionitis, April 2023

American Journal of Obstetrics and Gynecology, Infectious Morbidity Associated with Early Amniotomy During Labor Induction, January 2022

American Journal of Obstetrics and Gynecology MFM, Role of Early Amniotomy with Induced Labor: A Systematic Review of Literature and Meta-Analysis, November 2019

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