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How is an ARM performed?
Arguments for and against an ARM
Breaking the waters to augment the labour is known as an 'artificial rupture of membranes', 'amniotomy' or 'ARM'. An ARM is a mechanical way to stimulate contractions. Some caregivers will suggest (or the woman may request) an ARM if the membranes are still 'intact', and the labour is progressing slowly. If all women were left to labour naturally, about 75% of them would have intact membranes until the end of the 1st stage of their labour (or when they started to push).
It is possible for an ARM to increase the intensity of the woman's contractions, because the cushion of fluid has gone, enabling the baby's head to press more firmly against her cervix (stimulating it to open) and the baby's head to descend further down the birth canal. If the ARM is done when the woman is near full dilation (or in the 2nd stage of labour), it will usually bring the baby further down, or start the pushing phase earlier.
An ARM to augment the labour may still be possible if the waters have already broken. This is because sometimes the waters break behind the baby's head (inside the uterus), instead of in front of it (where the cervix is opening). This is called a 'hind water leak' and normally presents itself as a 'trickle', rather than a 'gush' of fluid. If you have experienced a hind water leak, there may still be a bag of waters cushioning the baby's head, which can be ruptured by your caregiver to augment the labour.
Some caregivers like to routinely rupture the membranes at some stage during the labour, regardless of whether the woman is progressing slowly or not. Sometimes this is out of habit (in an effort to facilitate as fast a labour as possible), at other times caregivers are curious to see if the water is
meconium stained