Artificial Rupture of Membranes

[robino]

I am 38 wks pregnant with number 2 and I'm hoping for a VBAC. To cut a long story short I'm currently in the position where I have finally got the consultant to agree to not continually monitor me and I'm going to be "allowed" to labour in a room on the labour ward which is set up in the same way as the MLU and be "allowed" an active labour. Have just spoken to head midwife and she has informed me I have zero chance of labouring in the MLU because of trust policy (I know I could/ should fight this but it's been hard work getting this far).

Head midwife is very supportive of VBAC and sounds like she's fighting a daily battle with the trust/ hospital/ other midwives on numerous issues. I'm not totally happy with the way things are going so far but she made me feel happier than I have been.

However, she did suggest (in order to support my VBAC) that I stay at home as long as I feel able to once labour has started because it is policy to artificially rupture membranes if they haven't already gone by the time you reach 4cms dilated. This seems totally ridiculous to me.

I am intending to stay at home as long as possible and am hoping I won't encounter this ridiculous situation but I'm also fully aware that I won't know how dilated I am until someone can check... So, I have 2 questions....

1. From what I know/ have read it is likely that AROM will increase pain for me, can increase pressure on babies head, can increase the likelihood of infection, doesn't really speed up progression of labour effectively. Are there any more cons? And are there any reals pros which I should know about?
   
   
2. I can refuse to allow them to do this to me, can't I?
   
   Thanks in advance for any advice.

[mrsmalumbas]

Yes you are completely right, AROM is active management through and through. It can speed things up, yes, but why would you want to do that if things are progressing normally anyway? It can increase the risk of infection yes, can increase the risk of a malpresentation, etc etc.

I agree with Starlight yes you can refuse anything but that is possibly not a position you want to find yourself in during labour. Do you have an opportunity to go over your birth plan with her before the event? You could write in there that you do not consent to AROM unless there is a clear medical indication for it (and I can't even think of what that would be - even if your labour was slow to progress, keeping the mebranes intact is usually a much better idea than rupturing them)

Have you thought about hiring a doula? A doula can be with you and support you at home in early labour. She wouldn't be able to do VE's even if you wanted her to but most doulas are pretty good at "guesstimating" how you are progressing if you would find that helpful in deciding when to go in (although the actual decision would always be yours).

Good luck with VBAC, sounds like you are well clued up and prepared to fight your corner, and you do have a supportive head midwife which is a big factor in your favour.

[Divvy]

Very good info here www.radmid.demon.co.uk/arm.htm

Infact the whole site is worth a read

[DaisySteiner]

If you want quotable evidence then the Cochrane meta-analysis is a good bet. This is a very up to date review of the studies looking at amniotomy and concludes that: "The evidence showed no shortening of the length of first stage of labour and a possible increase in caesarean section. Routine amniotomy is not recommended for normally progressing labours or in labours which have become prolonged."

I am that a UK hospital is still advocating this out of date practice!

[MarsLady]

Also I've begun to see women being hooked up to antibiotics after their waters have been broken for them to prevent infection (which is why they should leave them be).

But it is up to you to make informed decisions. You can refuse anything. Sadly you do need to fight for things but it can be very rewarding. I had a client who fought to have a natural twin birth. After giving birth with gas 'n' air the staff congratulated her on getting her way.

[rozzyraspberry]

I agree that seems like a ridiculous policy!! With ds2 I did have my waters broken but I was 8cm + at the time - it certainly speeded things up but contractions were definitely more painful once it had been done.

With ds3 my waters didn't break until I started pushing him out - he was born 2 pushes later.

[SarahLeosMum]

I think I'll be in the minority, they broke my waters when I was having my first (but not at 4 cm, more like 8) and it was a huge relief as there was an instant release of massive pressure and I did not find subsequent contractions more painful. Maybe my baby/waters were unusally positioned or something?

[TheProvincialLady]

They can have these policies (why?!) but that doesn't mean you have to go along with them. They still need consent. There is no way on earth I would let anyone break my waters without very good reason, nor without an epidural in place after last time.

[detoxdiva]

SarahLeosMum - not in the minority! My waters didn't break and I was fully dilated and pushing when the mw asked if I was happy for her to break them - it was a massive relief, I wasn't aware of any increase in pain, and dd was born 20 mins later.

Saying that, you have to give consent, so if you're not happy then that's your choice. Good luck

[goingfor3]

I had my waters broken when I was 6 cms, I had a huge amount of pressure so was very relieved - I had polyhydraminous which is probably the reason for the increased pressure. As soon as my waters stopped flowing the midwife examined me and I was 10 cms dilated and ds was born 40 mins later.

[lulumama]

IMO< do not agree to anything that is offered simply because it is policy

ARM at 4cm is not a good idea, IMO, it can increase pain leading to the mother feeling out of control and wanting more pain relief.. it can also affect the ability of the baby to get into a good position for labour

if you want a VBAC, then the less interference the better.

you can refuse anything to be done, and the best thing to do is to document it in a birth preferences plan and to ensure that your birth partner (s) are fully aware of your requests.

www.aims.org.uk can help you with your issues around labour

[robino]

Thanks all, am in the process of writing a short but to the point birth plan and my birth partner is fully aware and supportive. I'm just thankful that I found out this kind of stuff in advance so can prepare myself - to be truthful, if I'd found out earlier I think I'd have tried my hardest to persuade my OH that homebirth was the way forward (I wasn't bothered about one before but am beginning to think it would have been preferable) and pushed for a homebirth

[robino]

Starlight - I know, and thanks! I'm pondering on it but don't think I'm up for the struggle at this late stage. I'm feeling incredibly tired and lazy and I'm not sure what will work me up more - having to fight during labour at hospital or fight now so that I don't have to later!

[robino]

Starlight - I feel the same about adjustment in expectations. Pretty sure I'm going to go to the labour ward but knowing that myself and birth partner are as clued up as poss about VBAC and things which can help/ hinder a successful VBAC and my rights , praying I get a supportive midwife and if not, using that big pointy stick I have packed in hospital bag to keep "over-enthusiastic" consultants at bay unless necessary! . You can have use of the big pointu stick after me, if you want!

[ScaryHairy]

I am no expert, but my waters were broken when I was 4cm (after I finally gave them permission, the 6th time they asked). Labour did not speed up but what did happen was that my baby who was in LOT position was unable to make the turn to come out once the liquid was gone. The end result was a section. If I ever have a VBAC, noone will be breaking my waters unless there is absolute medical need, not just box checking.

[Divvy]

What would the medical reason be?

Could it be something like putting clip on babies head for monitoring?

Is that a good enough reason?

[ScaryHairy]

For me, yes, if they needed to put a moitor on the baby's head or if they needed to take blood from the baby's head, those reasons would probably be enough.

Having said that, when those two things happened to me they were needed because the baby was having decelerations caused by the cord getting sqaushed by contractions which was itself caused by my waters having been broken. With my labour, rupturing my membranes was the start of a lot of trouble...

[Divvy]

Also, is ARM not really an induction of labour?

So can I refuse this, due to having c-section last time, and consultant says I should not be induced this time?

Last time, I had so much water when they broke them at 3cm (part of induction and policy once on labour ward)

They pushed the babies head back up, to let some of the water out, I felt like I was being torchored....looking back.....I was!

From that moment I was a cs waiting to happen. After 3 perfect births, before the policy of arm came in.

I am due another baby in 4 weeks, and very scared right now.

[reikizen]

that's very old fashioned and not evidence based practice (see the NICE website for guidelines). of couse you can (and should)refuse to have your waters broken if there is not a valid medical reason. How bizarre, is your hospital in the 1970's!?