Alright Birth Professionals, let's talk Artificial Rupture of Membranes. What are your feelings about the procedure? When have you seen it to be helpful? What do you think the risks are? What criteria do you think should be met before AROM?
AROM discussion. If it's not broke...?
I thought I might contribute not as a professional, but from personal experience. I had AROM less than 15 minutes before actual delivery - I had actually pushed through 2 contractions beforehand. I honestly believe that without AROM, I would have been one of those rare mothers who delivers with sac intact (which admittedly, would have been pretty cool).
My feelings regarding the delay - I am thankful to have not had AROM earlier than I did (and this is on my birth plan for the next, should my waters not rupture again). I think that this really assisted my body with preparing for the delivery, widening and opening up the birth canal, etc. Additionally, as I was Group B strep positive and made the choice not to have IV antibiotics on hand, it helped to protect my baby as long as possible by minimizing the window of exposure.
My feelings regarding the AROM - I felt it was done at the perfect time for me. To tell the truth, in my head between contractions I was trying to work out a way to ask about AROM, but I was also scared that my midwife would decline to do it, since she had not yet made the offer. It was such a relief when she asked if I wanted her to rupture the membranes, and really renewed my spirit there in the last few minutes of my labor. I was becoming very fatigued and discouraged as I entered the pushing phase, because I felt as though I was making no progress. It truly felt as though my little girl was bobbing right back up to her original position at the end of pushing through a contraction (which may or may not have been the complete case). This was the single time I cursed during labor - after the second of those experiences, I whispered a simple, "Shit! Shit! Shit!" Without the AROM, I feel like the pushing phase would have been much longer and far more exhausting, so I feel it was completely appropriate.
When I was pregnant with my daughter, one of the programs that I watched showed a woman who gave birth with her child still in sac (the first I had ever heard of it happening, actually). After having had the experience of having the sac intact far into labor, I felt differently about what I had seen - I actually felt that the mother had been pressured into giving birth that way. Also, she had gone in planning for a natural childbirth and took pain meds only shortly before pushing (probably near the same point where I had AROM).
I feel that there is probably a time and a place for AROM, and that in the end the benefits may outweigh the small risk in a slightly early rupture. If I hadn't been fatigued and discouraged, it would have been awesome to see if I would have delivered still in the sac. But I was. For me, helping ease those last few minutes of labor made the difference between a wonderful, exhilarating experience when I was first handed my daughter and what I feel would have been a different, fatigued experience after likely another hour or more of pushing. If I have the opportunity again to make the decision, I will again wait as long as possible (and am willing to try delivery in the sac, if I feel like I can make progress).
I will note that the only "complication" in my labor and delivery was that it took around 40 minutes to deliver the placenta (the birthing center only allowed 1 hour before hospital transfer), and I did wonder if the slowness of the placenta detaching was in any way associated with the AROM.