Do you perform AROM?

[cachet]

I'm reading Peggy Vincent's 'Baby Catcher' about her experiences as a homebirth m/w and was really surprised (and dismayed) to read how she would often break the bag of waters of her clients. IMO this is done way too much in hospitals, I didn't think HB midwives did this. My m/w specifically state on their website they don't ARM and I can't think of WHY this intervention is considered helpful??

Do you do the AROM?

[MsBlack]

I don't. CAn't say that I *never* would, but it is something that I just don't like.

[FairFlowers]

As a general rule, no, I don't rupture membranes. I might if I thought I would get a shower if they ruptured spontaneously during a contraction, but that would only be under certain circumstances. And I have seen a few times where things seemed to have stalled out at 9cm or so, and the midwife ruptured the membranes--baby was born soon after.

[nashvillemidwife]

There are a couple instances in which I would do it.

1. If the bag of water is truly holding the baby back. This happened at my last birth. She had a very strong bag, and it was acting as a sling to keep the baby's head from applying to the cervix and the elasticity was pushing the head right back up when she stopped pushing. And with every contraction she was pushing more water over the head, making the effect worse. I kept waiting for it to break any second, but it wouldn't. Mom was getting tired. I told her the water would eventually break, but at this point she had nothing to lose and everything to gain. I punctured it with a needle and it trickled out slowly. Baby was born 23 minutes later, after 4 hours of pushing.

2. If the mom's been in labor for a really long time and I'm concerned about how the baby's holding up, breaking the water can tell us if there's meconium.

3. As a last ditch effort to augment labor before packing it in and going to the hospital for failure to progress.

My partner had been practicing for 30 years when I started working with her. She had been taught by an old country doctor long ago, and would commonly offer AROM to clients who were in active labor, head well applied to the cervix, with a bulging back. She believed if the bag were out of the way, the head would put more force on the cervix and speed labor along. I followed her lead and offered this to a client with this scenario. Her labor ended up in a transport for FTP. No one else has considered this, but I believe I totally messed up her birth. The baby was big, and I think that even though his head was applied the bag was actually exerting more force against the cervix and once the bag was out of the way dilation receded. So I don't do that anymore.

[sevenkids]

There are occassions when it's helpful, but as a rule I don't routinely rupture membranes. I actually don't rupture them at all, I don't carry amnihooks or amnicots. Sometimes if the bag is holding up the head I put a small, slow leak in the bag with the wood end of a sterile swab. Gets a little of the fluid out of the way, but without the sudden gushing. Quite often, simply suggesting to mom that she let her bag of waters go does the trick. And sometimes the mother will ask to have them broken to relieve some of the pressure if she has a real bulgy bag.

The most common scenario is as nashvillemidwife says, a last ditch effort to augment before transporting.

[cachet]

Thank you for the replies and the insight! What struck me when reading one of the stories in the book (and there was quite a bit that bothered me!) was that she broke the water and then there was a prolapsed cord. I wonder if the AROM caused that?

I can see why in a few cases it would be helpful though. Thanks!

[conniebonnie]

i think also the fact that she is recounting her life as a midwife- many of the things she did when she was first starting out she would not do now... kwim?
i found the same when reading ina may gaskin and just chalked it up to the time in her life and in the country.

[mwherbs]

nashvillemidwife has listed when I would and have done it-- also when a baby is born in the caul I have broken it at the armpit or lower--