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| |    Assisted Rupture of the Amniotic Sac (Amniotomy) by Lisa Rodriguez, R.N. and Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Sometimes your water breaks on its own, and sometimes your practitioner makes a decision to assist this process. There are several reasons why it might be necessary for your doctor to intentionally rupture the membranes of the amniotic sac (also called amniotomy).
Amniotomy is usually done in the lithotomy position, where the pregnant woman reclines with her legs bent at the knees and relaxed. In this position, the practitioner can most easily reach the vagina and the cervix. Usually this is no more painful than a vaginal exam. The practitioner will use a special sterile instrument called an amnio-hook, which resembles a plastic crochet hook, to make a hole in the amniotic sac. When it is torn, the amniotic fluid, in which the baby has been swimming for all these months, flows out. It is quite common to feel a warm sensation as the fluid leaves your body. Most women will continue to leak fluid until they deliver. Will contractions feel different after my water is broken? Typically, uterine contractions will start to get a little stronger and may come more often after the water breaks. They also may seem more intense than before because the amniotic sac acted as a cushion between the baby and the uterus and cervix. Are there risks involved with an amniotomy? First the practitioner assesses whether a laboring mother is a candidate for having her water broken. In general, in order to perform an amniotomy, the cervix must be dilated and the baby's head must not be too high in the pelvis. If a baby's head is determined to be too high and it isn't tightly pressed up against the inside of the cervix, there is a possibility of the umbilical cord coming out through the cervix and into the vagina as the water rushes out. This uncommon complication, called cord prolapse, requires emergency cesarean delivery, but it can be avoided by not rupturing the amniotic sac if the baby isn't positioned correctly. Also, since the bag of waters prevents bacteria from entering the uterus by acting as a barrier, membranes aren't usually ruptured until delivery is imminent. Timing of amniotomy is a judgment call, depending on other factors like the need for internal monitoring. Sometimes after the amniotic fluid has been expelled, the umbilical cord starts to get compressed during contractions. (This typically is indicated by a particular pattern of fetal heart-rate changes known as variable decelerations.) Having the mother change position often can ameliorate this problem; however, sometimes sterile, warmed saline must be carefully infused back into the uterus (amnio-infusion). Dealing with anxieties All these medical terms and procedures may seem overwhelming as you think of what may (or may not) come to be during your own labor. Just keep in mind that knowing what to expect often can help to make any procedure less intimidating--and you deserve to understand any procedure being done if you are to participate in the decision making that surrounds your care.
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