Artificial rupture of the amniotic membranes during labour, sometimes called amniotomy or ’breaking of the waters’ was introduced in the mid-eighteenth century, first being described in 1756 by an English obstetrician, Thomas Denman (Calder 1999). Whilst he emphasized reliance on the natural process of labour, he acknowledged that rupture of the membranes might be necessary in order to induce or accelerate labour (Dunn 1992). Since then, the popularity of amniotomy as a procedure has varied over time (Busowski1995), more recently becoming common practice in many maternity units throughout the UK and Ireland (Downe 2001; Enkin 2000a ; O’Driscoll 1993) and in parts of the developing world (Camey 1996; Chanrachakul 2001; Rana 2003). The primary aim of amniotomy is to speed up contractions and, therefore, shorten the length of labour.

 

The first recorded use of amniotomy in the United States was in 1810; it was used to induce premature labor. Amniotomy and other mechanical methods remained the methods of labor induction most commonly employed until the 20th century. Amniotomy, or artificial rupture of the amniotic membranes, causes local synthesis and release of prostaglandins, leading to labor within 6 hours in nearly 90% of term patients. Turnbull and Anderson found that amniotomy without additional drug therapy successfully induced labor in approximately 75% of cases within 24 hours.

• http://www.glowm.com/section_view/heading/Induction%20of%20Labor/item/130#r5
• http://apps.who.int/rhl/reviews/CD006167.pdf

• Amniotomy was associated with a reduction in labour duration of between 60 and 120 minutes in various trials
• There was a statistically significant association of amniotomy with a decrease in the use of oxytocin: OR = 0.79; 95% CI = 0.67-0.92 in several randomized trials
• AROM does not involve any type of medication to mom or baby and is considered by some to be the most “natural” means of induction in a hospital setting.

• In several randomized trials there was a marked trend toward an increase in the risk of Cesarean delivery: OR = 1.26; 95% Confidence Interval (CI)=0.96-1. 66.
• Trial reviewers suggest that amniotomy should be reserved for women with abnormal labour progress.
• In 15 studies containing 5583 women there was no clear statistically significant difference between women in the amniotomy and control groups in length of the first stage of labour
• Evidence does not support routinely breaking the waters for women in normally progressing spontaneous labour or where labours have become prolonged.
• [Once membranes are broken} most obstetricians want the baby birthed as soon as 6 hours post-onset to reduce the risk of infection from the introduction of bacteria into the vagina due to repeated vaginal exams. Some obstetricians will wait as long as 24 hours but that is less common. In contrast, midwives, who do not routinely perform cervical checks unless specifically indicated or requested, thus limiting the chance of infection, will often allow up to 36-48 hours as long as no indications of an active infection are present.
• A large study of 3000 women’s opinions of the intervention was conducted by the National Childbirth Trust (1989). Two thirds of the women in this study reported an increase in rate, strength and pain of contractions following membrane rupture; they found these contractions more difficult to cope with, needed more analgesia and felt that the physiology of labour was disturbed.
• When there is concern that labour is slowing down, benign measures to intensify contractions such as positional changes and movement may prevent the need for more invasive interventions (Simkin 2010). The Cochrane review of maternal positions and mobility during first stage labour supports the positive impact mobility has in shortening labour (Lawrence et al. 2009).
• Smyth et al. 2007 studies showed that amniotomy is not an effective method of shortening spontaneous labour and increases the risk of caesarean section and more fetal heart abnormalities

• http://www.ncbi.nlm.nih.gov/pubmed/10796086
• http://www.ncbi.nlm.nih.gov/pubmed/23780653
• http://summaries.cochrane.org/CD006167/PREG_amniotomy-for-shortening-spontaneous-labour#sthash.mSDKXAcC.dpuf
• http://www.givingbirthnaturally.com/ways-to-induce-labor.html
• https://www.rcm.org.uk/sites/default/files/Rupturing%20Membranes.pdf

• http://onlinelibrary.wiley.com/doi/10.1111/j.0001-6349.2005.00700.x/abstract;jsessionid=1DAA1BECADB5A8556C9A3920E3726843.d02t01
• http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0CDsQFjAD&url=http%3A%2F%2Fwww.researchgate.net%2Fpublication%2F236275554_The_less_studied_effects_of_Amniotomy%2Ffile%2Fe0b4951b37ec067930.pdf&ei=avz7U96DLM6BygTO8oK4Aw&usg=AFQjCNFnuAFkfDAlqvd6mUyFysoAMs94cQ&bvm=bv.73612305,d.aWw
• http://www.scienceandsensibility.org/?p=556
• http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2010/1/1/baby-born-in-the-caul-amniotic-sac.html

Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

• Courtney was diagnosed with Gestational Diabetes via blood glucose test (usually administered between 24 – 28 weeks of pregnancy)
• High Blood Pressure was measured at office visits from 36 weeks on; whenever she checked her blood pressure at home, it was normal
• Midwife recommended induction at 38 weeks due to risks of having gestational diabetes (large baby, possible stillbirth) – Courtney negotiated for more office visits, more monitoring, and extra ultrasounds to “buy” two extra weeks of pregnancy

• Courtney and Jake agreed to induction on her due date with prostaglandin gels
• After about 12 hours at the hospital, the couple was told that labor had not progressed enough so they agreed to an amniotomy (artificial rupture of membranes)
• Baby was born vaginally with no other interventions at 11:56 pm

• Changing positions and moving around: we the used birth tub, knees on bed and arms draped over back of the bed, side lying position
• Being surrounded by people who support your choices is probably the most important thing: husband spoke up and asked people who were in the room to leave; midwife was amazing; everyone on staff who walked in the room acknowledged reading and supporting their birth plan
• Peppermint oil for nausea – helped control the pace of her breathing
• Unspoken communication with a loving coach – even though it felt silly at the time, the practice in classes and at home paid off because he knew what she wanted with the wave of a hand.

• Be prepared for everything
• Expect everything to not go the way you want it
• Try to predict what she needs so she does not have to say it

Courtney & Jake's Birth Journey Early labor after induction with prostaglandin gels. They are using the labor position we call "The Prom Dance".

Courtney & Jake's Birth Journey Using the deep tubs available for laboring at Mercy Gilbert Medical Center

Courtney & Jake's Birth Journey The awe that hits many couples after Sweet Pea arrives...we hope that you are supported in your birth choices so you can feel awed by your birth journey, too.

Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

A bigger selection of topics today...check out the news if you are "trying" to get pregnant, and more motivation to keep your pregnancy healthy, low-risk and as stress-free as possible.  Also, new study from ACOG that shows that there may be risks with the use of Pitocin.

“Previous research has shown that what mothers eat during pregnancy affects the health of their offspring. But now, a new study suggests that a father's diet prior to conception could also play an important role in their child's health, particularly when it comes to consumption of folate.”

"The early childhood diet and that of the mother during pregnancy determines the health of a child later life. This is the claim that the EU-funded research project Early Nutrition is trying to substantiate by the time it is due to be completed in 2017." 

“As a newborn passes through the birth canal, the microbiome of a mother’s vagina ends up in the offspring’s gut. In the first study, the team, led by Tracy L. Bale, PhD, Professor of Neuroscience in the Perelman School of Medicine, Department of Psychiatry and the School of Veterinary Medicine Department of Animal Biology at Penn, found that changes in the microbiome produced by stress in pregnant mice altered the microbe population in the newborn’s gut and correlated to changes in the developing brain.”

…

“In a parallel animal study, Bale and colleagues were looking for predictive biomarkers of maternal stress and found that a specific protein in the placenta, OGT, may have implications for brain development in offspring. The single enzyme is known as O-linked-N-acetylglucosamine transferase or “OGT,” which is important in a wide variety of regulatory functions, including development.

The researchers found that placentas associated with male mouse pups had lower levels of OGT than the placentas associated with female pups, and levels of OGT in the placenta were even lower when their moms were stressed.”

"A Swedish study of children admitted to hospital within the first year of life for lung infection has found that the increased risk this poses for later development of asthma is exacerbated by low gestational age.

Early respiratory infection and preterm birth are both known to be markers of increased subsequent asthma risk, but the relationship between these two factors has been unclear."

"These results suggest that Pitocin use is associated with adverse effects on neonatal outcomes. It underscores the importance of using valid medical indications when Pitocin is used.”

"Maternity care may play a role in determining a mother’s overall level of satisfaction during birth and months after labor. A mother’s decision on the mode of baby delivery and whether they opt for pain relief during labor will affect her overall happiness. A recent study finds a vaginal birth without epidural anesthesia increases the odds of happiness for new moms."

"For the third straight year the United States has fallen in rank in the World Health Organization’s international ranking for maternal mortality. The U.S. currently ranks 58, meaning in 57 nations women have a better chance of surviving childbirth than they do here. The U.S. fares a little better in infant mortality, ranking 34 in the world at keeping infants alive through the birth process. If this sounds outrageous, consider also that the U.S. spends more money on maternity health care than any other developed nation. Licensed midwife Sondra Londino, who recently opened Birthroot Midwifery, a private practice in the Fall Creek area, explains why out-of-hospital births have increased by 41 percent from 2004-2010 and how a midwifed home birth provides a safe and satisfying birth experience." 

“Our report suggests that progestin prophylaxis can reduce the rate of recurrent spontaneous preterm birth when barriers to care and treatment are aggressively removed and that the gestational age at initiation may affect the success of progestin prophylaxis," the authors write.”

“When people find out that I'm an at-home Dad, there's often an image that comes to mind that is not quite accurate, and is largely fueled by the "TV depiction" of stay-at-home and work-at-home Dads: A group of four or five guys standing around a park with outward-facing babies dangling from their chests. If this happens anywhere, I have not witnessed it, nor been a part of such a gathering in the past 4+ years of my career as a parent. When I have seen babies worn by other parents (and sometimes myself), the big question has always been "which way is the right way - inward or outward." It's been the subject of vigorous debate among parents, but the folks at Boba Family just might have the answer, and that answer is inward.”

“Professor Christophe Lacroix at the Institute for Food, Nutrition and Health, ETH-Zurich, led a study which found  the important good bacteria that babies receive from breast milk comes from their mothers gut. This is part of the innate support that assists babies with acquiring strong immune systems. It is also part of building colonic health and the babies gut.”

Therapy Dogs Help Students De-Stress During Finals

"Whether it's taking a break from the books, the workplace, or even the crowds at some of the country's busiest airports, four-legged friends are being used to help people feel good.

Scientifically, that's exactly what they're doing. Dr. Katherine Zupancic is a professor at SCC and says when people play with animals during stressful times, a hormone called Oxytocin is released that makes people happy."

From 1011HD http://bit.ly/1h3m6cs

Here are Dr. Bradley’s "Keys to Labor", as per his book, Husband-Coached Childbirth.  I love these simple steps – they could almost be considered a “recipe” for labor.  

• Mom should eat the kind of food she is hungry for: a meal, a snack, or a nibble, depending on where she has progressed in labor. 

A laboring mother should eat to her appetite.  Early in labor, she may be ready for a full meal.  We have students who go out to breakfast after they know they are in labor just to pass the time away.  If she is hungry, feed her accordingly.  As labor progresses and the body starts to divert bodily functions exclusively to labor and birth, you will see her appetite wane.  Later in labor, maybe she will want a bite of something – and definitely not the full meal she was requesting before.  If labor has been on the longer side and she is refusing food, or if she is being denied food and she is still hungry, you may consider clear broths for the dual purpose of an energy boost and hydration.

• Mom needs to be drinking every hour.  Whether she wants a full glass, a few sips, or ice chips – keep her hydrated.

Dr. Bradley wrote in his book that a mother should “drink to thirst”.  We now know that thirst is a late sign of dehydration.  It is best to keep mom hydrated by offering her a glass of water every hour in the early stages of labor.  Again, as labor progresses, she may not want that full glass of water.  You can offer her a sip of water after every contraction, or maybe ice chips will be better.  Some mothers may even prefer sucking on a damp cloth.

• At a good pace to rock baby down and encourage labor to progress.

Walking is a great way to speed up labor.  It is always a great way to work yourself into exhaustion.  You need to gauge how it’s working for your particular labor.  When you walk, are the contractions getting harder, longer and stronger?  If walking is not having that effect on your labor, then maybe you should just go for a 20-30 minute walk to labor baby down into the pelvis and exert some pressure on the cervix to encourage it to dialate, and then move on to the next step.  If walking is clearly making your labor progress, go for it.  You could walk until mom needs more help with relaxation besides reassuring words and counter-pressure.

• Water has been called the “midwife’s epidural”. A warm shower or bath can do wonders to ease the intensity of labor.

Water has an incredibly relaxing effect.  It can literally wash the tension away.  Some mothers may like the full submersion and weightlessness in a birth tub.  Other mothers may prefer the soothing sound and the sensation of water flowing down her body.  If your birth place has the equipment, try both and see what works for her.  You may want to consider limiting your use of water to an hour at a time if mom is in the tub.  See THIS article from Penny Simkin for more information about how to use water in labor.

• Now that Mom has fueled, hydrated, moved baby, and eased tension, do a relaxation exercise to ease her into a rest period.  An unmedicated mother *will not* sleep through the birth of her baby.

Mom has done everything she can to ensure a healthy, low-risk labor. She has nourished and hydrated her body as it prepares for the athletic event of birth.  She has walked to move baby and help dilate the cervix.  She has used water to dissipate any tension she may have been holding onto.  Now it’s time to encourage her into a side relaxation position, or which ever other position is comfortable enough for her to enter a state of deep relaxation.  Optimally, you want the mother to get a good sleep.  If it’s nighttime, then maybe she can sleep through the night, or until her contractions wake her up again.  If it’s during the day, hopefully she can get a decent nap.

Did you know that there is a national organization advocating evidence-based care and humanity in childbirth? 

I first became aware of ImprovingBirth.org when they held their first rally last year.  In order to bring awareness to the maternity health care crisis in our country, the organizers chose the date of Labor Day for the national event.  This year, they are truly nation-wide – there is at least one rally planned in all 50 states, and as of today, it looks like they are up to eight international locations.

What maternity health care crisis in the United States, you ask?  Here is a look at the numbers.  In the world:

• We are 34th in maternal mortality rates:  33 countries have lower maternal mortality than we do.
• We are 38th in neonatal mortality rates: 37 countries have lower neonatal mortality rates than we do.
• We are 41st in infant mortality rates: 40 countries do a better job at keeping newborns alive than we do.
• We are 66th in birth weight: 65 countries do better than us when it comes to birthing babies at healthy birth weights.
• We are 33rd in the breastfeeding: 32 countries had higher rates of exclusively breastfeeding at six months.

-International Comparisons from Childbirth Connection

“ Despite the poor international ranking, the International Federation of Health Plans recently reported that average U.S. payments for vaginal birth were far higher than all other countries reported, including Canada, France, and Australia (7).”

Quote from Childbirth Connection 

“It’s about women being capable of making safer, more informed decisions about their care and that of their babies, when they are given full and accurate information about their care options, including the potential harms, benefits, and alternatives.  It’s about respect for women and their decisions in childbirth, including how, where, and with whom they give birth; and the right to be treated with dignity and compassion.”

-Rally To Improve Birth

• Lower the C-Section Rate
• Respectful Maternity Care 
• Question Your Induction
• Informed Consent is My Right 
• Evidence-Based Birth

Donate HERE to the national organization:

http://bit.ly/19BXZ4u

Donate HERE to the local Phoenix Rally:
http://rallytoimprovebirth.causevox.com/phoenix

Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.