When I was in labor with my first child I was frightened when a midwife and her student came in with a big crochet hook saying “we have to break your waters to get things moving”. Suddenly the pain of contractions became super intense. I begged for the epidural but my doctor refused trying to give me a natural as possible birth. Instead she gave me a dose of Demerol.

I realized after my second birth that the Artificial Rupture of the Membranes procedure (ARM) was actually a routine intervention. Even if you don’t need it you, may get it. I came into the hospital, in labor with my second child, and was 5 centimeters dilated. My hospital midwife broke my water because “we needed to speed things up” after only being there for an hour. I agreed not knowing I had a choice. After all, she was the doctor who knows best, right? Again contractions became unbearably intense. The midwife asked me if I wanted an epidural but this time I declined and instead asked for some Demerol.

I did a lot of research when I found out I was pregnant again and made a detailed birth plan including my preferences in case of an emergency. I found out I could decline any procedure and stated clearly I didn’t want an ARM. I changed doctors three times within that pregnancy until I found one that didn’t make a face or try to compromise with my preferences. I ended up having my third child at a birth center and the labor wasn’t as bad as my first two when my water was broken. It was painful but I firmly believe that because my water remained intact until the 2nd stage of labor it significantly decreased my pain and I was able to have an intervention and drug free birth to give my daughter the best start in her life. Altogether the labor of my daughter lasted 16 hours and 14 minutes, it was my shortest labor yet.

Cons of an Artificial Rupture of the Membranes

An ARM process:

• Increases the risk for infection, prolapsed umbilical cord, fetal heart decelerations, and c-section¹
• When the cushion from the amniotic fluid is gone women have reported being more uncomfortable², so it often increases the likelihood of the mother requesting pain medicine.³
• Once the membranes are ruptured the mother will be running on strict time limits because the longer the water has been broken the more increased risk of infection there is which means she has  higher chances of induction and, as mentioned earlier, a c-section.⁴
• This process often results in one big cycle of interventions.

Pros of an Artificial Rupture of the Membranes

There are circumstances which make the procedure beneficial;

• If your baby needs to be monitored internally then your waters will need to be broken so that they can access the baby.
• Breaking the waters also allows medical professionals to determine if there is meconium present.⁵
• If your labor has stalled or become sluggish the ARM may get things moving if performed at the right time. ⁶

With any intervention or medication you and your medical provider should weigh the benefits against the risks. Are the risks of the ARM procedure worth your doctor simply trying to speed things up? Or have you been laboring for hours and making great progress and things seem to be slowing down and your body just needs a boost? You have the right to decline any procedure but its your responsibility to be informed and know how to decide according to your circumstances. Medical providers aren’t following recommended guidelines and evidence so it is really up to you to educate yourself.

¹ http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=492886

² http://www.mahalo.com/artificial-rupture-of-membranes-arom/#ref_4

³ http://www.mybirth.com.au/intervention/arm.html

⁴ http://www.mybirth.com.au/intervention/arm.html

⁵ http://www.americanpregnancy.org/labornbirth/inducinglabor.html

⁶ http://www.childbirth.org/articles/amnio.html