Innovation within the health care professions takes place at a rapid rate. As new therapeutic modalities are introduced, they must be tested for safety and efficacy. Sometimes these various analyses fail to arrive at definitive conclusions. Such is the case with amniotomy. Although the procedure has been widely known for most of this century, its benefit to the birthing process remains a matter of debate. The numerous studies on the topic tend to contradict each other. However, one aspect of amniotomy that they all do agree on is that the procedure shortens labor. Thus, by enhancing the efficiency of labor, amniotomy may be effective at minimizing the discomfort associated with childbirth. Furthermore, the evidence suggests that amniotomy does not expose either the mother nor infant to significant additional risk. In view of these facts, it seems reasonable therefore to continue to offer amniotomy as a therapeutic option for the management of parturition.
Twenty five to fifty percent of women who arrive at the hospital in spontaneous labor have already experienced rupture of their placental membranes (Fraser & Sokol, 1992, p. 535). For the rest, membrane management becomes the responsibility of the health care provider (Fraser & Sokol, 1992, p. 535).
One main priority during childbirth is that labor occur efficiently. Uterine contractions tend to constrict the blood vessels supplying the placental bed (Stewart et al., 1982, p. 41). This leads to a mild hypoxia in the fetus. When the uterus relaxes, the blood flow is restored. If the placenta is healthy and uterine relaxation is adequate, blood flow restoration is generally adequate to preclude deleterious consequences. As labor progresses, however, the mild hypoxic condition can gradually develop leading to fetal acidosis. In fact, labor can almost be thought of as a race between progressive fetal acidosis and dilatation of the cervix (Stewart et al., 1982, ...