The Benefits of Amniotomy

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. 4

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rous women is consistently associated with a rate of cesarean section below 10% and a duration of labor of less than 12 hours (Parisi, 1993, p. 1193). In addition, others have arrived at similar conclusions. At the University of Texas Obstetrical Service at Hermann Hospital in Houston, for example, amniotomy has been part of their active management of labor in nulliparous women since July 1985 (Parisi, 1993, p. 1194). They have found that their program has reduced the frequency of cesarean section for dystocia by one third and produced a consistent rate of approximately 10 to 12 percent for primary cesarean section (Parisi, 1993, p. 1194). Furthermore, they also observed that the average duration of labor in nulliparous women was reduced, from 11.5 hours to 7.5 hours (Parisi, 1993, p. 1194). In fact, investigators in both the United States and Canada have found that active management of labor reduces the frequency of cesarean section for dystocia, as well as the duration of labor among nulliparous (Parisi, 1993, p. 1193 1194). Moreover, it does so without increasing either maternal or perinatal morbidity (Parisi, 1993, p. 1193 1194). In addition, recent studies have lent biologic plausibility to these observations (F

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