p. 41). Thus it is physiologically imperative that the process occur expeditiously.
A number of methods may be employed to either induce or augment labor (Milhan, 1992, p. 17). These include both invasive procedures as well as physiologic approaches (Milhan, 1992, p. 17). The decision as to which particular technique is best has been the subject of considerable controversy (Bakos & Backstrom, 1987, p. 537). One invasive procedure that has received a lot of attention is early, or elective, amniotomy.
Elective amniotomy has been defined as "amniotomy done after labor is established, but before 6 centimeters dilatation" (Lynaugh, 1980, p. 3). The procedure is thought to expedite labor by accelerating the rate of cervical dilatation (Stewart et al., 1982, p. 41).
The technique basically involves instrumental rupture of the placental membranes. During examination, the clinician's fingers are inserted into the vagina and cervix until the fetus' presenting part is palpated through the amniotic membranes (Milhan, 1992, p. 18). Initially, care must then be taken to identify all structures (Milhan, 1992, p. 18). Then, a sterilized instrument such as an Allis clamp, an amnion hook or a hollow needle is placed in the cervix between the fingers and used to puncture the membranes (Milhan, 1992, p. 18).
Typically, between 100 and 500 milliliters of amniotic fluid leak out depending on the both the amount fluid contained within the sac and the location of the rupture (Milhan, 1992, p. 18). The practitioner's fingers remain in the vagina to allow for a gradual fluid release and preclude prolapse of the umbilical cord (Milhan, 1992, p. 18). At this point, fetal heart tones are usually auscultated (Milhan, 1992, p. 18). The clinician can also make an evaluation of the amniotic fluid for color, consistency, odor, and quantity (Milhan, 1992, p. 18). Furthermore, the fluid can be evaluated for meconium (Smith et al, 1993, p....