Midwife views on amniotomy to speed up labour

Should an intervention be performed when we are in a midwifery-led arena or at a home birth? At the 38 week antenatal visit, all women should be offered information about the risks associated with pregnancies that last longer than 42 weeks, and their options.

Amniotomy: to do or not to do?

Their work challenges the use of amniotomy to augment a dystocia labour, and also proposes that the use of the pool can be just as effective, if not more so, at improving the progress of labour.

The assumption is that labour will be slower, but is this definitely the case? Trial reviewers suggest that amniotomy should be reserved for women with abnormal labour progress.

Therefore, there can be no certainty that you are not tapping into vessels that are part of the overall blood supply to the fetus. Progress is complex and multifactorial, and depends on power, efficiency and the position of the fetus, as well as the response in the cervix.

To perform a membrane sweep, the examining fingers during a vaginal examination are introduced into the cervical os and passed circumferentially around the cervix Boulvain et al, Common beliefs about amniotomy The belief that amniotomy will increase contractions and thus power and progress is not always in evidence in clinical practice.

We apologise for this confusion. Caution should therefore be exercised in making comparisons in terms of outcomes. Those who did not receive adequate analgesia were likely to be women who Midwife views on amniotomy to speed up labour either short or long labours.

Would you like to author a How to page? The use of amniotomy is important under certain circumstances, but Marjorie Vincent argues that routine use of the procedure to speed up labour is not necessarily beneficial.

Local policies will often suggest 41 weeks for routine membrane sweeping as it is more likely to be successful, easier to perform and more comfortable for the woman. Their findings suggest that by conserving the membranes, there was a lower rate of maternal infections, cord compression, blood transfusion and severe variable decelerations.

No evidence was identified which assessed the best methods of information giving or emotional support specifically related to the induction of labour process.

This should separate the membranes from their cervical attachment. The Cochrane review of maternal positions and mobility during first stage labour supports the positive impact mobility has in shortening labour Lawrence et al.

Correction In the last issue of Midwives, reference was made to the fetal side of the placenta being made up of cotyledons. Used by midwives or obstetricians, its intent is to initiate the onset of labour physiologically.

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 Many midwives when inducing labour will have had the experience of no power or very minimal power at artificial rupture of the membranes ARM.

Why is amniotomy performed? Are we not losing our biological confidence in the birthing process? In fact, the pressure from intact membranes could and does contribute to the ripening and dilation of the cervix. Membrane sweeping will comprise the following steps: So where do we get this idea that amniotomy will speed things up?

Twenty percent of women had not heard of induction before their pregnancy. This leads to a further question regarding power and positioning of the mother — will any malpresentation correct itself and lead to the desired progress?

There are dangers to be experienced and findings that could alarm or panic both practitioner and mother. It seems that in our desire to question, we create more problems that need to be answered.

How to… perform a stretch and sweep

Without such information, clinical care risks becoming compromised and women are not in control. After all, it is a blind procedure. There is almost a public conditioning in expecting the waters to break and the impression that you cannot possibly be in labour if the membranes remain intact.

It is performed by the use of a crotchet-like, long-handled hook passed per vaginum commonly referred to as an amnio-hook. Some obstetricians will wait as long as 24 hours but that is less common. The Cochrane Pregnancy and Childbirth Database. Reference is made to the NICE clinical guidelines on antenatal care 37 and intrapartum care 17 as supplementary evidence.

There are a number of reasons why the procedure may be performed: However, at least the cervical os has demonstrated its ability to stretch to 6cm.Research recommendations on information and decision making Studies are needed to compare women’s views and experiences on the different methods of induction of labour with those during spontaneous labour.

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Evidence does not support routinely breaking the waters for women in normally progressing spontaneous labour or where labours have become prolonged.

(also known as artificial rupture of the membranes (ARM), or amniotomy), is to speed up and strengthen contractions, and BirthingWISE but we are loving what happens when. Midwife Views on Amniotomy to Speed Up Labour This dissertation considers the views of midwives on the procedure of amniotomy with the specific relevance of its use in speeding up labour.

Published: Mon, 22 Jan The primary aim of amniotomy is to speed up contractions and, therefore, shorten the length of labour. However, there are concerns regarding unintended adverse effects on the woman and baby.

Objectives. One of the most common methods is to use a medication called Pitocin. How is Pitocin used to induce labor? Some of this will depend on how you respond to the Pitocin and how well your baby responds to Pitocin. When used with an amniotomy, Pitocin can also be used to speed up your labor.

The use of amniotomy is important under certain circumstances, but Marjorie Vincent argues that routine use of the procedure to speed up labour is not necessarily beneficial.

Midwives magazine: May

Midwife views on amniotomy to speed up labour
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