AROM in the later stages of labor
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Thread: AROM in the later stages of labor

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    Question AROM in the later stages of labor

    I am mostly a lurker here, but am hoping to be more involved in the next several months
    Anyway, I was having a conversation with a family member about natural delivery. This person has delivered several babies naturally without meds or interventions. The topic of AROM came up when we were discussing things that can hinder a natural delivery. I understand that early AROM is more than likely going to cause more harm than good in most situations, but this person was vehement that it should never be performed.
    "Why do they have to interfere with the way God intended for it to be?" she said. Then she preceded to tell me that even if done in the later stage or phase (7-8cm) it can cause a stubborn cervical rim and can cause the baby to have more problems.
    I cannot find much about this from researching. Everything I've read said that as long as the baby is in a favorable position and the cervix is soft and stretchy, it can keep things moving in transition.
    I was stalled for hours at 7-8 cm. Once my water was broken I delivered in less than three hours.
    My question is, for those of you who've had experience with this, do you think it helped your labor progress? What does your MW/OB say?
    Beth

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    Posting Addict Spacers's Avatar
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    IMHO, breaking the water can be helpful when a bulging bag of fluid is preventing baby's head from getting good contact with the cervix because there's just no way that a bag of fluid puts as much pressure as the nice solid head of a baby. Cervical rims are usually caused by either poor positioning (which should be checked before AROM) or by scar tissue on the cervix, according to my midwife. If this came up again, I would ask my family member for supporting documentation for her claim.
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    I don't have any research about that either, but with my recent birth, I allowed them to rupture my membranes when I was 7, almost 8 cm with a "bulging bag of water" As pp mentioned, this allowed baby's head to get in contact with the cervix once they ruptured my membranes. 40 minutes later, I was holding my little man.

    with DS1, my water broke on its own, during a contraction when I was 9 cm, being checked into L&D. comparing the two labors, with DS1 I had contrax one on top of the other at the end of labor...whereas with DS2, the contrax were strong but I still got a break
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    Hmmm, I've had the opposite experience than what your friend is saying.

    With my 4th, we were avoiding ROM because I was GBS+. But, I got stuck at 7cm and despite hard ctx wasn't progressing (it had only been 4 hours since labor started, but my last two labors were precipitous so this was concerning). The mw did an AROM at 1125 and I got to 9cm immediately, was pushing in a few minutes and DD was born at 1138.

    In my situation, not rupturing was holding me up. And looking at my previous pregnancies, I must make tough amniotic membranes or something - I've always needed an AROM, with the exception of my 2nd when membranes ruptured as the head was delivered.

    I would be curious to know where your friend is getting her info? I agree to hold off on ROM in most cases, but sometimes it is needed.

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    Quote Originally Posted by Spacers View Post
    IMHO, breaking the water can be helpful when a bulging bag of fluid is preventing baby's head from getting good contact with the cervix because there's just no way that a bag of fluid puts as much pressure as the nice solid head of a baby. Cervical rims are usually caused by either poor positioning (which should be checked before AROM) or by scar tissue on the cervix, according to my midwife. If this came up again, I would ask my family member for supporting documentation for her claim.
    Yes. And a cervical lip isn't that big of a deal, it just requires patience or your midwives help to move the lip while pushing. If there isn't a bulging bag, I don't see the need to AROM, but that's just personal opinion. Other than the possibility of a prolapsed cord and infection, I haven't heard of any other issues with AROM.

    ETA: The bag of waters is protecting the baby from the stresses of labor. Maybe that's what she's talking about?
    Last edited by HockeyTownMom; 02-14-2011 at 06:48 PM.
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    I was too afraid to let them break my waters when I was in labour with DS, I only agreed to it when they told me I was at 10 and ready to push lol, maybe if i had let them break it earlier things may have progressed faster? My labour was only 8 hours anyway so I think it was ok.

    I was hoping to not have my waters broken at all this time, but we'll see
    Allie




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    I had AROM with DD#1 at 8cm to assist in progression of labor (doc was wanting to get to a golf game and I was hindering that) It didn't cause any damage and I still labored for another 4 hours before she came.

    I had AROM with DD#2 at 0cm as part of the induction "routine" and it pretty much did nothing, it was the double dose of PIT that slammed me into overdrive and she was born 10mins after that... PIT did the most harm there, I doubt the AROM even measures on the scale of how that labor was screwy!

    My Third DD my water broke naturally and I can say from experience that anything obstructing the head from putting pressure on the cervix (in this case her arm) is a pain and should be avoided.

    All and all If my water doesn't go naturally with this one, I'm not really going to blink if the Midwives want to break it... besides, at least when they break it there aren't any embarrassing mall scenes :P My friends hubby nearly ended up a single man after shouting at the top of his lungs "Clean up Isle 3" when her water broke at the mall... poor guy was walking funny for weeks!
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    Posting Addict MrsMangoBabe's Avatar
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    I don't think there is any evidence to support the idea that late AROM is associated with an increase in "stubborn cervical rims." I think whether or not AROM is helpful is a case-by-case thing. I have read many birth stories where it appears that breaking the water sped up a birth that slowed down late in labor. I, on the other hand, had a great birth where my membranes ruptured spontaneously when all that was left was a lip of cervix left and was very happy with that. I really think it depends.
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    Quote Originally Posted by Spacers View Post
    IMHO, breaking the water can be helpful when a bulging bag of fluid is preventing baby's head from getting good contact with the cervix because there's just no way that a bag of fluid puts as much pressure as the nice solid head of a baby. Cervical rims are usually caused by either poor positioning (which should be checked before AROM) or by scar tissue on the cervix, according to my midwife. If this came up again, I would ask my family member for supporting documentation for her claim.
    Well, she has no documentation. Apparently her very natural-friendly OB and a MW acquaintance told her all this. That is why I wanted to ask you ladies. I know this group has so much experience and knowledge as a whole.


    Quote Originally Posted by HockeyTownMom View Post
    ETA: The bag of waters is protecting the baby from the stresses of labor. Maybe that's what she's talking about?
    I am assuming that is what she is speaking of. I am sure that AROM isn't always appropriate, but it seems there is a place for it. Especially when things stall during the painful transition stage and the bag could possibly be hindering progress.
    Thanks for your replies. This person has a lot of influence on my sister who is pregnant with her first and I don't want her to be given random unfounded info. I am giving her (my sister) a copy of "The Thinking Woman's Guide".
    Beth

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    I had my midwife rupture my bulging bag which stalled me at 9cm, I tried breaking it on my own with small pushes with no luck. He was born 12 minutes later.
    Kristina, (formerly known as ~Kristina~)
    doula and apprentice midwife
    Wife to Jesse 8.18.01
    Mom to Ayden 12.18.01, Kailey 7.1.03,
    Ashlyn 6.11.05, Dylan 9.29.07 & Riley 12.8.09

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