What is artificial rupture of membranes (amniotomy)?

Artificial rupture of membranes, also called amniotomy or “breaking your water,” is a procedure to break a pregnant woman’s amniotic sac. The amniotic sac is a pouch of fluid that surrounds and protects the baby. Breaking of the amniotic sac releases hormones that signal your body to begin or intensify labor contractions.  

Artificial rupture of membranes is a common procedure but it does have risks and potential complications. You may have less risky options to help your labor begin or progress.  Discuss all of your treatment options with your doctor or healthcare provider to understand which option is right for you.  

Other procedures that may be performed

Your provider may perform other procedures in addition to rupturing your membranes. These include:

  • Cervical ripening techniques, which help your cervix soften and dilate (open) in preparation for delivery through the vagina 
  • IV oxytocin (Pitocin) drip, which is a medication that causes uterus contractions
  • Nipple stimulation, which produces natural oxytocin in the body to stimulate uterus contractions 
  • Stripping the membranes, which gently separates your bag of water (amniotic sac) from your uterus. This causes your body to release hormones, which can help soften your cervix and start contractions

Why is artificial rupture of membranes (amniotomy) performed?

Your doctor or midwife may recommend rupturing your membranes in the following situations:

  • To induce (start) labor
  • To speed up your labor if it has stalled or slowed for several hours
  • To attach a monitoring device to the baby’s head to record the heartbeat in a lengthy or high-risk labor and delivery
  • To examine the amniotic fluid for meconium (fetal stool), which can indicate fetal distress. Fetal distress requires immediate action, such as a cesarean section (C-section).

Who performs artificial rupture of membranes (amniotomy)?

The following healthcare providers perform the artificial rupture of membranes:

  • Family practitioners provide comprehensive healthcare to adults and children including labor and delivery care. Another name for family practitioner is family medicine doctor.
  • Midwives are healthcare professionals who provide prenatal, labor, and delivery care, and some gynecologic care. Certified nurse-midwives (CNM) and certified professional midwives (CPM) may perform the procedure during home births in some states.
  • Obstetricians/gynecologists (OB/GYNs) specialize in women's health, pregnancy, and labor and delivery.

How is artificial rupture of membranes (amniotomy) performed?

Your artificial rupture of membranes will be performed in the labor and delivery room in a hospital or birthing center.  It takes less than five minutes and includes these steps:

  1. You will lie on your back with your legs bent and open.
  2. Your provider will insert a small surgical hook or a gloved finger that has a hook on it through your vagina and cervix into your uterus.
  3. Your provider will scratch the surface of your amniotic sac.
  4. You will feel the amniotic fluid flow out of your vagina. It may be a trickle, a small stream, or a gush. 
  5. Your provider will examine your amniotic fluid for meconium (fetal stool).
  6. Your provider may attach a monitoring device to record the baby’s heartbeat.

Will I feel pain?

Your comfort and relaxation is important to you and your care team. You may feel brief discomfort as the amniotomy hook goes through the cervix. The rupture itself is painless for both you and your baby. Tell your provider if you have pain or discomfort during the procedure.

Your labor contractions should intensify soon after your provider ruptures your membranes. Follow your breathing exercises if you are using Lamaze or other prepared childbirth technique. Ask your provider about pain control options if you planned a natural childbirth but change your mind as your contractions intensify. 

What are the risks and potential complications of artificial rupture of membranes (amniotomy)?