Excerpted from Birth as an American Rite of Passage

Artificial Rupture of the Membranes (Amniotomy)

Description and Official Rationale

Amniotomy is frequently performed on women who labor in hospitals for the purpose of speeding up their labors, or for insertion of the internal electronic fetal monitor; occasionally it is performed so that the physician can take fetal blood samples, and/or ascertain whether or not there is evidence of meconium staining (fetal bowel movement), which under the technocratic model is considered to be indicative of fetal distress. The procedure is simple: a hospital attendant inserts an instrument like a crochet hook through the cervix, and snags and breaks the amniotic sac.

Physiological Effects

In a review of the literature, McKay and Mahan find that, if amniotomy is not performed and membranes are allowed to rupture spontaneously, most women will have intact membranes until they are either in very active labor or reach complete cervical dilation (1983:173). Although amniotomy does indeed often result in speedier labors (if performed once active labor is well-established), it also increases the danger of fetal infection from vaginal exams and/or inserted instruments. (Such infections can of course be cured with antibiotics, but that process can mean considerable discomfort and many extra days in the hospital, as several of the women in my study discovered.) Should false labor be mistaken for real labor, and amniotomy be performed too early, the 24-hour rule will be invoked, and pitocin induction with all its attendant hazards will be required (this particular complication can be avoided if amniotomy is performed only after 5-6 centimeters dilation is reached).

A further hazard of amniotomy is that without the protective cushion of the amniotic fluid the baby's head is subject to greater pressure during contractions, and the umbilical cord is more likely to become compressed, resulting in oxygen deprivation and consequent respiratory distress. Cord prolapse is also more common after amniotomy (Pritchard and MacDonald 1985:289). Moreover, unruptured membranes often cushion not only the fetal head but also the mother's perineum, allowing for more gentle stretching and reducing the likelihood of tears. The combination of rupture of the cushioning bag with pitocin-augmented contractions often leads to more rapid and forced stretching of the perineum and so to more tears (Brigitte Jordan, personal communication).

Women's Responses

The doctor came in and examined me, and said that if he broke my waters the baby would come in no time. So I said okay. And he was right! Three contractions later, I felt like pushing.
-Darlene Abney

Some guy came in, broke my waters with a long hook, you know. Apparently they said that would help. Well, that for me was one of the worst moments of the whole experience. It was like all of my hopes and dreams of how it was going to be just sort of floated out with the waters. I'll never forget that. It was just an awful feeling. Warm and sad, it was like tears flowing out, you know?
-Elise Pearsall

Ritual Purposes

Amniotomy was one of the first things the early male midwives of the 1700s figured out that they could do to intervene in the process of labor. Then as now, breaking the waters of a laboring woman was an effective means of making it appear that she could not have the baby without a physician's assistance (Wertz and Wertz 1989). When performed for the purpose of speeding up labor, rupturing the membranes of a laboring woman reinforces and intensifies the urgency of the institution's message about the necessity of condensing the woman's experience of labor and birth into a discrete, measurable unit of time. When performed so that an internal fetal monitor can be inserted, artificial rupture of the membranes further intensifies the message of the birth machine. In both cases, the underlying message is clear: culture, not nature, knows best.

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