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    Dec 16
    2009

    VBAC & AROM for Induction at 42 weeks

    Archived User

    I'm a doula for a VBAC mother who is pregnant with her 3rd baby.  Her first baby was born naturally and vaginally 11 days post EDD, second baby was a cesarean for breech presentation and low fluid at 11days post-EDD.  She has anticipated that this baby would also gestate a bit longer, and it has--today she is 11 days post-EDD.

    She wants labor to start on its own, but she is getting some enthusiastic prodding to have her water broken since she is already 4cm dilated (has been for at least a week).  She is starting to consider it at the 42-week point because her midwives are so confident that it will work well.  She has already had her membranes sweeped 2-3 times in 6 days, and is doing all the natural induction methods in the book (sex, walking, homeopathics, acupressure).

    My question is, do you have any information on how effective amniotomy/AROM is for induction (rather than augmentation) of labor?  For example, how often does it result in a vaginal delivery when done before the mother is having contractions?  The only information I have found has looked at AROM for augmention, after labor has begun.  As I mentioned, her midwives are convinced it will work, based on many experiences of their own.

    Thanks!

    Cindy

    Henci Goer

    Here is the link to the Cochrane systematic review on amniotomy alone to induce labor. As you can see, there isn't much data. The problem with amniotomy is that you can't take it back. Once membranes are ruptured, this woman is committed to deliver the baby--one way or the other. On the other hand, she is not a first-time mother, has had a vaginal birth, and is already 4 cm dilated, which put the odds in favor of it working. Depending on what her other options are once she goes past 42 weeks, it may be her best alternative.

    -- Henci


    All Times America/New_York

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