Breaking Your Water (Amniotomy): How It's Done, Risks, What to Expect

Medically Reviewed By William C. Lloyd III, MD, FACS
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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)?

Artificial rupture of membranes involves risks and possible complications. Complications may become serious in some cases. Complications can develop during the procedure or in the days after it. 

Complications of having your membranes ruptured are not common but include:

  • Infection in the mother or the baby

  • Injury to the baby

  • Umbilical cord prolapse, which occurs when the umbilical cord comes out of the uterus before the baby. This can compress the umbilical cord between the baby and the mother and cut off blood supply to the baby. Umbilical cord prolapse may require an emergency cesarean section (C-section).

  • Vaginal bleeding

Reducing your risk of complications

You can reduce the risk of certain complications by following your prenatal plan and:

  • Getting all recommended prenatal care

  • Following activity, dietary and lifestyle restrictions and recommendations during pregnancy and labor and delivery

  • Telling your care team about the type and extent of contractions you are already feeling

  • Notifying your doctor immediately of any concerns such as increase in pain or bleeding

  • Taking medications exactly as directed

How do I prepare for artificial rupture of my membranes (amniotomy)?

You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome. You can prepare for artificial rupture of membranes by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Taking or stopping medications exactly as directed

  • Telling your doctor if you have cramps, contractions, vaginal discharge or bleeding, or if there is any decrease in the baby’s movement

Questions to ask your doctor

Having a scheduled labor induction using artificial rupture of membranes can be stressful. It is common for parents to forget some of their questions during a prenatal office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before the procedure and between appointments.

It is also a good idea to bring a list of questions to your prenatal appointments. Questions can include:

  • Why do I need to have artificial rupture of membranes? What are my other options to artificially induce labor or help labor to progress more quickly?

  • How long will the procedure take?

  • What medications will I need before and after the procedure?

  • What happens once my membranes rupture?

  • What are the risks for my baby and me if I chose not to have artificial rupture of membranes or labor induction?

What can I expect after artificial rupture of membranes (amniotomy)?

Knowing what to expect can help you proceed with your baby’s birth with more confidence.

How will I feel after the membranes are ruptured?

You will feel warm water flow out of your vagina immediately after your membranes are ruptured. It may be a trickle of water or a quick rush. You may also experience menstrual-like cramps or discomfort in your lower back or pelvis if rupturing your membranes moves your labor forward quickly. 

Tell your doctor or care team if you feel sharp pain or something that does not feel right because it may be a sign of a complication.

When will I know that the artificial rupture of membranes was successful?

You should start to feel contractions or a strengthening of contractions after artificial rupture of membranes. This can happen right away or within a few hours of the procedure. This signals that your labor is progressing and that you are moving towards a vaginal birth.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 15
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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