This is part 2 of our Common Interventions discussion. Check out our part 1 (here) where we discussed IV fluids and continuous fetal monitoring. For part 2, we’re going to take a look at AROM and IV Pain Meds. If there are other interventions you’d like more information on, let us know!
AROM or Artificial Rupture of Membranes is a common intervention that is typically used to speed up the labor process. There are risks and benefits associated with AROM, and AROM may be offered up in any birth setting (ie, hospital birth, home birth, birth center). AROM is when the provider uses an amino hook to release the bag of waters. The actual act of opening the amniotic sac to release the amniotic fluid is generally not painful or uncomfortable, but it is often done in combination with a cervical exam.
The amniotic sac/fluid acts like a cushion between baby’s head and the cervix. This cushion often keeps labor tolerable and manageable. Once that cushion is gone—either through rupturing on its own, or via AROM—baby’s head applies direct pressure to the cervix and can cause more intense contractions. This is great for labor progress, but can be difficult to manage mentally or physically. Once that cushion is gone, the intensity goes up pretty quickly, usually with in a few contractions. You have to be in a good headspace in order to tolerate this quick uptick. If you have an epidural that is working well, you probably won’t notice much of a change.
Once your water breaks, there is a risk of cord prolapse. This is a true emergency situation and would very likely result in a STAT c-section. A cord prolapse happens when the amniotic fluid is released and the baby’s umbilical cord drops down below baby’s head and begins to come out through the dilated cervix. Because of this risk, some providers may not want you to be out of after your water breaks. To lessen the chance of cord prolapse your baby should be low, so once they perform AROM, baby’s head will act like a cork and block off the cervix. Your provider should explain these risks to you, and inform you of your baby’s station (or position) to ensure safety.
If your provider wants to break your water you can consent to it, you can ask them to tell you the risks and benefits, and/or you can ask for more time so you can think about your options. Hearing “this will speed things up” can be music to your ears when in the throws of labor. Be prepared for things to intensify if you consent to AROM.
IV Pain Meds
After AROM, labor may be too intense and you might be wanting something for a bit relief. IV pain meds are an option for pain management while in labor, but have their own set of risks and benefits. Some common medications used are Nubain, Fentanyl, Morphine, Stadol. These medications are administered through your IV line and typically start working within minutes. IV pain meds can be a great option for someone who needs to rest, but doesn’t want an epidural. These pain meds do not take the pain completely away, they just take the edge off and they last for about 2 hours. You can, typically, get a few doses as long as you aren’t close to delivery. Because these meds enter the blood stream, they can make your baby sleepy. Giving them too close to delivery can cause baby to have difficulties breathing immediately after birth.
Once the pain meds wear off, you may feel loopy or like you are hung over, and you may not be prepared for the contractions that follow. We know over the course of labor, contractions get closer together and stronger. If you receive a dose of IV pain meds and don’t really feel the contractions for two hours, you may be unprepared for their intensity once the meds wear off because you didn’t spend those two hours experiencing a gradual increase in intensity. IV meds are a tool that can be used to get some much needed rest, but there are potential downfalls or risks—as there are with any intervention.
We like to remind clients that this is your journey. You should be the one to call the shots and decide when an intervention or tool is used. As doulas, we can’t and won’t make decisions for you, or speak on your behalf, but we do encourage you and your partner to speak up and use your own voices. YOU are your own best advocate. Having a doula in the room with you who believes in you and holds space for you can make a huge impact on your birth experience.