ARM during induction of labour

A midwife or doctor makes a small opening in the amniotic sac during a vaginal examination. It is generally offered when the cervix is open enough to reach the membranes and the baby's head is in a suitable position.

You are usually positioned for an internal examination. The clinician uses a slim sterile instrument to catch and open the membranes; you may feel pressure or discomfort, followed by a warm trickle or gush of fluid. The fluid's colour and the baby's heartbeat are checked.

ARM cannot be reversed once the membranes are open. Contractions may start or become stronger, but labour does not always establish. If needed, oxytocin may be offered through a drip to stimulate contractions, with monitoring adjusted to your clinical situation.

Before agreeing, ask why ARM is recommended now, what alternatives are reasonable, how your baby's position has been assessed and what monitoring is planned. Tell the team about bleeding, unusual pain or anything that has changed since your last examination.

Afterwards, use a maternity pad rather than a tampon and tell staff if the fluid looks green, brown, bloody or has an unpleasant smell. You may be encouraged to change position or move if monitoring and your condition allow. Discuss pain relief early because contractions can intensify.

Further decisions depend on contractions, cervical change and the wellbeing of you and your baby. Induction can include several methods, while caesarean birth may become the safer recommendation if concerning findings develop or labour does not progress.

Tell the maternity team straight away about fresh or heavy bleeding, constant severe abdominal pain, feverishness, feeling faint, reduced baby movements, or fluid that is discoloured or smells unpleasant. These signs need assessment regardless of how labour is progressing.

If your waters have been broken and you are away from the maternity unit, contact the unit urgently if you feel or see something in the vagina, as this could be the umbilical cord. Call emergency services and avoid pushing it back while awaiting instructions.

Ask what finding makes ARM appropriate, whether a membrane sweep or cervical-ripening medicine has a role, and what happens if contractions do not begin. Clarify your pain-relief choices, how the baby's heartbeat will be observed and which developments would prompt oxytocin or a caesarean section.