Artificial rupture of the membranes

During an examination, a small instrument called an Amnihook is used to nick the membranes in front of the baby's head - it looks very much like a crochet hook. This is also called an ARM or artificial rupture of the membranes.

Once the membranes have gone, it is usual to start oxytocin to get the contractions started. Sometimes, particularly if you've had several babies before, your obstetrician may suggest you get up and about for a couple of hours to see if you start contracting on your own.

If it's your first, there's little to be gained by waiting and oxytocin is started.

My Cervix is Still Closed or 'Unfavourable'

For the main part of pregnancy, your cervix is thick, long and closed, like a cork, helping keep the baby inside. As you approach term, the cervix progressively softens, shortens (effaces) and starts to dilate.

This is what all those prelabour contractions are about. Also, your cervix releases some hormones locally, called prostaglandins. These are responsible for the changes described above.

If you go to be induced and your cervix is still thick and/or closed, you will most likely have a prostaglandin (Prostin) gel or pessary inserted. This brings about these changes, making it possible to rupture the membranes. The gel typically takes about 6 hours to work.

Some hospitals put the gels in at night, then re-assess you in the morning. Some start in the morning and try and get you started at tea time.

Using the prostaglandin gel makes your labour much more natural if the cervix is thick. It certainly reduces the number of caesarean sections, which used to be associated with inductions of labour in women with an unfavourable cervix.

Sometimes, it is necessary to use more than one gel treatment before ARM is possible. Many women start contracting and go into labour a few hours after having the gel.

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