The Relationship Between Amniotomy, Provider Type and Caesarean Section in a University Medical Centre

Peter G. Johnson, CNM, PhD Vandy Wiencek, RN, SNM

ABSTRACT
An active management of labour protocol that includes amniotomy has been widely promoted as a means of reducing a rising Caesarean section rate. However, evidence does not consistently demonstrate the effectiveness of amniotomy in promoting vaginal birth. This study explores the relationship of amniotomy, and the time at which amniotomy is performed, with the mode of delivery in term primiparous women admitted in active labour to a university teaching hospital. The study also explores several variations in practice between faculty-supervised resident physicians, community physicians and hospital-based nurse-midwives that the authors believe may confound the study findings. Selection criteria were designed to eliminate study bias. Records of 258 women delivering between January 2000 and December 2002, that met the selection criteria, were reviewed. Findings suggest that women receiving amniotomy are more likely to deliver via Caesarean section. Results also demonstrate that women ruptured prior to three centimeters are at higher risk of Caesarean. A comparison of records of cases attended by midwives and physicians suggests several significant differences in labour management including decreased use of amniotomy and amniotomy later in labour. These differences between medical and midwifery management may provide insights into interventions leading to promotion of vaginal delivery.

KEYWORDS
pregnancy, Caesarean (OB), labour stage-first, obstetrics, midwives

This article has been peer-reviewed.