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Guideline – Amniotic sac

Do not open it routinely

The amniotic sac protects the baby during pregnancy and also during birth.
If the birth is progressing normally, the baby's water should not be opened routinely. Neither should labor medications be given and the amniotic sac be opened at the same time. This combination to speed up birth should no longer be done routinely. Active opening of the amniotic sac (amniotomy) should be considered only if staff believe the birth is progressing too slowly. The procedure is intended to help overcome this delay. The woman giving birth should be informed about the procedure and the consequences of speeding up the birth process (7.36 ff) (16).

What do studies say? The time allowed has to do with economic aspects. Proven risks associated with the voluntary opening of the amniotic sac led to the decision to refrain from this routine treatment from now on.
kinderrechtsverletzungen titelbildWhat is the baby's amniotic sac good for? What can happen if the amniotic sac is opened intentionally? What should women/parents look out for when registering at a clinic? Iris Eichholz (12): "Amniotomy is the deliberate opening of the amniotic sac with a finger or a pointed hook by a doctor or midwife. The two membranes that form the amniotic sac consist exclusively of fetal tissue. They surround the child during the entire pregnancy ...

The amniotic fluid contained in it protects the child from mechanical impact, allows the child to move and practice the functions of its organs by swallowing the amniotic fluid as well as first breathing movements. Intact membranes protect the child from rising germs and thus from infection.

The routine opening of this well-protected space leads to unnecessary risks for the child ... The time guidelines for how long the respective stage of labor may last are based on the observation of births whose course was manipulated, for example, by amniotomy, use of synthetic oxytocin and forced pushing.

Knowledge of physiological birth ... is increasingly lost in the process. As a result of the destruction of the natural barrier between the amniotic cavity and the outside world, the risk of infection increases for the child due to germs rising into the amniotic cavity ... The sudden change in pressure can provoke a malposition of the child's head, which can lead to a birth arrest ... The increase in pressure on the child's head can lead to a change in the child's heart sound pattern, which may result in further interventions. Routine amniotomy without medical indication poses an avoidable risk to the health of the child."

(12) Eichholz, Iris: Violation of the Rights of the Child, Page 5. 
(16) These numbers refer to the location in the abbreviated version of the guideline "Vaginal Birth at Term."

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