What are your thoughts on AROM?

Specialties Ob/Gyn

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Specializes in Birth center, LDRP, L&D, PP, nursing education.

Reading about vasa previa, and having had 3 patients with chorio in the past month... I'm beginning to be really concerned with my 1 cm, posterior, high, 50% effaced pts having a first AROM attempt.

I've been looking at the research that says AROM is mostly beneficial in speeding up labor in a pt who is 4-5 cm dilated.

OB RN's, what are your thoughts on AROM?

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Specializes in all things maternity.

JMHO but I don't like it when our OB's AROM someone at 2 or 3 cms. :banghead: And to be honest, I prefer to labor moms who are trying to go natural with no unneeded interventions. But I am open to interventions when they are truly needed. Not just cause doc has another commitment and needs to get home early or doesn't want to be up all night. I think women should demand the right to be given time to deliver normally without someone pushing her to hurry. Of course some mama's want to get it over with as quickly as possibly....:p

:balloons:

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Personally I was AROM at 5-6 cm and it made labor much worst. I wanted it to be natural and didn't stand up for myself. ARTIFICIAL was not part of my plan. that bag of water there makes labor so much easier and it will happen when its ready...my 2 cents

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I don't have time to look for the links right now but the "official" answer is that AROM speeds up labor by about 15-20 minutes- worth it?

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Specializes in L&D.

It seems to me a patient like that would be better off with prostaglandin of some sort until she had a better Bishop's score. Do any of your docs use a foley balloon to manually dilate the cervix? That works pretty well too.

Have you noticed how often you get a baby in a persistant posterior position after an AROM when the baby is high? Many many reasons not to do it.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I think it's best off not done until labor is well-established and station is low, for what I feel are obvious reasons.

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Specializes in Birth center, LDRP, L&D, PP, nursing education.

I agree with all of this-- we don't ever use foley balloons on the cervix-- we do use cervidil as a cervical ripener, occasionally cytotec based on Bishop's score. I feel like AROM is done very frequently and very unwarranted. How do we stop this AROM attitude?:heartbeat

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

We use a double-balloon cervical opening device. Like a foley but has 1 80ml balloon for above the cervical os, and another of equal size for below. It is designed to irritate and dilate the cervix. Usually a 4cm cervix will drop the balloon out, much like the foley did in the old days. Once a reassuring strip obtained on baby and mom is stable, she goes home for rest to come back for induction next day. I rather like this MUCH more than cytotec.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

it is the Cook Cervical Ripening Balloon pictured in link below:

http://medgadget.com/archives/2007/07/the_cook_cervical_ripening_balloon.html

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AROM to speed labor is not evidence based. Follow link below to Cochrane Review:

http://www.cochrane.org/reviews/en/ab006167.html

In my opinion, AROM makes it much more difficult for women to stay on top of their pain if they desire unmedicated births, and increases infection rate.

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HATE it as a method of induction. Seems to be the preferred method in my area "AROM/PIT" is the norm. Also hate it as a method of "speeding" up labor. It isn't proven to work. Personally, I wish our OB's would get over the whole thing already, lol.

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Specializes in Birth center, LDRP, L&D, PP, nursing education.
HATE it as a method of induction. Seems to be the preferred method in my area "AROM/PIT" is the norm. Also hate it as a method of "speeding" up labor. It isn't proven to work. Personally, I wish our OB's would get over the whole thing already, lol.

Agreed.

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