Cervical Dilation & Membrane Rupture During Labor: What You Need to Know

Question
During childbirth, if the cervix is fully dilated, but not engaged yet, should the membrane be ruptured? If wait, how long should it be? thanks.

Answer
Usually, the baby is "engaged" by the time you go into labor. It may have to travel down towards the vagina a bit more and you may have to push for awhile to get it down. However, engagement has nothing to do with cervical dilatation. Once you are fully dilated (10cm) you can start pushing. By then, your membranes should have been ruptured. I usually rupture the membranes as soon as the cervix is dilated enough to get an instrument into the cervix. I usually break the water at 5cm diltation. That enables me to see the color of the fluid and it enhances progression of labor. Once you are fully dilated, there is no reason to avoid rupturing the membranes.