What should you do if the amniotic sac has not ruptured upon delivery?

• A. Wait for it to rupture naturally
• B. Remove the sac manually
• C. Push the sac back inside
• D. Poke a hole in it

Answer: (D)

When the bag of waters remains intact at delivery, you need to create an opening so the baby can breathe and the birth can progress. Rupturing the amniotic sac by puncturing or tearing it gently with a sterile gloved finger (creating a small opening) is the appropriate action. Once the opening is made, continue with delivery and peel the sac away from the infant's face as needed, then clear the airway if fluid is present and suction if necessary.

Delaying rupture by waiting for natural rupture can obstruct the airway and slow delivery, which risks the baby not receiving enough oxygen. Pushing the sac back inside or trying to remove it completely before birth isn’t helpful and can complicate the delivery. Creating a controlled opening to break the sac is the correct, practical step.