Stretch and Sweep..... What You Need to Know!!
So I live in the land of the stretch and sweep from as early as 35 weeks. Yes, you read that right. 35 weeks. Now I am not sure what the logic is here for trying to stimulate your cervix when your baby isn’t even fully cooked yet. Well, except there is no logic here. If for some reason your baby needs to be delivered earlier then this is what induction of labour is for. So let’s just get the information right, the what and when. So that when you are confronted with anything like this you are empowered in to making the best decision for you.
What is a sweep?
A sweep is a procedure performed prior to a formal induction of labour.
Here comes the gory bit…. So your Doctor or Midwife inserts two fingers in to the vagina (basically a vaginal exam). They locate the cervix. If you are not full term or ready to labour, it is very likely your cervix will actually be far back. What we call posterior. So the Doctor or Midwife will reach her fingers round, feels like she’s trying to reach your throat.
Top Tip…. To make this easier before you start put your hands in to fists and sit on them, have them under your bum to tilt your pelvis forward, it can make it easier to reach your cervix. In fact do this for any vaginal examination in early labour or induction of labour! If you have a drip in your hand get the midwife to roll up a towel and it will do the same job.
To perform the sweep the Doctor or Midwife will insert a finger in to the cervix if it is open. A proper membrane sweep can only be performed if the cervix is at least 1cm open. They sweep their finger around the inside of the cervix and try to separate the membranes (the bag of waters) that surround the baby from the cervix. This releases hormones which can encourage labour to begin.
Will it hurt?
Ok…. I am not going to lie. It isn’t nice. It is more painful than a vaginal examination because of the nature of what we are trying to do. It can be more painful if you are not expecting it. Or you have not consented to it. There is no reason your Doctor or Midwife cannot go slowly, use a lot of lubricating gel and just be patient. Tell them to do this! Demand it. But I will be brutally honest….. A good, effective sweep is painful because we want to release the hormones and that is done by the separation of membranes from the cervix.
Does it work?
Well….. it can. Annoying answer I know. Approximately 50% work, 50% don’t. It can reduce your likelihood of going to 42 weeks by up to 40%, if performed at 41 weeks (so a week after your due date). On average, successful sweeps can reduce the length of your pregnancy by 1 to 4 days. But be aware that it doesn’t mean you will go in to labour in 4 days, it means that whenever your body was going to labour, this time can be shortened.
I can say that if you are post dates, fed up, exhausted, accept the membrane sweep if offered, or ask your Doctor or Midwife to perform one. After all, 50:50 odds aren't so bad.
Anecdotally, as a midwife, sweeps are only successful if your body, your cervix is already on its way to spontaneously labouring. This is just my opinion, for whatever that is worth. But many of my colleagues are inclined to agree with me.
Pros vs Cons….
Can be a successful way to induce labour without any major intervention.
Can reduce the length of labour by 1 to 4 days.
Can prevent you going to 42 weeks pregnant.
Can be effective in early labour.
Can be painful.
Often performed uneccessarily.
Can not be performed on a closed cervix.
Can cause bleeding from the vagina afterwards (this is normal and no cause for alarm, but always inform your midwife).
So, why am I writing about this? Well, to be honest, I am sick and tired of women being pushed in to sweeps before they have even had a chance to reach their due date.
Let’s think logically about this. If your Doctor is recommending one before you are even at your due date, then stop and think WHY??? If this is for their own scheduling reasons (I am not being skeptical here, this is a real issue, especially in private healthcare), then this is simply not acceptable. If there is a need to get your baby our for a medical reason, to reach the safest outcome, then a stretch and sweep is not actually the way to do this. Induction of labour is. And I am by no means suggesting declining induction of labour if medical intervention is the best solution and you have been given all the correct information to make an informed decision.
The truth is, in a low risk pregnancy, there is no reason for anyone to be sticking their fingers anywhere unless you are concerned your waters have broken or you think you are in labour, are having an official induction of labour or there is any deviation from normal. Doctors and Midwives should keep their fingers to themselves unless clinically indicated.
According to NICE guidelines (followed in the UK) the evidence suggests that with your first baby, in a low risk pregnancy, a sweep should be offered at 41 weeks gestation. And in subsequent pregnancies, again, low risk, a sweep can be offered at 40 weeks. This is high quality, up to date evidence. The NHS runs off it. However I am well aware I do not work in the NHS anymore (cue small tear running down my cheek and many happy memories) but what I do know, is that every Doctor should use the best evidence based practice in their care. Not their own anecdotal evidence, but solid research that has shaped international policies. So it is perfectly within your rights to question everything!
Questions to ask your Doctor:
So let's say your Doctor is suggesting a sweep for you prior to your due date, you have a low risk pregnancy, there is no apparent reason to encourage labour to begin before it is due to and you are not 100% convinced this is the right path for you. What do you ask?
I am not at my due date. WHY do I need this sweep?
Why can we not wait until I have gone over my due date?
What is your reason for suggesting this course of action over an induction of labour if you are trying to encourage labour?
If everything is normal can you leave me to labour spontaneously?
Can you show me the evidence for suggesting I have this as a method of induction? (If they say baby is "small", then growth scans and graphs should prove this. If they say the "placenta is calcifying" then an ultrasound doppler should assess the blood flow)
Can I think about it? (If you are not comfortable do not feel you have to say yes on the day, take your time and think it over)
Can I have a second opinion? (Absolutely your right!!)
Remember ladies, take control of your body, of your pregnancy. Know what is happening to you before you consent. Do not be bombarded or scared by medical terminology. Take a step back and have time to think. If you have any questions on this, feel free to drop me a message. And remember.....
NO DECISION ABOUT ME, WITHOUT ME.