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Stretch and sweeps - The massive mindgame

by lizzi (follow)
Helping plant the seeds of positive birth. www.sproutbirthing.com.au
Birth (105)     
"Will a stretch and sweep help bring on labour so I don't have to be induced?”

“I really want to wait for labour to start spontaneously - will a stretch and sweep make it happen?”

The frequency with which I hear these questions leads me to ask:

Are women aware that there are risks associated with stretch and sweeps?

Why don’t we acknowledge that doing something for the purpose of initiating labour is an induction?

You can’t *make* labour start spontaneously – either you make it start (induce) OR it starts spontaneously. You can’t have it both ways.


So, what is a stretch and sweep? This is a procedure during which the midwife or obstetrician will insert a finger into your cervix and try to “sweep” around, separating the amniotic membranes from the cervix. It is supposed to release prostaglandins into your system, thereby helping the cervix to ripen and, potentially, initiating labour. Yep - they’re every bit as fun as they sound. Having sex will do the same thing, as semen contains prostaglandins and the orgasms (the woman’s!) release oxytocin, so if having sex isn’t putting you into labour it’s unlikely that a sweep will. I know what I’d rather have in my vagina and, even at 42 weeks pregnant, sex was a far more enticing prospect than a sweep (never a better time for multiple orgasms)!!



Stretching
This is the only stretching I want to be doing while pregnant! Image courtesy of Wikimedia Commons.


The physical risks generally associated with membrane sweeping include:

Potential for pre-labour rupture of membranes. This seems fairly obvious to me. Given that the care provider will be poking at the membranes, sometimes quite “vigorously”, there’s a chance the membranes will tear. Or if your care provider is really pushing you to consent to a full induction and you have been declining they may poke a little harder with the hope that the membranes will release.

If the membranes release you and your baby are then exposed to all the risks associated with pre-labour rupture of membranes and AROM. You can learn more about these at: In defence of the amniotic sac


• It is generally accepted that a woman may experience increased pre-labour cramping and extended prodromal labour. This can cause a woman to become exhausted before labour has even established. There are also psychological impacts of this which will be explored further.


• It is generally considered that there may be a small increased risk of infection (there is currently no proof of this link in the data but many women and even care providers consider this to be a risk) – especially if you are having several sweeps done over a short period of time and then continue to have VE’s done during labour and after your membranes have ruptured.


For me though the biggest risks associated with stretch and sweeps are the psychological and emotional ones. The messages that we are sending to pregnant women and the impact these can have on the last weeks / days of pregnancy and the birthing journey cannot be underestimated. The following scenarios are one’s that I have come across as shared by other women.



Stretching
Although I'm not even keen on this type of sweeping...pregnant or not. Image courtesy of Wikimedia Commons.


• A care provider may “suggest” a stretch and sweep at 38 weeks to “see what your cervix is doing and help get the ball rolling” and then advises that the cervix is still completely closed and she’s unable to complete the sweep. The woman comes away feeling dejected as she’s now “going to have to have an induction as my cervix isn’t doing anything”. The main problem with that? At 38 weeks and not even in labour your cervix doesn’t need to be doing anything!! But you are already feeling miserable about the fact that your body isn’t working and are feeling unable to completely enjoy the rest of your pregnancy. Nobody tells you that actually your body is working perfectly and doing exactly what it should be.

• A care provider may suggest a stretch and sweep and advise that “you are 3cms dilated and the sweep will ensure you go into labour any minute now”. The woman walks out thinking “awesome! I’m going into labour any second now. OMG I need to get organised!” Then she calls her birth partner in excitement telling him it will be “any minute now”, gets her bags packed, calls her mother, organises care for her other children. Maybe she develops some cramping (as a result of the sweep) and thinks that “this is it!” When this keeps up for a few days she feels that maybe her body doesn’t work after all? And heck...if she can’t even go into labour WITH help, how on earth is she going to birth her baby without it?

The messages offering a stretch and sweep send to your subconscious are really horrid. A midwife or OB might say “let’s do a stretch and sweep to help you go into labour”. The underlying message is this “You won’t go into labour without some form of intervention. Your body does not work. You need us to save you from this pregnancy and this birth.” Regardless of whether the sweep puts the woman into labour or not she is now heading into the birth of her child with the belief that she can’t do this without help. So the next time an intervention is offered she remembers that she couldn’t even go into labour without help so, of course, she must need more interventions. And just why is it okay to tell women, without a single shred of evidence, that their body doesn’t work?! How is it okay to send these messages to women who are at their most vulnerable? Do care providers even realise what messages they are sending? Do they even care?


So...stretch and sweeps – A common intervention with a big psychological impact. As with any intervention your care provider recommends it’s really important to ensure that you have ALL the information you need to make an informed decision. Knowledge is power and being aware of the risks can really help you minimise them if you decide a sweep is a necessary course of action. Use the BRAIN decision making tool and decide what is best for YOU and your baby. Remember that if you decline you can always change your mind and get it done tomorrow, if you have it done, and something goes wrong, you can’t undo it.

Your body, your birth, your choice, your responsibility.

#Birth

Further reading:

Trust - A crisis in maternity care

Birthing revolution - the fight against cultural conditioning

Evidence based care - No thanks!

Avoiding induction - without eating pineapple!

The final weeks of pregnancy - What will you be doing??

Women's bodies aren't designed for birth...or are they??
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I actually just experienced the exact same thing during mg 39w prenatal check-up. My OB said she will IE to check the progress of my dilation. Then commented I am 3cm dilated and should already consider being admitted. She then said she will donsweep to help contractions. After the process, i informed my OB that since i am not feeling regular contractions, i would rather to observe progress at home. Good thing I did not heed her advise, after 2 days with spotting, i am still not having regular contractions. Just abdominal pain that I associate with the sweepml. I like my care provider, but i think she worries too much for me since thisnis my first time. Good thing I read about gentle birth often to educate myself. And thank you for blogs/articles like these.
Great article.I believe that the precious time at the end of pregnancy is being tainted by the constant pressure to have sweeps and the expiration date of induction. Interesting points too about the messages that sweeps send to women and how this can cause them not to believe in their bodies ability to birth.

Thank you! I am really passionate about the messages that we send women and how language use can affect how we think about birth. I went to 42weeks and 5 days and found that the final weeks were really made less enjoyable by all the meddling and stress.
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