I used to think it dind't do anything. It never did anything to ME. Then I saw a client get an irritable uterus for 20 hours, become exhausted, and end up with all sorts of interventions (epi/pit/arom at 2 centimeters) and finally end up with a cesarean.
Then last week, I saw it send an overdue mom hoping for HBAC go into a (longish-but-tolerable) beautiful labor pattern.
Looking for pros and cons. Discuss. (no client involved here, just learning about it now.)
I've seen it do nothing, and I've seen it appear to "work" but result in long labors.
Risk assessment is key here.
Stripping the membranes poses the risk of ROM, as well as ascending infection. Any bad bacteria in the vagina will be introduced directly into the uterus. Which is why a woman who is GBS+ should never have her membranes stripped, and even better no vaginal exams prior to labor and minimal exams in labor, especially with ROM.
As for pros, I can't really think of any solid ones. It "might" push someone over the edge into labor, but then again it might just cause a uterine infection or cause ROM and put a woman on a time clock.
It's certainly not one of those "Can't hurt, might help" kinds of interventions.
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I have heard from a reputable midwife (whom I love, and who has been documented in many a lovely midwifery text, lol) who was a homebirth midwife for YEARS before getting her CNM and stepping into the hospital, that ROM *COULD* happen, but in her 25+ years of practicing she has never had it happen. But she is also "not committed" to a particular procedure if no reason is warranted -- if parents want to have it done, she will do it -- if not, she leaves it alone.
I have heard from a reputable midwife (whom I love, and who has been documented in many a lovely midwifery text, lol) who was a homebirth midwife for YEARS before getting her CNM and stepping into the hospital, that ROM *COULD* happen, but in her 25+ years of practicing she has never had it happen. But she is also "not committed" to a particular procedure if no reason is warranted -- if parents want to have it done, she will do it -- if not, she leaves it alone.
I think it "accidently on purpose" happens way more than it happens "on accident." If you know what I mean.
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my personal experience is that for my first birth it didn't do a thing.
for my second birth it didn't do anything but the next day my water broke. of course then the clock started ticking for me and i didn't go into labour for 48 hours which caused me all sorts of stress as the midwives were threatening to make me have a hospital birth/induction if labour didn't start on it's own.
a few weeks after that birth i read a study that indicated that membrane sweeping can significantly increase your risk of water breaking prematurely. after my experience i wouldn't choose to do it again.
I had my membranes stripped to no avail as well. It DOES cause your body to release prostaglandins, though, and every time I had mine stripped, I had cramping, aching, and HOURS of miserable contractions that did nothing...even though I was 40 weeks with the first and 41 weeks with last stripping attempt with the second. Both were born about a week after the stripping.
If I had it to do over again, I would say that the last few weeks of pregnancy are miserable enough and if they want to tempt more misery and prodromal labor on the off chance they *might* get things started...Go ahead, but they may be sorry, and VERY discouraged when they have all those contractions and no change... If I ever have another baby it will not be done unless there is an unavoidable induction, in which case stripping might aid the induction in "taking" since it can prepare the body for an imminent birth. But if they aren't being induced and waiting to labor naturally, it is a roulette of sorts.
I had mine stripped with DD and it did send me into labor that night and I had DD 22 hours later by c-section. I still don't know if it was a good idea or not, but I'm leaning towards not. I don't think DD was in a good position yet. I know of several women who it did nothing for though.
Liz
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What are the reasons caregivers give for doing this in the first place, and what is the actual procedure?
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Some sample reasons:
"Let's just give your body a nudge toward labor"
"This is gentler that pit, and just might work, and since your due date is tomorrow and I don't like having moms go overdue"
"If you don't birth by 42 weeks, I can't provide care for you at home/birth center any more, so let's do everythign we can to make sure that doesn't happen."
"You're sick of being pregnant? I can strip your membranes and we'll see if that helps"
and last, but certainly not least (this is my "favorite")
"I start stripping the membranes of all my patients at each visit starting at 37 weeks. I've found it greatly reduces the number of inductions I have to do."
The procedure (knows as stripping the membrance, sweeping the membranes, or a stretch-n-sweep) involves the care provider inserting a finger through the cervix, between the cervix and the amniotic sac, and moving it around full circle to loosen the sac from the cervix all the way around. They also manually try to stretch the opening of the cervix. The goal is to provide enough irritation that the mom's body will respond by producing prostaglandins, which may help ripen and soften the cervix and/or cause contractions.
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The reasons for clients having it done were not compelling to me, but I have had two clients have successful vaginal deliveries after stretch/sweep - however, they were both very soft, forward and beginning to open. They were also done by midwives who TOOK THEIR TIME and were very gentle. From the reading I've done, this seems to be the most important factor - if mom is closed, anterior and rigid, and if the caregiver is not experienced in gentle, slow sweeping, the risks outweight the benefits. There are less risky ways to ripen a cervix (like leave it alone perhaps...) if a mama is being threatened with a hospital induction, but that's my opinion.
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Often women get theri memberanes swept and they aren't even made aware of it -- it just seems like an aggressive vaginal exam.
I had this happen to a client (where I actually forewarned her it could happen -- we were talking about why she might want to refuse a VE). I make the point with clients, that during a VE, we don't really know what a practitioner is doing, you know? How are we supposed to know what checking a cervix is supposed to be like? She had an appointment, and like I said, I don't like to get all conspiracy-theory, but we did chat about it. After her appointment she called (about 5 hours later) to let me know she was bleeding a bit, and she was worried. I asked her about her appointment and if her doc swept her membranes. She said he didn't. She called the office, the receptionist asked, "How many weeks are you?" When my client replied 38, the receptionist said, "It is very common for women to spot after having their membranes swept." I was glad I never had to be the one to put the pieces together, I just gave her the pieces; had her doc not swept, she would have not needed to piece it together.
I had another client (where I gave the same spiel about VEs) who came back to say, "Dr. P asked if I wanted him to 'massage' my cervix. That stood out to me because of what we had just talked about. I told him I didn't want anything extra, like sweeping the membranes, done -- I just wanted my body to decide when it was ready."
In hindsight, isn't a male doc asking a female patient if she 'wants' him to 'massage' her cervix kind of creepy?
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Pros:
May produce more prostoglandins helping to soften the cervix.
May help mom avoid an induction.
May keep mom from being labeled high risk for post dates..
May make the dr. or the momma feel like "something is being done" which is sometimes a benefit.
Cons:
Water may be broken though I've never heard it done accidently.
Bacteria may be pushed further up.
Not to be done with GBS positive women.
Ok I did that off the top of my head, then came to the conclusion that we need to get back to what the research says and keep clear of anecdotal reasoning. When clients ask us, we need to tell them what the evidence says not what happened to us, or what happened to such and such client. So here is one.
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