Let’s talk about stretch & sweeps…
“I’m booked in for a sweep on my due date!”
This is a really common comment in the birth world right now. Sweeps are everywhere, but what are they, why would you want one (or not) and do they even work? Let’s dig into this…
What do I need to know about a ‘stretch & sweep’?
Nothing is ever simple. So, let’s start with the facts:
Where? A stretch and sweep (also known as a membrane sweep, cervical sweep or just a sweep) can be done at your normal midwife appointment. It does not have to happen at hospital.
What? Stretch and sweeps are internal: the doctor or midwife inserts their fingers inside your vagina and ‘sweep’ them across and around your cervix. They are a form of induction and can lead to normal, unassisted deliveries but can also lead on to other interventions.
Why? They’re is designed to stimulate the hormones that encourage your cervix to soften, efface (get thinner) and dilate (the first stage of labour)
How many? In the UK, you can have a series of two or three sweeps (with 48 hours between them)
When? NICE guidelines state that sweeps should be routinely offered from 39 weeks (previously this was at 40 or 41 weeks) regardless of whether you’ve had a baby before or not, despite NICE recognising that more research needs to be done into the effectiveness of the procedure.
Know that: while they are very routine, they are also a choice. Your choice. it’s important to weigh up the risks and benefits (see below) when deciding to accept, delay, discuss or decline.
Do stretch and sweeps work?
The thing is, sweeps are designed to prompt a body that’s on the cusp of labour, to go into it and sustain it by itself.
It isn’t designed to make labour just happen.
There are a million factors associated with that, including actual length of pregnancy (not just a guestimate based on the last day of your period), your baby’s stage of development and your own genetic disposition for when to go into labour. That makes measuring the success of sweeps really tricky because the individuals being measured might not be comparable.
But even the data that we do have is tricky to interpret. Thanks to geniuses like Dr Sara Wickham, who decode the research for non-science people like me, we do know that:
Sweeps may bring on the onset of labour by around 24 hours
Statistically, eight women would need to have sweeps for one of them to have a sweep that ‘works’.
This data assumes that ALL pregnant women would be given a sweep… which is not the case.
What are the pros and cons to having a stretch & sweep?
Every intervention was invented for a reason, and stretch & sweeps are no different.
But not everything things suits everyone; only you can weigh-up the balance between the risks and the benefits to decide what’s best for you.
Here are some benefits reasons why you might want to accept one if it’s offered to you:
Drug-free: if you’re wanting to encourage labour to start, this is a medicine free way of doing so.
Works with your body (to an extent): the procedure is designed to encourage your body to release the hormones needed to start and sustain labour.
May avoid formal induction: if it works, having a sweep could help you avoid further interventions or chemical induction methods (especially if you’ve already gone past your due date)
Outpatient option: there is no need to go to hospital for a sweep. Normally, they are done at a community midwife appointment or could be done at home if your midwife sees you there.
BUT there are also negatives and risks to consider when you’re making your decision. Here’s some reasons why you might want to delay or decline accepting a stretch & sweep:
Painful experience: 51% of participants in a Cochrane review said they experienced some pain during the procedure, and 17% said it was very painful.
Infection: as a medical procedure, measures are taken to reduce infection but you’re still having someone’s gloved fingers in your vagina. This means that there is the potential for bacteria, alien to you, are introduced into your body and therefore (when your baby comes through your vagina) your baby too.
Unintended side-effects: some people report bleeding and cramping following a sweep that are not linked to labour. Depending on the severity & duration of both, this may affect medical recommendations and adjustments to your birth plan.
Amniotic rupture: if your cervix is dilated already, and the midwife or doctor touches your amniotic sac, there is a chance that it may be ruptured (breaking your waters) as part of the procedure. This interfere’s with the ‘natural’ physiology of labour and could affect how your labour progresses, particularly if labour is then slow to start (as induction methods would be recommended after 12-24 hours of your waters breaking). It also increases the risk of infection.
Invasive: at a time in your pregnancy (and life) when you need to be tuning into your own body and mindset, an internal examination and procedure may not be the vibe you are looking for. It could offset oxytocin and endorphin production which is needed for an effective labour.
Understanding this area of birth is complex: if you’d like to know more about the research and science, head over to Evidence Based Birth & listen to their podcast presentation of the benefits and associated risks of membrane sweeps.
You know me: there is no right or wrong to this.
What’s important is that you have the reliable and evidence-based information you need to weigh up the pros and cons (for you) and make your own decision.
But this can feel tricky and heavy: if this is the case, why not book a power hour with me? Using all of my doula knowledge, life-coaching experience and thought-provoking questioning skills, I’ll get you feeling confident about what to do next, in only 60 minutes.
