A Midwife’s Muse

We are now halfway through December, and only 4 of the 20 babies in my caseload due this month have been born, looks like Christmas week is going to be busy. I saw two of the post dates Mums at clinic yesterday, I’m quite hopeful that one of them will have baby over the weekend but the other one is giving no signs of baby putting in an appearance anytime soon. I have arranged to go round to their homes on Monday to do stretch and sweeps to try and  ’stir things up’, here’s hoping that they either beat me to it, or that a little ‘old fashioned’ (now in vogue) midwifery does the trick.

Even the NICE guidelines concerning induction of labour recommend ’sweeping the membranes’ -

Membrane sweeping

This has been shown to increase the chances of labour starting naturally within the next 48 hours and can reduce the need for other methods of induction of labour.

Membrane sweeping involves your midwife or doctor placing a finger just inside your cervix and making a circular, sweeping movement to separate the membranes from the cervix. It can be carried out at home, at an outpatient appointment or in hospital.

If you have agreed to induction of labour, you should be offered membrane sweeping before other methods are used. The procedure may cause some discomfort or bleeding, but will not cause any harm to your baby and it will not increase the chance of you or your baby getting an infection. Membrane sweeping is not recommended if your membranes have ruptured (waters broken).

Reports concerning success rates vary, but it would appear to be between 60% and 78%. However, reading the studies the timing of the proceedure varies widely, with some studies initiating ’stripping membranes’ at 36 weeks and many of the others involving women whose pregnancies were not yet post dates. It is noted that the efficacy depends on the cervix being ‘favourable’, soft, stretchy and 1-2cms dilated. To me, this ‘favourable’ aspect means that the pregnancy should be at least at term, 40 weeks. The guidelines at our Trust suggest that the woman should be 41 weeks pregnant, in other words 7 days past her EDD when we do a stretch and sweep and, on the whole, I follow the guidelines because I have found that this is when a stretch and sweep appears to work. If it has not been successful I will then arrange to repeat it 48 hours later and, looking through the results, I have a 70-80% ’success’ rate. Who knows though, these women may well have gone into labour without my actions, it is impossible to judge really.