Should I have a stretch and sweep?
Towards the end of your pregnancy the midwife takes your blood pressure, uses a dip stick on your wee, everything is fine and as she leaves she says in a casual manner, 'let's book you in for your stretch and sweep next week, OK?'
You nod, smile and the midwife leaves.But what have you just agreed to?
According to the NHS website informed consent is:
"Consent to treatment is the principle that a person must give their permission before they receive any type of medical treatment."
For this consent to be valid it must be voluntary and informed and with capacity. That means there must not be coercion on the part of medical staff, friends or family. You should be in receipt of all the facts about the procedure and you should have the mental capacity to make a decision this includes being able to refuse any intervention or procedure and this decision should be respected.
In order to gain consent for a sweep a midwife should firstly explain what it is. You can not give informed consent for a procedure if you do not know what it involves.According the the Royal College of Midwives a sweep should involve the following:
• The midwife will re-explain the procedure before she starts and explain that it will take approximately ten minutes
• The woman will be encouraged to undertake relaxed breathing techniques if any discomfort is felt
• The woman will be asked to empty her bladder and remove her underwear
• The midwife will use a sheet or throw to cover the woman protecting her dignity
• The woman will be asked to lie on a couch or bed, with her hands at her side. A tilt may have to be placed under the mattress or cushions on the maternal left side to prevent supine hypertension
• The midwife will perform an abdominal palpation, listen to the fetal heart rate and document all findings. If there is any deviation from the normal, the midwife will refer the case to an obstetrician and the procedure will be abandoned (NMC, 2004)
• With a gloved lubricated hand, the midwife will perform a vaginal examination and ascertain if the cervix is favourable for the procedure by assessing cervical effacement, consistency and dilation.
If the cervix is unfavourable, such as uneffaced and high, the membrane sweep may have to be delayed or abandonedo If the procedure is abandoned, the midwife will make arrangements for induction of labour as per local trust guidelineso If the cervix is closed but soft, the cervix may be massaged until it allows insertion of a finger
If the cervix does not open, the effects of massage around the vaginal fornices may be enough to stimulate the release of prostaglandins and stimulate labour
If the cervix is determined as favourable for labour stimulation, the midwife will begin to insert one finger into the cervix. The finger will be used to separate the amniotic sac from the uterine wall and cervix by making circular, sweeping movements.
• A sanitary pad will be applied after the procedure
• The woman should be advised to have a warm bath and to take paracetamol for any discomfort or painful contractions
• The woman and her partner should be advised that if there is any fresh blood loss, spontaneous rupture of membranes or the woman is not coping with the pain that she should attend the maternity unit
• There is no available evidence to determine the frequency with which membrane sweeps can be repeated, but a sensible suggestion is that they can be undertaken every three days
• The midwife will arrange for a repeat membrane sweep if labour has not started within the timeframe agreed with the woman and according to local trust guidelines
• If labour does not occur spontaneously then the midwife will arrange for formal induction of labour as per local trust guidelines.
All this should be explained to you along with the potential risks as well as evidence for the benefits in order for you to make a fully informed decision about whether to consent. Sometimes it can feel like you are unable to ask the questions you want or you feel you didn't get a chance to properly make a decision.
If you feel you'd like more time, take it! You can simply say,'I am unsure about what to do for the best, can I have some time to think about it please?'
This is polite and easy to remember and gives you the chance to get your breath and do your research about whether you want the procedure or not. For more brilliant phrases on assertiveness take a look at Mary Cronk in this blog post from Birth Joy.
So back to the sweep, what do we know about it?
It might or might not work,It may or may not be painful,It might or might not break your waters and introduce infectionThe thing with a sweep is that IF your cervix is favourable (moving forward, softening, opening) the sweep will 'work' but you are more than likely going into labour anyway.
Having a sweep may bring on irregular contractions which you and your body are not ready for and only serve to tire you out.IF your cervix is not favourable (high, facing back, closed) then the sweep probably won't work, probably will be painful if it is not abandoned and you may feel disappointed in this result.
I am not a midwife and this is not medical advice. I am passionate about advocating for your right to chose what happens to your body and your baby during your birthing day by helping you prepare.
Further Resources:"There is no allowed...." https://www.newerabirth.co.uk/3/post/2013/09/there-is-no-allowed.html
Birth Rights – Respect for your human rights in childbirth https://www.birthrights.org.uk/