June 04, 2003

"Sweeping" the cervix

During the Birmingham workshop yesterday, we discussed the many blocks that stand in the way of normal births occurring. Unit policies always features high on this list, and many maternity units are still using outdated guidelines that are not evidence based. One of the policies that always rankles midwives is the unit’s approach to post-date pregnancies and the resultant guidelines for induction of labour. Everyone knows that an induction is the start of the cascade of intervention for many woman. Reducing the rate of induction would be a quick way to reduce the numbers of caesareans, since an increasing reason for a surgical birth is “failure to progress”.

I was therefore very shocked to hear of midwives being encouraged to “sweep” the cervix either at the end of pregnancy or in early labour in order to “bring induction rates down”. Apparently the National Institute for Clinical Excellence (NICE) recommends this procedure! This is perhaps not surprising, as the NICE body is controlled by obstetricians. Other NICE recommendations have already been challenged as non-evidence based and one would have to wonder where this hair-brained idea sprang from.

What on earth are midwives doing, “sweeping the cervix”? Have they seriously thought about the implications of this procedure? This is a very invasive, painful and potentially risky procedure, and one that could be interpreted by many women as a physical assault. I appreciate that midwives may think that sweeping the cervix may avoid an induction, but why are so many women being induced in the first place? Surely logic suggests that the way to reduce induction rates is to reserve this procedure for only those cases where clear medical indications (not a date on a calendar) indicates the baby would be healthier if born. A careful selection process would return the induction rate to a more justifiable rate if under 10%. Midwives must learn to say “no” to unnecessary inductions and to use their professional judgement to argue against this procedure.

Subjecting women to physical abuse, especially at the hands midwives, is shameful and must be discouraged. This is an issue I will be exploring further as we travel around - another challenge for midwives!

Posted by andrea at June 04, 2003 05:33 PM

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