April 12, 2004

Cervical sweeps

Over the Easter holiday I have been having a lovely quiet time catching up on my reading. I always seem to have a pile of midwifery journals waiting to be read, and for once, I am determined to reduce this pile to zero.

One article caught my eye. It described the British NICE (National Institute for Clinical Excellence) guidelines that recommended that once a woman’s pregnancy has passed 40 weeks , she should have her membranes swept to encourage cervical ripening and perhaps initiate labour. This involves a finger being introduced into the softened cervix and then circled around inside, between the membranes and the wall of the uterus. The aim is to loosen the membranes and at the same time, to stretch the cervix. It is thought that this will help the “ripening” process and perhaps reduce the necessity for an induction, a procedure with well documented adverse effects for mother and baby.

As a result of this recommendation (not based on any solid research, as I understand it), many midwives in Britain are now performing this invasive procedure in prenatal clinics. Although it may help avoid an induction, there are also risks, mainly of accidental membrane rupture, infection and bleeding. In addition, it can be painful for the woman, not to mention potentially threatening. Many women would interpret this as a gross invasion of personal space, and find it deeply distressing.

I remember many years ago (25 plus years), during my first visit to Darwin, hearing of the local obstetrician who routinely performed “strip and stretch” manoeuvres on all the women in his practice from 38 weeks onwards. His proud boast was that he rarely needed to induce any labours. The midwives, however, reported that many women would call the hospital in tears, complaining of pain and bleeding after each prenatal visit. In those days, the idea of “informed consent” was sketchy at best, and these women didn’t know that this was what was being done to them - they thought they were just having an “internal” done. This obstetrician has now retired, but on subsequent visits, over many years, I heard the ongoing saga of this abuse of women and their bodies.

Why are midwives now being coerced into performing this invasive, painful and unnecessary procedure? To an outsider, a “cervical sweep” looks a lot like sexual abuse, and it is certainly physical abuse. Midwives should think carefully before falling for the obstetricians (NICE) guidelines that clearly are not based on woman centred care, but obstetric and hospital needs. The basic tenet still applies to midwives: “First do no harm”......

Posted by andrea at April 12, 2004 10:05 AM

Comments

I note that you write 'to an outsider this looks like sexual abuse'.

Indeed sexual abuse does include (among other things) touching a woman's genitals without her full informed consent. Sexual abuse occurs when people use emotional blackmail to coerce people to 'consent'. Sexual abuse may also occur when people abuse their positions of power in such a way that a person feels they must give 'consent', or pretend to consent. These definitions are fully recognised within our legal systems, and within society as a whole.

Based on these definitions, it appears to me that some midwives and obstetricians are indeed committing sexual abuse. They may have practices which do not involve full informed consent or they may use their positions of power to coerce, threaten or even force women to comply with their wishes. they may use emotional blackmail such as suggesting or exaggerating danger to the baby if the woman doesn't comply, or subtle blackmail such as disapproval or withholding of help.

As a volunteer counsellor of women who have been traumatised by birth, and in a past role as a consumer advocate, I have heard many stories of sexual abuse. This includes:
-the benign sounding 'pop up there while I do an internal';
-offensive sexual innuendos and jokes;
-comments like 'you don't want a dead or sick baby do you' to a woman who was refusing internals and instrumental delivery;
-women requesting no internals being treated with ridicule, disbelief, scoffing or being told 'that's not possible' (oh, how many rapists claim that it was 'just not possible' to stop)and
-women being bullied and coerced into intimate invasion, including being physically restrained.

And having worked in the past with sexually abused women, I am struck by the similarities between the language used by some maternity service providers and that of rapists.

This all appears to be done with the best of intentions, and in blissful ignorance that these actions are not consented to and are harmful. Likewise many peadophiles claim that their actions do no harm, that children do consent and many peadophiles act as if their greater power gives them the rights over the bodies of vulnerable human beings.

It appears that a significant number of maternity services professionals do not see birthing women as sexual beings and certainly not beings of equal power to themselves, therefore they are able to get away with thinking that their actions are not sexual abuse.

It is also important to note that many women do not know that they can refuse an invasive intervention because this is not explained to them. One woman I spoke to had been given 'at least' fifteen internals in three hours because the students were lining up to 'do her' as they put it. She had no idea she could refuse. An interesting parallel can be made with child sexual abuse, or spousal rape. Many children do not know they can refuse. Some wives do not know they can. However, legally and morally, this does not mean that sexual abuse has not occured.

I think it is time to call these actions what they are: sexual and physical abuse, to name the perpetrators as abusers. Maternity service providers treating women in such a manner could perhaps be reminded that ignorance of, or disagreement with what constitutes sexual assault has never been and never will be a legal or moral defence against sexual abuse.
Kate McMaugh

Posted by: Kate McMaugh on April 17, 2004 04:41 PM

Comments

Hi there,
I just wanted to share my experience on this topic. I had a cervical sweep at 40 weeks. I was told what it was (thankfully) before the proceedure, but it was the most painful thing I have ever experienced. I had a 14 hour labour with no drugs and the only pain I remember throughout the whole period was the sweep that I had. My son died during labour (with no reason given). I'm confident that the sweep was not a factor - but sadly for me, I have this burnt memory of a pain that was in no way cathartic - it just felt wrong.

Jess

Posted by: Jessie Williams on April 17, 2004 10:10 PM