September 23, 2004

the cervical sweep - a "natural alternative" to induction?

I spoke to my former neighbour today. She is four days overdue with her second baby and as I was present for the birth of her first baby, we have kept in touch throughout this pregnancy. She has been having building work done at her house, and this has been stressful and worrying and this could be the reason why she is holding onto her child - she is still not feeling really settled after all t he upheaval she’s had in the last couple of weeks.

She is booked into the local birth centre this time, which she has so far found to be a very satisfying experience. At her check-up yesterday, the midwife, noting that she was now overdue, suggested that she come in for a cervical sweep in 3 days time, to attempt to get labour started on its own. My neighbour has always avoided medical interventions of all kinds and so asked the midwife for details about this procedure, which she had never heard of.

She was told that is was a “completely natural” was of promoting labour and in response to a direct question, stated that there was no risk to her or her baby. I was speechless when I heard this, and angry as well. I explained exactly what this cervical sweep entailed - inserting a finger inside the cervix and circling it around between the amniotic membranes and the wall of the uterus to lift the membranes away from the uterus and cervix. My neighbour said that she had not understood exactly what would be done and was surprised to hear what it involved.

The midwife had said that the procedure was “uncomfortable” but many women have reported it as quite painful. The insertion of finger (or an instrument) into the cervix requires some dilation to be undertaken and depending on the way this is done, it can cause pain. I also explained that she would probably bleed a bit afterwards (something else she wasn’t told). There is also the risk of introducing infection into the uterus and of causing the membranes to rupture prematurely.

There is some evidence that this procedure (also called a “stip and stretch”) may shorten pregnancy and encourage labour to start. However, to describe it as “completely natural” is unworthy of midwives and dangerous misinformation. Putting anything into the cervix in this way is far from natural, and will inevitably carry risks.

I have noticed that midwives are now promoting this procedure because they see it as less risky than an induction, which is a well known starting point for the cascade of intervention. Some women may experience a procedure like this as a form of rape, and it may evoke considerable anxiety, especially is a woman goes home in pain and bleeding.

I explained the risks to my neighbour. She knows her baby is well and she herself is in good health. She also knows she could be out in her dates. I have suggested that instead of submitting to this interventionist technique, she find ways to calm herself and get over the trauma of the home repairs - a massage, quiet dinner with her husband, picnic in the park, or whatever else takes her fancy. The baby will come when it is ready and her body is ripe for action. Why do some midwives suddenly start acting like “pregnancy police” and reading the riot act when quite the opposite would be a far more woman friendly way of achieving the desired labour? A cervical sweep is a medical technique, dreamed up by obstetricians and should not become the province of midwives.

Posted by andrea at September 23, 2004 04:33 PM

Comments

I agree that this proceedure should not be carried out without the woman making a truely informed choice.I do offer a cervical sweep to the post term women in my care, and the majority of the time it is performed by maternal request, however, I always insure that they are aware that it may only be sucessful in 1 in 7 cases where formal induction may be avoided. I also explain that the proceedure may be uncomfortable, and for some painful and that I will stop at any time the woman wishes.I believe that this applies to only only a small number of women in my care, and I would like to think that by 40wks + the majority of these ladies are prepared both physically and emmotionally for the birth of their babies and that they have enough confidence in their bodies, to know, that they will birth when they are ready.

Posted by: Jackie hayes- Caseloading Midwife -England on October 10, 2004 06:18 PM

Comments

I had a sweep today. I was told I was having an examination, being4 days overdue. I was given no warning, not told to relax or prepared in anyway whatsoeveer. It was a complete shock, extremely painful and when I yelled for the doctor to 'stop it', she ignored me saying that it was a perfectly normal procedure if I was determined to go ahead with a vaginal delivery after the C.section I had 4 years ago. I felt angry violated and in pain. That was 10 hours ago and labour has not started yet - nor do I expect it to!!!

Posted by: Vilja on November 7, 2004 02:31 AM