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Sweeping the membranes

A technique for avoiding an induction of labour is being discussed amongst midwives in Ireland. Stretching the cervix and sweeping the membranes is sometimes seen as a way of avoiding an induction and has been recently resurrected in Ireland and some parts of the UK. I first learned of this technique on my first visit to Darwin about 25 years ago. One of the local obstetricians (now thankfully long retired) was very proud of his low induction rate. He credited these figures to his habit of doing a “strip and stretch” on every one of his patients at every visit from 36 weeks of pregnancy. He didn’t tell them what he was doing, but just said he would do an internal check. Many women went home bleeding and in pain from strong contractions or cramping. They would ring the hospital to ask if this was normal, and sadly, the midwives knew that it was normal for this particular obstetricians clients. In those days, the concept of “informed choice” or even “consent” was unknown and the midwives also tended to side with the doctors rather than the women. That didn’t make it right. These women has been physically assaulted without their permission - it could be described as a form of rape.

These days we ask women first if they want this aggressive and invasive procedure performed. They may be told that the evidence says that this “simple” technique performed “gently” by a midwife may reduce the chance of going overdue and the resultant induction for post-maturity. Even if this was the case, it still begs the question of why we feel we need to induce so often and why we feel that physical assaults on women can be sanctioned if someone does a study that suggests there might be some small benefit.

Have people gone mad? Are we losing the plot? If the baby’s health is being compromised by its intrauterine environment (which happens rarely) then surely a caesarean section is a better approach, as this will avoid the added stress of a labour for the sick baby.

My suspicion is that this procedure, largely forgotten until the last few years, has been resurrected by midwives who are distressed by the impact of induction on women and babies and who are looking for ways of helping women avoid this intervention. However, to substitute the risks of a “strip-and-stretch”(infection, ruptured membranes, bleeding, heavy cramping) for another set of risks of induction (the well-known cascade of interventions) seems to me to be questionable. There are many other ways that midwives could help women avoid an induction, and none of them involve a physical assault on women.

It’s time for some common sense to enter the debate. Research evidence is not always the answer.

Posted by andrea at January 26, 2006 04:16 PM