Stretch and Sweep: a Doula's perspective

If you’re reading this blog, you’re probably more than 37 weeks pregnant and your care provider has suggested a Stretch and Sweep. It would likely be the first step your Midwife or Obstetrician will offer before suggesting other forms of induction, to help bring on labour and avoid going “overdue”. Hopefully they discussed the process itself, plus the benefits and risks associated with this procedure, and have allowed you time to reflect, consider, research and decide if you’re happy to go ahead with it.

Perhaps you’re unsure if you want to consent to this or decline it – or maybe you didn’t know you had the choice? That’s OK! It can be common to feel some pressure to do this and it’s often presented as a “simple procedure” or a “natural” thing to do… ie, there are no drugs.

Please note that while there are no drugs included, it is definitely a form of intervention. Here’s what happens:
1. The midwife or obstetrician will put gloves on (hopefully sterile), and insert their hand into your vagina (an internal examination)
2. They will then try to insert one finger into your cervix to stretch it to be wider and more open in the hope that this stimulation may be enough to start the softening and ripening of your cervix
3. If possible, they will then move their finger around the cervix and try to sweep the area around the amniotic membranes (your waters at the lower end of the womb)
4. This separation should release hormones (prostaglandins) which can increase the chances of labour starting within the next 48 hours

The Cochrane review (linked below) states:

"Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits. When used as a means for induction of labour, the reduction in the use of more formal methods of induction needs to be balanced against women's discomfort and other adverse effects."

And:

“To avoid one formal induction of labour, sweeping of membranes must be performed in seven women.“

 what is a stretch and sweep? will it work to bring on labour? here is the opinion of a birth doula in sydney

So, here are my personal thoughts as a Doula around a stretch and sweep:
1. It may help to bring on labour
2. It may not help to bring on labour
3. It may cause pain, discomfort, irregular contractions and/or bleeding
4. While rare, it’s possible they may even accidentally rupture your membranes which could introduce infection
5. It may get your hopes up that you will go into labour and you don’t
6. Which may make you doubt yourself and feel like your body isn’t working if it doesn’t bring on labour
7. Someone is sticking their hands up your vagina and it probably isn’t necessary
8. If you’re already say 41 weeks and trying to avoid a medical induction, while this is still an intervention, it is unmedicated (ie no drugs) and usually doesn’t require a next step to commence the cascade of intervention that could follow, and you can usually go home straight afterwards
9. If you’ve simply had enough of being pregnant and want to try everything possible to get things going (and you’ve exhausted my list of natural induction methods – see blog post here), then give it a shot before going for other more invasive options
10. And, remember there is no guarantee it will work, and it may just cause you discomfort, pain or false hope

FACT: Sperm contains natural prostaglandins that can help to soften the cervix. So perhaps, if you have access to sperm and a partner willing to help *wink wink* #justsaying, you may prefer this to someone’s hand?
(Apparently, eggplant and goji berries also have prostaglandins and they are absorbed orally through the membranes in your mouth!)

QUESTION: Personally, I would question your care provider further to make sure you feel totally comfortable in going ahead with this. To me, if they are suggesting the stretch and sweep, it feels like they think my body won’t go into labour spontaneously or naturally, and it would make me question myself about why they think my body won’t do what it is meant to do. I would also question if there is a problem with my baby and why they are in a hurry to get things moving

If you’d like to read some more on the Cochrane review study, here is the link: http://www.ncbi.nlm.nih.gov/pubmed/11405964

And as always, please note that I am a Doula. I am not medically trained and this blog post is simply my opinion. I would highly suggest you have a long conversation with your medical care provider (midwife or obstetrician) regarding this procedure to see if it is right or not for you. It’s so important that you trust your care giver, and if this discussion brings up some red flags for you, please note that it’s never too late to get a second opinion. I truly believe that it’s important that birthing women feel informed and that they can make a choice. There is no right or wrong choice, just what’s right for you.

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About Essential Me

Hi, I'm Amanda.  I support women and couples during their pregnancy, birth and postnatal journey as a Doula, Ka Huna massage therapist and Pilates instructor.  I'm Based in Sydney and would love to help you.  Please check out my Top 10 Tips for the best possible birth experience here.  I'd love to meet you for an obligation free interview to see if you feel we're the right fit.  Contact me here. Thanks, Amanda x