Welcome to the Evidence Based Birth® Q & A Video on Membrane Sweeping!
In this video, you will learn:
- The benefits of membrane sweeping
- The cons of membrane sweeping
- Why you have the right to informed consent/refusal with membrane sweeping
Links and resources:
- Check out our Q & A video on routine vaginal exams.
- To read more about your right to informed consent and refusal.
- Major research studies on membrane sweeping:
- Boulvain, M., Stan, C.M., Irion, O. (2010). Membrane sweeping for induction of labour (review). The Cochrane Library 2005(1).
- De Miranda, E., van der Bom, J.G., Bonsel, G.J., et al. (2006). Membrane sweeping and prevention of post-term pregnangy in low-risk pregnancies. BJOG (113), 402-408.
- Hill, M. J., McWilliams, G. D., Garcia-Sur, D., et al. (2008). The effect of membrane sweeping on prelabor rupture of membranes: a randomized controlled trial. Obstetrics and Gynecology 111(6): 1313-9.
- Tan, P.C., Jacob, R., Omar, S.Z. (2006). Membrane sweeping at initiation of formal labor induction. Journal of Obstetrics and Gynecology 107, 569-577.
- Wong, S.F., Hui, S.K., Choi, H., & Ho, L.C. (2002). Does sweeping of membranes beyond 40 weeks reduce the need for formal induction of labor? BJOG (107), 632-636.
- Yildirim, G., Güngördük, K., Karada, Ö. İ., et al. (2010). Membrane sweeping to induce labor in low-risk patients at term pregnancy: A randomised controlled trial. Journal Of Maternal-Fetal & Neonatal Medicine, 23(7), 681-687.
Enjoy the video, I hope you find it helpful! Stay tuned for our next Q & A!
Want to submit a question for consideration?
Hi, my name is Rebecca Dekker, and I’m the founder of Evidence Based Birth®. Today we’re going to talk about the evidence for membrane stripping or membrane sweeping.
Today let’s talk about the evidence for membrane stripping or membrane sweeping. This is often done at the end of pregnancy when your care provider is doing a vaginal exam. They may go ahead and do something, what we call membrane stripping. This is where they insert their finger up your vagina towards your cervix. Let’s say this is the opening of your cervix, if it is open at all. They take their finger and they kind of sweep around to separate the membrane that surrounds your baby from the lower part of your uterus down here by your cervix.
They can only do this if your cervix is dilated at least a little bit. Sometime this is done routinely without even talking to the woman about what’s about to be done, and you may just notice that the vaginal exam is very painful. Other times you may have an actual informed consent discussion where your care provider explains the pros and cons. For those of you whose care provider doesn’t explain the pros and cons to you, what are they?
Well, membrane stripping or membrane sweeping is seen by many as a form of induction, although it’s not necessarily always a very successful form of induction. It really does warrant a discussion about pros and cons. Now there have been a lot of randomized trials on membrane sweepings, and what they show are the benefits are: If your membranes are stripped or swept at 41 weeks, so one week after your estimated due date, this can lower your chance of having to go past 42 weeks and needing an induction at 42 weeks. It decreases your chances of going to 42 weeks from 41% down to 23%. It pretty much cuts your chance in half of having what we call a post-term pregnancy or a pregnancy that goes past 42 weeks.
It can also decrease the length of your pregnancy by one to four days. Most studies found four days on average. That doesn’t mean that you’ll go into labor within four days. What it means is, say, your body was naturally going to go into spontaneous labor at 41 weeks. Then, instead, if your membranes were stripped, it would shorten your pregnancy by about four days. Maybe you would go into labor at 40 weeks and three days instead of 41 weeks.
Membrane stripping has also been shown in research studies … lower your chances of needing a formal induction if your pregnancy goes on too long and you and your care provider decide that you want a formal induction. Membrane sweeping can help prevent needing medications for an induction.
What are the cons of membrane sweeping? One of the cons is you can’t have your membrane swept if you cervix is closed. Your cervix needs to be at least one centimeter dilated in order for this procedure to occur. Another con is that most women report that the procedure is either somewhat or very painful. In fact, one study found that 70% of women reported that the procedure was significantly painful, with an average pain score rating of seven on a scale of one to 10, with 10 being the worst pain possible.
Membrane sweeping can also cause bleeding after the procedure. It can also cause your uterus to become really irritable and contract irregularly. You may lose some sleep and worry a lot because you’re having lots of weird, irregular contractions that are not labor, but they just really bother you. Or it could be the start of labor, so you may be unsure as to what’s going on because it just leads to that uterus irritability.
When women in studies are randomly assigned to have their membranes swept and their membranes are actually swept, they actually receive the procedure, about 9% of them experience their water breaking as a side effect of the procedure. You have about a one in 10 chance of your water breaking if you have your membrane swept. This can lead to longer labors, and it can also lead to the chance that you might need a formal medical induction if your water broke and you didn’t go into labor on your own.
Finally, one of the cons of membrane sweeping is when it’s done without informed consent. I hear reports of women all over the world who tell me that their membranes were stripped or swept without their consent. Although there has never been a research study done on this phenomenon, it is anecdotally something that does happen to some women. That’s just something to be aware of when you’re going into those appointments.
We have a Q&A video all about routine vaginal exams at the end of the pregnancy. It might just be something you want to talk with about your provider. Do they consider the membrane stripping to be part of a vaginal exam? Because technically they are separate, and technically you should be giving informed consent or refusal for membrane stripping. It’s just good to know ahead of time if that’s something that your provider does before they’re doing their cervical or vaginal exam.
I hope this video was helpful, and I hope you can join me in another Q&A video. Feel free to browse our resources at Evidence Based Birth®. Thanks and bye.