Your due date approaches, you are tired and possibly even ‘over it’…your care providers offer a ‘stretch and sweep’ or ‘membrane sweep’.
What is a stretch and sweep?
The care provider will need you on your back, with your knees up to be able to insert their fingers into your vagina. If your cervix (the very top of your vagina, the cervis is the ‘gate’ to your womb, during labour it opens up to allow the baby to be born) is beginning to open. If it is, the care provider will place a finger in your cervix and sweep around it, the idea being that the membranes holding your baby will come away and release ‘go into labour’ hormones.
Evidence suggests that it works 50% of the time within 48 hours…though this could be because labour would have happened anyway. This procedure can introduce a seed of self doubt and possibly increased risk of infection. At the same time as this is done, a ‘cervical exam’ will provide you with information such as ‘softening’ or ‘2cm dilated’. This does not really tell you much, beyond what your cervix is doing in that moment.
see also: pregnancybirthbaby.org.au/stretch-and-sweep and this article by Sara Wickham
You are now past your due date, and induction is being discussed: gels, synthetic oxytocin, breaking waters/membranes.
What is Induction?
Induction of labour is a medical intervention that artificially brings on labour. Often induction is coupled with the use of drugs to intensify the contractions. This usually leads to an epidural. This increases the likelihood of an ‘assisted delivery’ (forceps or vacuum suction) or a caesarean.
Far more inductions are done than are medically necessary, with most actually for logistical reasons or to reduce a perceived risk. You may live rurally or remotely, perhaps your birth location cannot provide you with care if you go past 42 weeks, as your care will transfer to a bigger hospital – possibly a great distance away.
The risks associated with induction include increased likelihood of caesarean or assisted delivery. Assisted delivery uses vacuum extraction or forceps, with an increased risk of 3rd and 4th degree tears. Induced births also increase the likelihood of your baby needing assistance after birth, and a separation from you.
If you are feeling fed up towards the end of your pregnancy, or your due date has passed, you may be tempted by this option. Consider these questions in advance to help you make informed decisions at the time:
- Are you well?
- Is your baby well?
- Is it medically required and urgent?
- Is it being offered to reduce a perceived risk (your age, weight, multiple pregnancy, IVF, gestational diabetes)?
- Is it logistically required (distance to travel, FIFO considerations)?
- What method will be used (balloon catheter, pessary, gel, artificial rupture of membranes with or without synthetic oxytocin)?
- Are you aware of the ‘cascade of intervention’? (time limits placed on you, monitoring required, you may not be able to move around)
- Have you considered the Benefits, Risks and Alternatives?
- Do the risks of induction outweigh the risks of waiting?
These questions will help you prepare your Birth Map.
DO NOT LEAVE THE INDUCTION DISCUSSION TO THE LAST MINUTE!
Birth should not be on a ‘need to know basis’. Take time throughout your pregnancy to understand the modern maternity landscape, and consider various scenarios.
see also
Induction – a step by step guide (Rachel Reed)
Induction associated with adverse outcomes (Sara Wickham)
or listen to Midwives Cauldron Podcast, discussing induction from the baby’s perspective