These archives contain extracts from discussions held on the UK Midwives and Consumers email list, a discussion group for people interested in midwifery in the UK. Open to midwives, students, mothers, and anyone interested in improving maternity services in UK. Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives.
I thought list members might be interested to know that a newish consultant
in the local unit is asking midwives to do Cervical sweeps at 38,39 & 40
weeks. The 1st patient was very uncomfortable with SPD, she wanted a sweep so
I carried one out. To my surprise, very soft, thin cervix. She went into labour
within 6 hours and had a wonderful birth.
Last week same instructions, woman with 2 previous CS hoping for VBAC, same
result SVD 12 hours later.
I saw same consultant yesterday & asked did he have any research to
support this intervention, none, just thought it might work.
I have now spoken to my manager and we will be collecting data on outcomes
but I wonder if any one else has come across this as a method of early induction.
My usual recommendation is for lots of passion, but that's just to cheer them
up !
VH
The midwives in Montrose MLU are offering "sweeps" from 37/38 weeks.
Since they've started doing it, women have been very enthusiastic about it and
the transfer rate for IOL is/was 0% -It was May when I got the statistic. They
will (I'm sure) be auditing everything. You could contact Avril Nicol, user
rep, at avrilnicoll@speechmag.com or contact the midwives on 01674 832175
(ask for Bertha Leatherbarrow or Phyllis Winters).
I'm not sure how I feel about it.
FC-S
It doesn't make sense, it's another intervention that's being normalised. I'm
assuming it's 'offered' as an alternative to chemical induction but wouldn't
it far more physiological to only offer induction at real post term (ie + 42
wks).
I speak not only as a midwife but also as one who has birthed babies at 41+
and 42+ wks. Instead of being reassured by my midwives I was made to feel twitched
as if I were a ticking time bomb! Babies come when they are ready, not always
when we are ready.
Crazy world innit?!
JD
The following is from the NICE guidelines on IOL. The research they looked at was of sweeps from 38 weeks, which may be where they are getting their info from?
MEMBRANE SWEEPING
6.2.1 Performance 68
Sweeping the membranes in women at term reduced the delay between randomisation
and spontaneous onset of labour, or between randomisation and birth, by a mean
of three days.
Sweeping the membranes increased the likelihood of both:
o spontaneous labour within 48 hours (63.8% vs. 83.0%; RR 0.77; 95% CI 0.70-0.84;
NNT 5)
o birth within one week (48.0% vs. 66.0%; RR 0.73; 95% CI 0.66-0.80; NNT 5).
Sweeping the membranes performed as a general policy from 38-40 weeks onwards
decreased the frequency of prolonged pregnancy:
o over 42 weeks: 3.4% vs. 12.9%; RR 0.27; 95% CI 0.15-0.49; NNT 11
o over 41 weeks: 18.6% vs. 29.87%; RR 0.62; 95% CI 0.49-0.79; NNT 8.
Membrane sweeping reduced the frequency of using other methods to induce labour (formal induction of labour). The overall risk reduction in the available trials was 15%. This risk reduction of a formal induction of labour was 21.3% vs. 36.3% (RR 0.59; CI 0.50-0.70; NNT 7).
The risk of operative delivery is not changed by the intervention. There was no difference in other measures of effectiveness or adverse maternal outcomes.
Sweeping the membranes was not associated with an increase in maternal infection or fever rates (4.4% vs. 4.5%; RR 0.97; 95% CI 0.60-1.57).
Similarly, there was no increase in neonatal infection (1.4% vs. 1.3%; RR 0.92;
95% CI 0.30-2.82).
Induction of Labour 33
Evidence level
1a
No major maternal adverse effects were reported in the trials. A trial that
systematically assessed minor adverse effects and women's discomfort during
the procedure found that women in the sweeping group reported more discomfort
during vaginal examination. Median pain scores were higher in women allocated
to sweeping of membranes. Pain was assessed by
the Short Form of the McGill Pain Questionnaire,69 which included three scales:
o a visual analogue scale (0-10 cm)
o the present pain index (0-5)
o a set of 15 descriptors of pain scoring 0-3.
In addition, more women allocated to sweeping experienced vaginal bleeding and
painful contractions not leading to the onset of labour during the 24 hours
following the intervention. There was no difference in any fetal outcome between
the membrane sweeping and the non-membrane sweeping groups. These results must
be interpreted with caution due to the
presence of heterogeneity. The trials included in this review did not report
in relevant clinical subgroups.
6.2.2 Summary
o Membrane sweeping is associated with a reduction in the length of time between
treatment and spontaneous labour.
o Sweeping of the membranes reduces the incidence of prolonged pregnancy.
o Sweeping of the membranes reduces the need for the use of formal methods of
induction of labour.
o Sweeping of the membranes is associated with an increase in maternal discomfort.
FN (3rd year student midwife).
Why are these women having their labours induced? What is the advantage?? I
note you give anecdotal evidence of successful outcomes, but one could be putting
over the message intervention to encourage labour=good; awaiting one's body
knowing best = bad
Is this just another example of a medical practitioner being unable to mind
his own business and interfering ??
MC
I originally wrote in response "I think it is simply unethical for health
professionals to put their fingers in women's vaginas on the off chance that
it might precipitate labour. If women request this and have full information
it's a different matter. This may seem extreme but I think there are a number
of issues.
1) the consultant's motivation and the assumption that on what is essentially
a whim he can determine other health professionals actions.
2) the acceptance that pregnancy should be shortened for no apparent reason.
3) the disregard with which the female genitalia are held.
I'm on one of my hobbyhorses -- that any interference with normal physiology needs to be justified in ethical terms."
Since then I've read the various abstracts which people have posted and I'm
not sure that it really undermines the substance of what I wrote. There was
an unthinking assumption that a shorter pregnancy is better and according to
my reading of the original mail the consultant didn't justify or rationalise
this instruction. And even if it doesn't cause infection and regardless of the
degree of discomfort it seems wrong to me to subject women routinely to this.
It seems to suggest that pregnant women's genitals should be generally available
to any old health professional. It is common for women to say after they've
had a baby that they have lost all modesty -- and I don't think it should be
like this. This kind of routine treatment is a way of inducting women into a
submissive role.
Yours,
MT (retired midwife, probably with a rather strange sense of proportions)
MT, What a wonderful way you have of putting things! I entirely agree with
all you've said, and wish you were still practising...
H
Re Montrose women being 'enthusiastic' re sweeps - I know one such woman who
was not enamoured with them at all and eventually declined any further after
2nd VE, I doubt she is alone there.
I know the consultant who is involved with this and she does not recommend this
for all women - she asks that certain women are 'offered' from 38 wks apparently
(probably those keen for SVD this time or keen to avoid other (worse) forms
of induction). All other women 'may' be offered after 40-41weeks. This info
is from one of the midwives who works at Montrose.
We have one of the worst IOL stats in the country, and are trying to reduce
it. Our protocol is IOL after 41+4 according to RCOG green top guidelines I
think, and even with informed choice many women will still favour IOL then (like
they do Vit K and Syntometrine etc.. because it seems to be the norm - and if
it's the norm for others then it's good enough for them - my
interpretation)
Given this (awful) situation, some midwives (and women) might feel that a few
sweeps after 40 weeks which may start labour before 41+4 weeks may actually
be favourable to some women than a whole hog induction with Prostin etc.
Of course I do discuss this with women, so they are fully informed about the
whole process of IOL and their right to decline and await labour. All the women
(not that many - about 4, those fed up with being pregnant etc) who have wished
this procedure in my practice went into labour after the first sweep in the
space of a week and did not require IOL. But this may have happened anyway.
A colleague had a woman who wished to avoid IOL and C/s she had a fair sized
baby and the head had been slow to descend - at 40+ weeks it had come down and
the mw swept her membranes at her request. I was asked to see her in three days
time to sweep again - which I did with consent - when I found the cervix to
have changed quite a lot. She laboured 4 days later and went into labour suite
fully dilated - the mw who admitted her could not believe she was fully because
she didn't act at anytime like someone who was at that stage.
She had a lovely birth and breastfed well, and was happy because she had avoided
IOL and C/s (things which had been mooted because of the size of the bump and
the head not engaging (prim). Of course you and I could argue that it was the
negative programming she had received that this babe might not come that could
have delayed her going into labour, and eventually could have led to the interventions
she dreaded. And yes a VE is intervention best avoided, but for some women it
is a whole lot better than three or four VEs for Prostin and ARM plus an IV
and Synto etc etc….
Ethically it is a difficult situation - a woman might avoid IOL with a sweep
or 2 that she was happy with and end up with a lovely birth, or she could be
left to get on with it and at 41+ weeks will be offered IOL, which she consents
to although she is informed that pregnancy is 37-42 weeks long normally and
therefore actually not indicated. She has IOL, it fails and she requires
C/S. Or it's ok, she has epidural and ends up with a Kiellands/Haigs Forceps
or Ventouse and a third degree tear. These are average outcomes where I work.
If you have been fully informed which would you choose?
Just putting over the other side of the story - in a perfect world all women
would absolutely decline IOL but it does seem to be becoming the norm.
See following studies:
Am J Obstet Gynecol 1998 Oct;179(4):890-4
Can we decrease postdatism in women with an unfavourable cervix and a negative
fetal fibronectin test result at term by serial membrane sweeping?
Magann EF, McNamara MF, Whitworth NS, Chauhan SP, Thorpe RA, Morrison JC Department of Obstetrics and Gynecology, Naval Medical Center, San Diego, California, USA.
OBJECTIVE: Our purpose was to determine whether the risk for postdatism can
be reduced by serial membrane sweeping in women with an unfavorable cervix at
39 weeks' gestation and a negative fetal fibronectin test result. STUDY DESIGN:
Women with uncomplicated pregnancies, who were candidates for a vaginal delivery
with an unfavorable cervix at 39 weeks' gestation and a negative fetal fibronectin
test result were asked to participate in this investigation. Patients were chosen
at random and assigned to a group for membrane sweeping every 3 days or to a
control group who received gentle examinations every 3 days. RESULTS: Sixty-five
women were selected at random for serial membrane sweeping (n = 33) or for the
control group (n = 32). Although gestational age and Bishop score at study entry
were similar, the
gestational age on admission for delivery was earlier in the membrane sweeping
group (39.9 +/- 0.3) versus the control group (41.5 +/- 0.6, P < .0001).
The Bishop score on admission to labor and delivery was greater (8.8 +/- 2.1)
in the membrane sweeping group than in the control group (6.2 +/- 2.7, P <
.0001). The number of women admitted for labor inductions at 42 weeks' gestation
was 18 of 32 (56%) in the control group versus none (0 of 24) in the membrane-sweeping
group (P < .0001). CONCLUSIONS: Women with an unfavorable cervix at 39 weeks'
gestation and a negative fetal fibronectin test result are at risk for not being
delivered by 41 completed weeks and thus may require postdates induction or
antenatal testing. Serial membrane sweeping significantly reduces the risk of
postdatism and induction of labor.
Br J Obstet Gynaecol 1998 Jan;105(1):41-4
Sweeping of the membranes at 39 weeks in nulliparous women: a randomised controlled trial.
Cammu H, Haitsma V Department of Obstetrics and Gynaecology, A.Z.V.U.B., Brussels, Belgium.
OBJECTIVE: To determine whether weekly sweeping of the membranes from 39 weeks
of gestation results in a reduction in the number of women reaching 41 completed
weeks and subsequently in a reduction of the number of women who will need induction
of labour.DESIGN: Randomised controlled trial.
PARTICIPANTS: Two hundred and seventy-eight nulliparous women, who were seen
at the antenatal clinic of a university teaching hospital, were randomly allocated
at 39 weeks of gestation to receive on a weekly basis either sweeping of the
membranes (n = 140) or a routine pelvic examination (n = 138). MAIN OUTCOME
MEASURES: The time interval between randomisation and delivery, the incidence
of prolonged pregnancy (i.e. > 41 completed weeks),
and the incidence of induction of labour. RESULTS: In 24 women (17%) sweeping
of the membranes was not possible. Fifty-three women (38%) in the sweeping group
and 50 women (36%) in the control group were delivered within one week after
randomisation. Women allocated to sweeping showed a trend towards having a shorter
randomisation-delivery interval: 9.4 days versus 10.6 days in the controls (P
= 0.087). Sweeping had no statistically significant effect on the mean duration
of pregnancy (282.8 days in the sweeping group versus 283.8 days in the control
group, P = 0.127). The need for induction of labour was significantly reduced
in those women who underwent sweeping (11% versus 26%, P = 0.004), merely as
a result of a
decrease in the number of women that exceeded 41 weeks (19% versus 33%, P =
0.016). CONCLUSION: Sweeping of the membranes weekly from 39 weeks does not
increase the number of women who will deliver within the first week but significantly
decreases the number that will reach 41 weeks. Induction of labour then becomes
less necessary.
Br J Obstet Gynaecol 1993 Oct;100(10):898-903
Sweeping the membranes: a valid procedure in stimulating the onset of labour?
Allott HA, Palmer CR Department of Obstetrics and Gynaecology, Royal Berkshire Hospital, Reading, UK.
OBJECTIVE: To determine whether sweeping the membranes in pregnancies of longer
than 40 weeks gestation results in an accelerated onset of labour and a reduction
in the incidence of induction of labour. DESIGN: A prospective randomised controlled
study. SETTING: The antenatal clinic of a district general hospital. SUBJECTS:
One hundred and ninety-five antenatal women with pregnancies proceeding beyond
40 weeks gestation. INTERVENTIONS: A Bishop
score assessment of the cervix alone or combined with a membrane sweep, on a
randomised basis. OUTCOME MEASURES: Subsequent duration of pregnancy to the
onset of spontaneous labour. The incidence of induction of labour for post-maturity.
RESULTS: Sweeping the membranes significantly reduces the subsequent duration
of pregnancy, from an average of five days to two days following the procedure.
The proportion of inductions of labour was 8.1% in
the swept group and 18.8% in the control group. No harmful side effects to the
procedure were noted. CONCLUSIONS: Sweeping the membranes is a safe and useful
procedure which results in a reduced incidence of post-mature pregnancies, and
a subsequent reduction in the labour induction rate.
Am J Obstet Gynecol 1998 Jun;178(6):1279-87
Management of pregnancies beyond forty-one weeks' gestation with an unfavorable cervix.
Magann EF, Chauhan SP, Nevils BG, McNamara MF, Kinsella MJ, Morrison JC Department of Obstetrics and Gynecology, Naval Medical Center, San Diego, California, USA.
OBJECTIVE: Our purpose was to determine the optimal management of pregnancies beyond 41 weeks' gestation with a cervix unfavorable for induction. STUDY DESIGN: All uncomplicated pregnancies that reached 41 weeks' gestation with a Bishop score of < or = 4 were randomly assigned to one of three groups: (1) daily cervical examinations, (2) daily membrane stripping, or (3) daily placement of prostaglandin gel until 42 weeks. RESULTS: In 105 pregnancies the Bishop score on admission to labor and delivery was significantly greater in the groups receiving prostaglandin or stripping of the membranes versus the control group, whereas the converse was time of gestational age at delivery (p = 0.0001). Fewer patients required induction in the two treatment groups (20%, 17%) versus the control (69%) patients (p < 0.0001). CONCLUSIONS: Daily membrane stripping or daily placement of prostaglandin gel is successful in reducing the number of inductions at 42 weeks for postdatism.
Int J Gynaecol Obstet 1998 Feb;60(2):115-21
Safety and efficacy of stripping of membranes at term.
Gupta R, Vasishta K, Sawhney H, Ray P Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
OBJECTIVES: To assess the efficacy of stripping of membranes in initiation of labor and to study its effect on maternal and perinatal morbidity. METHOD: One-hundred primigravidae with certain gestational dates were randomized at 38 weeks gestation to either receive stripping of membranes or only gentle cervical examination. Cervical swabs were taken before pelvic examination at 38 weeks and again at the onset of labor. Placental membranes were sent for bacteriological study after delivery in all patients. RESULTS: The mean gestational age, parity and Bishop score were similar in both groups at recruitment. Gestational age at delivery was lower in the study group (38.70 +/- 0.63) compared to the control group. Seventy-two percent of the study group and 8% of the control group had spontaneous onset of labor within 7 days of examination. Labor was induced in one patient (2%) of the study group and 16 patients (32%) of the control group. No statistically significant difference was noted in incidence of premature rupture of membranes (PROM), mode of delivery, intrapartum events and perinatal outcome. No increase in neonatal morbidity was seen in association with this procedure. No patient in the study group had clinical evidence of chorioamnionitis. There was no statistically significant difference in the microbiological flora of both groups. CONCLUSION: Stripping of the fetal membranes is a safe and efficacious procedure for induction of labor. It decreases the incidence of induction of labor with no increase in incidence of maternal and neonatal morbidity.
Obstet Gynecol 1996 May;87(5 Pt 1):767-70
A randomized controlled trial of membrane stripping at term to promote labor.
Wiriyasirivaj B, Vutyavanich T, Ruangsri RA Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand.
OBJECTIVE: To determine the effectiveness of membrane stripping at term to promote the onset of labor. METHODS: One hundred twenty gravidas at 38 weeks' gestation, who were attending an antenatal clinic and planned to deliver at Maharaj Nakorn Chiang Mai University Hospital in northern Thailand, were assigned randomly to one of two groups. One group had weekly pelvic examinations only, and the other also had membrane stripping, beginning at 38 weeks' gestation and continuing until the onset of labor or until 42 completed weeks' gestation. Outcome measures included the proportion of patients who delivered with 7 days after the first examination, Bishop scores among those who did not deliver, days from the first examination to delivery, incidence of postterm pregnancy, and maternal and fetal complication. RESULTS: Twenty-five of 61 patients (41%) assigned to membrane stripping delivered within 1 week, compared with 12 of 59 controls (20.3%), a statistically significant difference (P = .014). There was also a statistically significant difference (P = .013, Mann-Whitney U test) in the Bishop scores among those who did not deliver within 1 week (4 +/- 2.5 versus 2.6 +/- 1.7 in the study and control groups, respectively). A significant difference was also observed with respect to the mean number of days to delivery (8.8 +/- 6.7 versus 13.6 +/- 7.5, respectively; P < .001). The incidence of postterm pregnancy was one of 61 (1.6%) and three of 59 (5.1%) in the stripping and control groups, respectively. No significant differences were observed in maternal and fetal complications. CONCLUSION: Membrane stripping is safe and effective in promoting the onset of labor at term.
Br J Obstet Gynaecol 1999 May;106(5):481-5
Sweeping of the membranes to prevent post-term pregnancy and to induce labour: a systematic review.
Boulvain M, Irion O, Marcoux S, Fraser W Unite de Developpement en Obstetrique, Departement de Gynecologie et d'Obstetrique, Geneva, Switzerland.
OBJECTIVE: To evaluate the effectiveness of sweeping of the membranes to prevent post-term pregnancy and to induce labour. DESIGN: A systematic review of randomised controlled trials. METHODS: Potentially eligible trials were identified in Medline and in the Cochrane Controlled Trials Register. Inclusion of studies and data extraction were performed by two reviewers working independently. Summary estimates of the effect of the intervention were computed as relative risks, risk differences and weighted mean differences. MAIN OUTCOME MEASURES: Use of formal methods of labour induction, delay before spontaneous onset of labour, prevention of post-term pregnancy, side effects, maternal and perinatal morbidity. RESULTS: Sixteen reports were identified. Thirteen were included in the review, with a total of 1992 women. Sweeping of the membranes, when performed at term, reduced the duration of pregnancy and the proportion of women continuing pregnancy beyond 41 and 42 weeks. When sweeping of the membranes was performed, a reduction in the use of formal methods for labour induction was observed (RR = 0.48; 95% CI 0.28-0.85). There was no difference between groups in the mode of delivery or in the risk of infection. Discomfort during vaginal examination and other side effects (e.g. bleeding, irregular contractions) were more frequently reported by women allocated to sweeping. CONCLUSIONS: While sweeping of the membranes reduces the interval to spontaneous onset of labour, there is no evidence of a reduction in maternal or neonatal morbidity. When used as a means of induction of labour, the reduction in the use of formal methods must be balanced against women's discomfort and other side effects attributable to the procedure.
J Nurse Midwifery 1999 May-Jun;44(3):320-4
International Journal of Gynecology and Obstetrics Vol: 86 Issue: 3, September,
2004 Article Full Text PDF (33 KB) pp: 388-389
Brief communication
Membrane stripping versus single dose intracervical prostaglandin gel administration
for cervical ripening
V. Kaula, N. Aggarwala Department of Obstetrics and Gynaecology, Postgraduate
Institute of Medical Education and Research, Chandigarh , India b. Department
of Microbiology, Postgraduate Institute of Medical Education
and Research, Chandigarh , India
Received 31 December 2003; revised 30 March 2004; accepted 6 April 2004
Keywords: Membrane stripping; Prostaglandin E2 and Cervical ripening.
Article Outline
References
As the quest for satisfactory conversion of a resistant cervix to a favourable ripe cervix continues, prostaglandins have been thought to be more physiological in initiating the process of labor [ 1, 2, 3, 4 ].
This study was carried out to compare the safety and efficacy of membrane stripping with single dose intracervical prostaglandin PGE2 gel (cerviprime 0.5 mg) administration for cervical ripening. Sixty women with singleton pregnancy and ascertained gestational age between 34 and 38 weeks, Bishop score <6 were randomized either to membrane stripping or cerviprime gel instillation. Repeat vaginal examination was done and Bishop score reassigned after twelve hours. Cervical swabs were sent for culture and sensitivity both before treatment and after 12 h.
Oxytocin induction/augmentation was done as required as per the protocol of the labor ward. Following delivery, the placental, membranes were sent for culture sensitivity. All samples were processed for aerobic and anaerobic organisms.
Maternal outcome was compared in terms of pre study Bishop score and change in Bishop score at the onset of labor or at the time of induction of labor, any complications due to intervention such as premature rupture of membranes, fever, hyperstimulation, abruption, vaginal bleeding, oxytocin requirement, spontaneous labor, induction delivery interval and duration of labor, mode of delivery and maternal pyrexia and requirement of antibiotics. Neonatal outcome was compared in terms of Apgar score at 1 and 5 min and evidence of sepsis or requirement of antibiotics.
The mean gestational age, parity, Bishop score were similar in both groups
at recruitment. Bishop score change following intervention showed efficacious
improvement ( P<0.01) in both groups, although on comparison between the
two groups there was no statistically significant difference. More women (22.73%)
in membrane stripping group needed oxytocin >32 mIU/mt than in cerviprime
group (16.53%). The mean duration from intervention to delivery and the duration
of labor was significantly reduced in cerviprime group in comparison to membrane
stripping group ( - Table: [ 1]). No statistically significant difference was
seen in the incidence of complications, mode of delivery, intrapartum events,
perinatal outcome and biological flora of both groups.
Membrane stripping as well as cerviprime instillation are both safe and efficacious, decreasing the incidence of induction of labor with no increase in incidence of maternal and neonatal morbidity. While membrane stripping is cheap, easy and safe, it lacks a time-bound response and thereby its judicious use is recommended as an alternative to cerviprime gel, especially in inductions where urgent priming is not required.
References
[1]. Boulvain M., Iron O., Marcoux S., Fraser W., "Sweeping of the membranes
to prevent post term pregnancy and to induce labour: a systematic review",
Br J Obstet Gynaecol, Volume: 106, (1999), pp. 481-485
[2]. Boulvain M., Stan C., Iron O., "Membrane sweeping for induction of
labour", Cochrane Database Syst Rev, Volume: 2, (2001), pp. CD000451
[3]. Keirse M.J.N.C., "Prostaglandins in preinduction cervical ripening.
Meta-analysis of world wide clinical experience", J Reprod Med, Volume:
38, (1993), pp. 381-384
[4]. Gemer O., Kapustian V., Harai D., Sassoon E., Segal S., "Sweeping
of membranes vs. intracervical prostaglandin E2 gel for cervical ripening. Randomized
trial", J Reprod Med, Volume: 26, Issue: 8 (2001), pp. 706-708
AC
Perhaps, like most things, whether or not a woman accepts a membrane sweep
depends on how we introduce the subject? I think G has said something about
this before? Along the lines of: "if we suggested to a man that we scraped
the end of his penis until we drew blood because doing so was good for him in
the long run, how many of them would accept it?"
RK
When I visited Montrose and I heard about sweeping membranes in advance of
a due date - I'm sure they must have seen me jump. I was shocked but wanted
to know more about it. My immediate reaction was NO, NO, NO. Having thought
about it and living an area where you're given a date for IOL at a routine consultant
appointment (all women apart from those having planned CS), my judgement at
the moment is that I admire the midwives in Montrose for showing a lot of initiative
in finding a way to provide a normal birth for more women. How I saw it, was
that they had managed to get round many obstacles and had increased the local
birth rate by a huge amount - IOL was the next obstacle and they wanted to find
a way round it. Obviously it would be better if there wasn't the pressure to
induce labour in the first place.
F
Good for those midwives, but wouldn't stopping the routine appointment with
a consultant and encouraging homebirth lower the IOL rate and stop the need
for invasive membrane stripping?
Women are booked to see a consultant mostly by community midwives... as autonomous
practitioners, why do they do this for normal uncomplicated pregnancies if they
know the outcome will be pressure and a date for IOL?
I would never have ended up with a c/s if I hadn't been sent for a routine appt
with a consultant.... Too young, too uninformed....
JA
Sorry I didn't make myself clear. It's not in Montrose that the routine appointments
are happening - it's where I live on the opposite coast of Scotland. Every time
I've questioned why women are routinely seeing a consultant, I am told that
the women want to. In fact there are two standard answers to everything I query.
Either it's already happening (hollow laugh) or it's what women want.
FCS
As a women who was induced in my first pregnancy I had the whole hog prostin,
syntocinon, multiple VEs and having my waters broken; all of which may I add
were not explained to me at all, I would have liked to have the option of a
sweep as it might have prevented all the interventions and eventual CS. I know
it is an uncomfortable procedure but if the whole induction process is explained
I think many women would chose this option first. I'm not medically trained
but I don't understand why consultants etc would want to start labour before
40wks unless there was a good reason.
Today I have had a sweep as I'm 42 wks and I had a scan which shows that my
dates are correct, small amount of fluid and the placenta looks old. I asked
for a sweep, to which the lovely female doc said she would do it for me, as
I think everyone in the day assessment unit is
aware that I do not want a CS (which has been booked for Monday).
I'm hoping it will help labour along or at least give me a chance to try
Wish me luck. (Feeling lots of period pains, etc)
DS
DS. Wishing you lots of luck following your sweep - I really hope it works
and
you avoid that section
C
Thank you for your good luck wish. I think I need it as I had contractions
every ten minutes yesterday after the sweep and they got really strong about
10.30. I went to bed to relax and fell asleep, only problem is that today I
have only had a few mild ones and I am trying to stay
active to encourage them back, any ideas ??
I am going back to the assessment unit tomorrow and if nothing has happened
I might ask them to do another sweep!!
The midwife said to me that on Monday morning, before CS, they could break my
waters to try and get me going to help avoid CS. Could this work ?
DS
Hi DS. Hope you have more success with your sweeps than I had with mine - 4
in total ! Each sweep brought on lots of strong contractions that then petered
out - I had strong reasons for not waiting too long too.(After 1 sweep I even
did a vigorous cleaning out of our large car but to no avail).
In the end labour did start, probably a combination of things, but the main
thing was that I managed the best birth of all 4 of mine (have to confess to
taking castor oil which I know people have differing opinions on...).
All the best anyway & hope it happens soon & you avoid that cs.
RL
Hi DS
how are you - any more ctx? Do you have to have the C/S tomorrow - how many
weeks/days are you now - you know you can decline?
I agree that another cervical sweep may do the job if you could wait a few more
days. Breaking the waters may work - but it commits you to contracting within
a certain length of time usually advised by Drs - but since we leave women who's
waters have gone for upwards of 24 hrs then why not after breaking waters -
but it is interference with the whole process (and there is a
theoretical risk of infection following breaking the waters and waiting a long
time for labour to commence).
Is babe moving lots - are you happy to continue with the pregnancy - are you
happy to accept/decline their offers of intervention. ?? Anyway - I hope you
are well, and that whatever you decide works out for the best for you and yours.
Thinking of you
Ch
Hi Ch. My contractions stop the minute I fall asleep , when I wake up they
are gone I had a second sweep done on sat and we walked for ages and on the
bus I started to get ctx building up to really strong ones. This went on from
6pm every 6 mins till 11pm when they slowed down and I fell asleep. They have
been rare today so I'm fed up. One midwife did say that tomorrow they could
break my waters and I think I might let them. I had a scan which showed not
a lot of fluid around the baby and the placenta is old so I don't want to risk
leaving it to long I'm about 43 wks so any ideas on how to help thinks along
??? I'm wondering if another sweep and ARM could do the job tomorrow as after
the last sweep it seemed to work. The baby seems happy but as the fluid has
decreased I don't want to leave it longer. I will let you the know what happens
DS
hello everyone
just a quick post to let you all know that my baby has arrived. She weighed
8lb 7oz, born on Tuesday at 6.05pm by emergency c/s after 24hrs of extremely
painful labour. Although the
outcome was not what I had hoped for, it was still a brilliant birth, and the
staff were all amazing.
I will post again and tell my story. Thank you ladies for all of your advice
and support
DS
LW updated April 9, 2005