What Is A Stretch And Sweep?

This week I've been on some social media and there were several discussions about sweeps. One example of a question asked was, "...on an instagram post of theirs that membrane sweeps aren't designed to induce labour. I mean, What?? That's exactly what they are trying to do?!" Another post asked if it was better to do a sweep or use pitocin. So it occurred to me, that people may be little mistaken or misinterpreting what a sweep actually is.

So what is, what's called a Stretch And Sweep? Basically the procedure involves the care provider (doctor or midwife) attempting to insert one or two fingers into the cervix and sweep around the top of the cervix and attempt to dislodge the amniotic membrane from the area around the cervix. Below is a picture of what I'm trying to explain.

This procedure is often offered starting around 38 weeks. Offering it earlier, without a medical reason, would be a red flag for me as there are some risks, including early labour, that need to be considered. At 38 weeks it may not even be possible to do a sweep as there would need to be some dilation of the cervix, which for some doesn't start happening until even right before labour starts. Also, often the procedure would require more than one sweep to really make a difference.

So what are the risks? Many care providers will suggest "there are no risks, but..." The buts are the risks. Statistically there is no risk to baby in terms of infection. However, the procedure is uncomfortable. The discomfort usually ends when the sweep is over but you can experience cramping for a period of time after the sweep is done which may confuse you into thinking its labour contractions and possibly send you into the hospital sooner than you need to be.

The sweep can also cause spotting which can increase your anxiety levels and again, send you into the hospital sooner than you planned to be.

And finally, there is a small risk of the amniotic sac rupturing prematurely when the sweep is done, and this could lead to other induction interventions.

So is a sweep an induction? Well, if you want to get specific, which I do, it's almost like a pre-induction. Can a sweep put you into labour? Ultimately, doing one sweep between 38 - 40 weeks gestations, the likelihood of labour starting quickly after one sweep, is quite low. One study suggested that labour would, on average, start no more than 4 days after the sweep. And likely need more than one to achieve that goal when compared to not doing a sweep at all. So the answer is, maybe.

What often happens, is that after a couple of sweeps, and as you approach 40 weeks gestation, care providers will discuss your options for induction. The discussion usually highlights how your cervix may not have changed and the risks of going over 40 weeks gestation. This can make you feel like your body is failing you (it's not) and that there is pressure to get baby out. Plus, being 40 weeks pregnant and not going into labour can feel like torture. I know, I've been 40 weeks pregnant in a heat wave with no air conditioning in my home. It's the worst. And I absolutely chose induction.

My only concern is, if this wasn't your original plan, it can make you feel disappointed. This is why I think it's important when having these discussions with your care provider, make sure you are expressing what your hopes are and also finding out what all the benefits and all the risks are.

So should you agree to a sweep? Ultimately that decision is up to you. What I will say is, if you already have a medical induction in play for whatever reason, a sweep can help the induction be more likely to end in a vaginal birth. The study referenced earlier, state "Our results indicate that membrane sweeping had a success rate of 86.4% in achieving vaginal delivery, consistent with previous studies."

Having a sweep done without a planned medical induction already happening, may not mean you don't still get an induction at some point. The sweep will get you closer to going into labour on your own but there is no guarantee you won't still need to go through the full set of steps for an induction including pitocin.

My advice? If a medical induction is already on the table, then absolutely, I think the benefits can often outweigh the risk. If there isn't a medical induction planned, then I will often suggest you hold off on the sweep until you have reached 40 weeks gestation and have no other medical risks such as gestational diabetes or being over the age of 35.

Want more information on Medical Inductions? I have a video for that.