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Old Sep 24th, 2010, 05:32 AM   1
lexi88
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Very interesting... about sweep's.


My friend (who is a MW) has sent this to me via email so i copied and pasted it for you

DeLee (Principles and Practice of Obstetrics) writes: "Occasionally in a primipara, the head will be deeply engaged, but the cervix is far back in the hollow of the sacrum and very thin, the membranes are tightly stretched over the head and there are no forewaters . By pulling the cervix gently to the middle of the pelvis, separating the membranes around the lower uterine segment for 2 inches, and pushing up the head a little to allow some liquor amnii to run down and make a pouch, the mechanism of labour is started right and the pains improve at once."

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If amniotomy is safe (i.e. cx dilated and effaced, well applied to vertex, low station), and mom agrees, I think amniotomy induction is the appropriate thing to do. It's a risk/benefit analysis - I see very little risk to the procedure and lots of benefits.

I agree. IN SELECTED CASES as you mention (far from hosp. well dilated, bulging bag, history of rapid labours etc etc). I would sure like to make certain she is at term, and the head is WAY down there and would like to have some signs of uterine irritability first -- the more the better.

It's been done around here under those very tightly defined circumstances. Usually stripping membranes is done early AM or day before and some add an herbal tincture for a couple hours first. One really hopes it works and we get a good labour pattern going and don't end up with no labour (or lousy labour) and PROM. and if any question of dates I wouldn't think of it.

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Hi! I love the topic of stripping membranes!!
First of all I wish it had a better name, like "separating" the membranes, because "stripping" sounds so painful.
I am a direct entry, homebirth, relatively non-interventive midwife. I think that stripping membranes is a fabulous was to get a labour started, when a lady is overdue, or needs to get her labour going for some other reason.

A finger, or two, are placed inside the cervix, and swept around as far as the fingers will reach. What happens is that the amniotic sac is separated from the cervical wall, thus releasing prostaglandins into the blood stream. If it is to work, it usually works within three days. If we see a little blood after the exam, that is a good sign that it will work. You can sometimes feel the membranes separating. It feels shiny, or squeaky. When I can feel that, it is more likely to work. I have a very high success rate, but then I almost never do it unless mom is overdue.

I would do it at 42 weeks, or if I had a client with lessening amniotic fluid and non-reactive baby. Any signs of postmaturity or a labour-support client who is up against any kind of chemical induction. I would strip membranes for someone who's only other choice was to get a biophysical profile, and NST, and hospital induction. Better and cheaper to get the baby born, in most cases.

Con- very small chance of breaking water. It is sometimes very painful. I do it slowly, with informed consent, calmly, explain every step. The slower it is done, the less the pain. It doesn't have to be painful.

Pro- better in my opinion, than any other means of induction, with virtually no side effects. Castor oil gives terrible diarrhoea, which may last throughout labour. Breast pump is often very effective, but gives a brand new mom very sore breasts, and can get baby off to a bad start Herbs often don't work. Most of the other stuff doesn't really work. Drugs -- well, do I need to say anything about the side effects of drugs? Stripping can be done at home, is safe. The worst thing that can happen is that it doesn't work. The consequences of postmaturity are so much more serious than membranes stripping, that I never understand what the reluctance is about. I would not strip an unripe cervix, mostly because I don't think it would work, and because it would be very painful. I have heard horror stories about doctors who stripped without consent. I think that is unethical. It was done to me with my first baby without my consent. (It did work.)

Once it has been determined by caregiver and client that baby needs to be born, then I would vote for membrane stripping, first. It is the most effective means, with the least amount of side-effects. it doesn't start any time clocks, or cause any harm (in my opinion.) If it's being done for doctor or midwife's convenience, or because mom is impatient, well, that is a different subject altogether.

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I take my time, am gentle, and slow, but I really go in, if I can. If I get blood (or mucus plug) the success rate goes way up. I usually have them sit on their fists, for a better "reach". Sometimes you really have to walk a posterior cervix down, so that you can get in. I have also found that if the baby is not ready to come, mom off on dates, etc, then it doesn't work, and if the cervix isn't ripe I usually don't even try.

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For a better picture, I'll often explain it this way to my clients: To envision stripping the membranes, imagine a filled water balloon (BOW) inside another balloon (uterus); you want to loosen any "sticking" between the two balloons by putting your fingers through the opening of the outer balloon (the cervix) and sliding your fingers between the two layers -- just a little ways though...

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Formation of the forebag of waters helps to start labour. Squatting may help to form the forebag.

Well, I figure you do a "good one" if you're going to do one at all. Must be good indications and mom must have been given informed consent. Never do it preterm, with a feverish mom, or if any suspicion of low lying placenta or previa....

That said: When mom is ready and relaxed (as much as possible), start as if a usual internal exam. It helps a lot if the mom can be in a position to give you a greater reach -- lying on firm surface with bottom elevated on low pillow helps. Using sterile gloves, and sterile technique, (gently) put one and then two fingers into the cervix. You will attempt to "follow the cervix around", loosening the membranes from their attachments. As you slowly do this, gently stretching the cervix, you should feel it opening and relaxing. (Often you can only get one finger in at first, after a minute, the cervix will open another few centimetres). Moving gently and slowly, you should gradually be able to move your finger(s) more deeply to the sides, separating the bag of waters from the lower uterus... take your time, be very gentle, move slowly -- five minutes is not too long -- stop and wait (or back off) if it's too uncomfortable for the mom. Move your fingers outward, to the sides, not upward toward the BOW. STOP if you feel firm adhesions, or a gravely surface (this might be placenta).

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Often folks will say that sweeping the membranes doesn't work -- but (often) they just don't get in there deeply enough or spend enough time to make a difference. If you take your time at this, you might find the woman only 2 or 3 centimetres dilated at the beginning, and 4 or 5 with good forewaters formed by the end. I can often get two knuckles deep, most of the way around. If you get this far, it's an excellent bet that labour will start within 24 hours -- and probably sooner than that! the mom may begin cramping immediately, often this continues into active labour within a few hours.

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You are loosening the plug, and will probably carry it with you as you withdraw your hand. It's a good sign that you stripped the membranes well. Let the mom know she may find more bloody show through the day. If labour doesn't begin within 24 hours, the plug should reform.



 
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Old Sep 24th, 2010, 05:55 AM   2
jollygood000
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I just had a good read of this, its quite interesting isn't it... maybe the fact that they are waiting until Im 10days post date for my sweep is a good idea it might kick start labour straight away... when I was getting the contractions last night I checked my cervix, it was difficult as my tummy was so hard it was in the way lol but it felt much much lower and I could easily reach the amniotic sac, I think I was probably about 2cm dilated but not certain, I dont wanna check today in case its gone back to how it was

xx



 
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Old Sep 24th, 2010, 07:23 AM   3
going_crazy
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This is very interesting, thank you. I have a sweep booked nex weds when I will be 38+5. The reason it is being done early is because I have GD and I have also had a previous c-section, which makes other forms of induction difficult (I am not really allowed drugs to induce labour because of scar rupture).

Although I won't be 40 weeks, I think that because this is my 4th baby, my cervix may be ripe enough for it to be successful!

Good luck to all others having sweeps xxxxxxx



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