Birth, Uncategorized

Sweeps ARE induction (…and there is nothing natural about them)

There is an abundance of misinformation given to women about the infamous ‘stretch and sweep’. This misinformation leads women to believe that a sweep is completely harmless, and in some cases necessary! The feeling that comes from these kinds of ideas is that labour needs help to start and that it would be dangerous to do nothing, undermining the fact that labour is a perfect system that involves lots of hormonal changes before any obvious signs of labour can be detected.

 

Misinformation Exhibit A:

A poster that was displayed in the waiting room of a maternity clinic

Where do I begin? 
Maybe from the top and work our way down.

 

1.Let’s start with due dates. Due dates are calculated on the assumption that all women have the same length menstrual cycle. This is simply not the case, they can differ hugely from woman to woman, month to month. The “normal” range of being full term is between 37 – 42 weeks, so that is already a wide window but it doesn’t take into account how many women are induced due to the fear of going “overdue” (like a library book). So in reality, if we were all left to our own devices this window of normality would probably stretch much further. Whilst we’re on the topic of being left to our own devices – have you ever heard of a woman being pregnant forever? I haven’t. I have heard so many times “I’ve never gone into labour before so I don’t even know if I can” or “I wasn’t going into labour so I had to be induced”. There is no reason to think that your body wouldn’t go into labour naturally given enough time and patience, it is the healthcare system’s incessant need to interfere that undermines women’s confidence in this.

 

2. The next point of focus on this awful poster is the second line; “want to start labour naturally?” … WHAT?! The only natural way for labour to start is to leave well alone because anything that you try to bring labour on before it naturally would, isn’t labour ‘starting naturally’. The other important thing to ask here is why would we want to start labour early? The only reason women feel pressure to “kick things off” is because of the information they are being given about due dates and going past them. That pressure is coming from the maternity service, so they are offering a “solution”. Sweeps are often offered as a way to “avoid induction” but a sweep IS part of induction.

 

3. So you’ve so far been told that approaching your due date means that you must want to get labour going, and that having someone put their fingers inside you to “sweep” around your cervix is a “natural way to induce labour”, and that you should talk to your community midwife about it. I’m not sure about you but the information they’ve given so far isn’t exactly filling me with confidence that talking to them about it would benefit anybody. It is easy to tell from this poster that birth is not seen as a normal bodily function because there is a continuous want to DO something or measure something or fix it. Midwives have to follow the policies of their hospital, and clearly, this hospital (like many others) see birth as something to be managed, which includes inducing labour at all costs. Offering a more “natural method” of a sweep (rather than a chemical method) seems like a compromise, and women are expected to take this compromise to avoid being pressured into further induction techniques. The idea that you can only avoid a formal induction by having a sweep suggests that saying no isn’t enough and won’t be respected. But here’s the thing… you don’t have to compromise. If you don’t want an induction, you don’t have to have one. You can tell your midwife that you will not have an induction and therefore don’t want to discuss it any further, and if they do bring it up against your wishes then you can tell them that they are harassing you. There are many, many ways to avoid the pressure to be induced, but having a sweep isn’t one of them because it is a form of induction, and once you have said yes to one form of induction, it becomes much harder to say no to the rest.

 

4. ‘Available at your local clinic from 40 weeks pregnant’ despite the fact that most women who are 40 weeks pregnant have already been offered multiple sweeps. The main purpose of a sweep is to avoid going post-term (two weeks past your only 5% accurate due date), and the reason for that is based on the increased still-birth rate associated with post-term pregnancy. The research for this is varied, but there are 10 years worth of CEMACH, CMACE and MBRRACE reports that actually show a lower percentage of stillbirths in women who gestate for 42+ weeks, compared to women who gestate for between 37 – 41 weeks.

 

5. ‘Successful for 8 out of 10 women’… I’m not sure where they have found this stat or what they consider to be “successful”. The most recent Cochrane review on the topic, done in February 2020, states “Membrane sweeping appears to be effective in promoting labour but current evidence suggests this did not, overall, follow on to unassisted vaginal births.” So it might be the case that a sweep can trick the body into contracting, but is that really a success if it just leads to a longer, more exhausting labour with more interventions? 

A stretch and sweep can only be performed if the cervix is “favourable”, meaning your body is already preparing for labour (so it’s probably imminent anyway), which means that for women who do go into labour following a sweep it might be that their body was already ready to go into labour and would have done so regardless of whether they had the intervention or not. There is no way to know this, but if you ask around I’m sure the majority of women who went into labour after a sweep has had more than one sweep previous to that one and did not go into labour, so it could have just been a coincidence.

The review also found that women who had a sweep were “less likely to have a formal induction”, but this only perpetuates the notion that a formal induction is inevitable and non-negotiable. What actually makes any form of induction less likely is giving women all of the information and breaking the cycle of thinking that women’s bodies are incapable of going into labour on their own. 

 

6. ‘No known side effects’ … this is a blatant and dangerous lie.

Stretch and sweeps can cause;

  • Pain during and after the procedure
  • Vaginal bleeding
  • Painful contractions for the following 24 hours without leading to labour
  • Longer labours
  • An increased risk of infection
  • An increased risk of rupturing the membranes

And for what purpose?

The Cochrane review found that it did not generally lead to labour within 24 hours, and it did not reduce the incidences of further intervention such as the use of synthetic oxytocin and instrumental births. The very fact that a sweep can cause contractions that aren’t effective will lengthen labour, and there is often a lot of pressure put of women who have been contracting for 24 hours, makes you wonder whether there are actually any known benefits.

 

7. ‘Unlike curry!!’ 

This is clearly meant to mock the more “natural methods” of induction, but as I said at the beginning, anything that you do to try to bring on labour is a form of induction, whether it is chemical or otherwise so they fall under the same umbrella, except eating a curry doesn’t involve someone putting their fingers inside your vagina. The theory behind the curry method is the irritation spicy food can cause to your bowel, which could potentially trick the body into contracting. But, unlike sweeps, eating curry (if you like curry) has many benefits and not just to pregnant women! These include;

  • Satisfying hunger
  • Spicy foods tend to release endorphins which can give you a bit of a buzz
  • Cooking curry can be really fun
  • It tastes great
  • If you don’t like it or it is causing you discomfort/pain, you can stop eating it instantly without having to tell anyone (unlike having a sweep where, if you wanted it to stop, you would have to rely on the midwife performing the procedure to listen to and respect your decision, which isn’t always the case)

 

In conclusion, this poster is a load of shit and is a perfect representation of how frequently women are misinformed in pregnancy and how flippantly this is done. It shows how easily things become routine without really being based on any solid evidence. It also says a lot about the systemic mistrust in women’s bodies and the belief that they need help to perform the most natural of bodily functions.

If you find yourself being offered or pressured into a “quick sweep to get things started” or any other kind of induction, take whatever time you need to go through the BRAIN acronym and consider the benefits, risks and alternatives to what is being offered, check in with your intuition and ask yourself (and your midwife if you want) what happens next if you accept the intervention and what happens if you decide to do nothing. All of this information will help you to make the decision that is right for you.

If you want to chat about any of these decisions or navigating the maternity system, feel free to get in touch with us and book a ‘holding space’ session by emailing hello@greatermanchesterdoulas.com

 

Related Sources:

https://billieharrigan.com/blog/2019/5/6/birth-hijacked-the-ritual-membrane-sweep

https://www.aims.org.uk/journal/item/induction-at-term

https://www.sarawickham.com/articles-2/unpacking-sweeping-policies/

https://www.aims.org.uk/journal/item/ten-things

https://www.cochrane.org/CD000451/PREG_membrane-sweeping-induction-labour

https://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12011000682&LinkFrom=OAI&ID=12011000682

Birth, Birth Story, Doulas

The wild home birth of baby Seren

Today is the 2nd anniversary of the wild home birth of baby Seren. I know we’re not meant to have favourites… but I loved supporting Naomi and having the privilege to witness her give birth in her wild power. What better way to celebrate than by sharing her story. 

Naomi got in touch with us in her third trimester after she found herself feeling unsupported by her midwives. She is the perfect example of a women who recognised what she needed and responded to those needs, in both her pregnancy and in her birth. She centred herself completely in her birth and it resulted in a powerful experience, completely on her own terms. A wonderful, wild home birth. You rock Naomi!! Happy birthing day 🥳

“I went to bed after feeling restless and uncomfortable, and had a fairly restless sleep. In the morning I felt dull, mild, period type cramps. I told my partner and asked him to keep his phone on as he left for work.

I then paid little attention to this as I focused on my toddler. We went to playgroup, where I kept moving position as I couldn’t get comfortable; choosing to kneel rather than sit, and continued to have mild cramping.

We left around 11.30am. While pushing the buggy I had to keep stopping due to the increased intensity of these feelings. I got us home and made lunch and had the urge to sort, so I quickly tidied and cleaned while thinking, “I need my toddler to nap.” I lay down with him and nursed him to sleep. During this time I concentrated on noticing the cramping, and realised they were every 10 mins now, and getting stronger, but still extremely manageable.
I thought maybe I’ll meet my baby tomorrow.

I decided to call my partner around 12.45pm just to let him know I thought I may be in very early labour, but not to bother coming home, as with our first baby I’d had two episodes that fizzled out at 38 and 40 weeks, with him finally being born at 41+1. He decided he would come home anyway.

I also called my neighbour to ask that if things continued could she take my toddler on the school run, before my friend came for him after work at 5pm.

My partner arrived home around 1.30pm, and I asked him to pick up some things from the shop while our toddler was still asleep. At this stage my attention was on organising for “if I go into labour” and not really on “I am in labour”.

When our boy woke up I would take myself just out of sight for a contraction as I was now having to give attention to them. I leaned on the kitchen surface, furniture and doorways. In between contractions I just carried on caring for and interacting with my toddler. I told him he was going with our neighbour to do the school run, and he was excited about that.

He left at 3pm. I had a shower, listening to music and leaning into the walls during the two surges I had there. I washed and dried my hair, and shortly after that my partner started timing my contractions.

They were five mins apart. I was leaning on surfaces, doorways and him for these now, and although requiring my concentration they felt good. I was relaxed and talking between them. We sat down to eat some soup around 4pm. When I could feel a surge coming I’d get off the chair, lean into birth ball, and then return to the meal.

woman in birth pool holding her partner

My partner asked if I wanted the pool filling, to call the midwife, and Lori our doula. I initially said no to all but then asked him to get Lori to come in half an hour. This was when my toddler would be collected by our friend and I thought things might move along once I knew he was with her. I wasn’t “in the zone” and therefore couldn’t believe I’d be meeting my baby soon!

When Lori arrived she’d had a busy day and I told her to have a lay down, as, “I’m only very early on…”

Things quickly felt more intense, and I took myself upstairs without saying anything. It was dark, and I put on some fairy lights and carried on listening to music. I went into the small spare room where I had set up the pool, and I enjoyed being alone, having several surges there and feeling very calm and fuzzy.

My partner came up to see how I was and I held onto him. He showed me a photo of our son having a good time with the neighbour’s kid but I couldn’t focus on it. I called for Lori to come upstairs and she sat in the room with me crocheting in the corner. 

Around 4.30pm I agreed to him calling the midwives but I didn’t want them to come yet. As it was we didn’t get through for a while and when he did they said the team would call back. My contractions were building and becoming more intense. We got a call back around 5pm and I was told to come into hospital due to staffing. I was speaking between contractions but another one was coming so I said “speak to my partner” and handed the phone over. He said I was not going to come in. They agreed to check availability again.

women standing on sofa holding partner and giving birth
“Standing on the sofa like you do”

I then felt a shift in gear, my water broke, and I pulled at my trousers to see – I had the mucous plug/show and my inco pants had held the gush of waters. Then around 5.20pm I said to my partner that the baby was coming and to call the mw back. They decided to send an ambulance.

My body was on automatic, I felt intense pressure in my pelvis, I could feel my sacrum making space and I felt like I was going to poo myself, the feeling of bearing down made me cry out loud low sounds, I felt as if I was singing. I was stood on the sofa at one point- my body moving about where it needed to go. I looked at the pool and asked if I could get in… No chance! It was under minimum.

Lori was calmly topping it up with buckets of water. In the next couple of contractions I could feel my baby’s head nudging down, and I felt SO much pressure and intensity. I was told the pool was on minimum, so I got my partner to check she was just crowning and her head wasn’t out. As soon as he said, “Yep, just crowning”, I jumped in the pool.

The relief was instantaneous. I was leaning over the edge on all fours holding my partner tight. I felt suddenly overwhelmed as my body was taking over, then one more massive surge, and I knew my baby’s head was out. I said, “Her head her head is out oh my god oh my god”, then I flipped onto my back, and back to back contractions, she slipped into the water. I said “get the baby!!” to my partner. He passed her straight to me, I held her on my chest and she did the loudest cry! I rubbed her with a towel vigorously, and kissed her head.

I’d thought I’d want to stay in the pool to deliver the placenta but I was too hot and not comfy, so I climbed out and sat on the sofa, where we were wrapped up together. I wanted her to feed to encourage the placenta to be delivered, so my ideas of breast crawl etc went out the window. She fed a little and would pop on and off, taking me in and crying.
Just as the control room said the paramedics were nearly with us I felt a contraction coming so I stood up holding my baby and asked my partner to put a bowl on the floor under me. I felt a slippery movement, and then a bigger fuller feeling and plop! Out came the placenta into the bowl. Less than half an hour after she was born.

I got two hours skin to skin just with my daughter – no one took her to be weighed, and all checks were done with her on me. We declined transfer in to hospital and a mw came to see us in the early hours. It was an amazing way to meet my baby earthside.”

home water birth
Welcome to the world baby Seren!