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

Uncategorized

Why it takes so much more than just hiring a doula to have a good birth

 

As we hear more and more about doulas, it’s easy to get the impression that having a doula will somehow magically lead to having a better birth experience. It often feels like one of the things on the ‘positive birth’ checklist; hire a doula, do a hypnobirthing class, read a birth book etc. and it’s true that having a doula can significantly reduce the risk of interventions and birth trauma, but that is largely due to the work that a woman does with her doula, and by herself, during pregnancy.

What we have learnt from women

Through our years of working as doulas in Greater Manchester, we have come to realise that birthing within the maternity system can and often will come with complications, barriers and difficulties. One of the best ways to combat these hurdles is to know what’s coming. Knowing how the maternity service works and knowing their policies gives you a head-start and also shows you that there are other options, such as birthing outside of the system. Knowing your rights and your options are the first steps to having a positive birth. A doula can support you in learning all of this, provide you with information and books on the subject, they can give you information about how the system works and how you can navigate it, and tell you all about the birth process, but it takes you to make the difference. 

Women who have had a traumatic birth in the past often come to us believing that their body failed them and that they need to do something different this time. Hiring a doula is a great start because it gives them the space to talk openly about what happened last time, a place to wonder whether those things were necessary or completely unacceptable, a place to cry and ask questions. Once women learn and start to believe that the process of birth is not inherently dangerous, and is not a medical event, it leads to an awakening that is incomparable. Getting to this point though takes a whole load of courage and openness from that woman, and when that woman is heard, she can find the answers she’s been looking for. So many of the women we listen to were having a perfectly normal, healthy pregnancy and labour until it was interfered with by medical staff, and realising that sometimes complications in birth are caused by the interference is key to protecting themselves against it. Their body did not fail them, the system did.

We have been programmed to think that authority means safety, but in so many instances we have been proven that in fact, the opposite is the case. When we trust someone else’s word over our own feelings of discomfort, we are left feeling violated. When we look to someone else for the answers, especially in birth, we are handing over our control and ignoring our intuition. We often hear in women’s stories that the parts that felt the most traumatic are when they went against what their body was telling them, and just did what they were told – so far I haven’t met a woman who regretted following her body. Our intuition is what has kept us alive and safe for so long, and birth is such a private and personal event that it makes very little sense to look for external approval or guidance. When we trust women, birth is safe. A doula is often the only person in the birth room who is solely focused on you, as the birthing woman, and having someone who completely believes and trusts in your body at that moment can make a huge difference to the energy. Questioning the authority of medical staff is necessary to get the birth you want, because going with someone else’s flow will inevitably lead you down a path that makes you uncomfortable or feels wrong. You ARE the authority, and you DO know best, even if you have never birthed before. Birth is a hormonal event and a normal bodily function – if you were monitored, observed and examined whilst trying to have an orgasm it probably wouldn’t go very well, would it?

Birth is led by the hormone oxytocin – as are orgasms – and for oxytocin to be released it needs the right environment. For women to release oxytocin they need to feel safe, warm, unobserved and undisturbed, so when you put a labouring woman in a brightly lit hospital with a bunch of strangers, unfamiliar loud noises and smells, and continue disturbing her with monitoring and examinations, it’s no surprise that birth takes longer or is more difficult. When birth is undisturbed, endorphins are released to match the intensity of labour as it builds – this is what makes labour pain manageable. When we interfere with the body’s natural pain killers, we cause more harm than good. Understanding what birth needs is a great foundation for planning where you want to give birth, and who you want to be there. Doulas can be really helpful in supporting you to navigate the maternity system when you are “going against medical advice” or just declining what you are being told is “how they do things”.

What we wish women knew before giving birth

We wish that all women knew that they were in charge of their body and their birth, that they didn’t have to agree to anything that feels uncomfortable or compromise with medical staff. We wish that women knew that birth doesn’t need to be fixed or monitored or sped-up and that they have the right to say no or to seek the care they are not being offered. We wish that women who have had traumatic experiences knew that they were not alone and that what happened to them was not okay. We wish that women weren’t expected to be “good girls” and do what they are told even when it feels wrong and that it’s okay to be “difficult” or “bossy” – in fact, that shows a belief in yourself, and the ability to assert your boundaries!

The work we do is to create the space for women to ask questions, to speak up and use their voice, to take what they need and to take back their power. We listen to women’s traumatic birth stories, we help them to write birth plans, we share information and experiences, we are behind them when they are navigating the system, or choosing to birth outside of it, and we have that unwavering trust in the birth process and in the woman in front of us. 

We support their choices, we hear their voices and we are privileged enough to witness their power.

But ultimately, what makes a positive birth is a woman who is ready to go deeper, to question what she is being told, and is fully supported in her decisions.