Introduction:
Labor and childbirth are physiological processes, and most women have natural and spontaneous onset of labor. A pregnancy reaches full term by 37 weeks. However, some pregnancies can continue past 41 weeks. Such pregnancies are called post-term pregnancies. Gestations past their due date may require artificial inductions of labor. A post-term pregnancy can increase mother complications and cause respiratory distress and trauma to the fetus. The placenta becomes less effective in delivering oxygen and nutrients to the baby, increasing the risk of stillbirth (death of a fetus before delivery). So an artificial induction of labor is required. Labor induction requires stimulating uterine contractions artificially to help with the onset of labor.
There are many mechanical and surgical methods used to induce labor. Membrane sweeping is one such method used to induce labor. This procedure was introduced in clinical practice in the 17th century and has been practiced for over 200 years. A membrane sweeping is also called membrane stripping or stripping of the membranes. This is a conservative and relatively noninvasive procedure. Most women only require a single cervical sweep to induce labor.
What Is Membrane Sweeping?
A membrane sweeping is a nonsurgical intervention done in pregnant women to induce labor naturally for term pregnancies (37 to 42 weeks) or post-term pregnancies (more than 42 weeks of pregnancy). Sweeping means to move with an object. So membrane sweeping means moving the amniotic membrane (which surrounds and protects the fetus in the uterus) using the doctor's fingers. Membrane sweeping helps the body to release chemicals called prostaglandins which soften the cervix and starts preparing the body for labor.
Membrane sweeping is done in uncomplicated pregnancies around 37 to 40 or 42 weeks. This method can prevent the patient from delivering through the cesarean section. The procedure negates the need to induce labor along with drugs or by using other invasive methods.
How Is Membrane Sweeping Performed?
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Consent is taken before performing the procedure.
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The healthcare professional performs the procedure during the cervical or vaginal examination.
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The doctor inserts their gloved finger into the vagina up through the cervix (a lower portion of the uterus, which forms a canal between the vagina and the uterus) of the patient.
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After inserting the finger, the doctor will sweep around the cervical opening in a circular motion.
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This continuous circular sweeping motion will loosen the amniotic sac (a fluid-filled sac containing the fetus) from the uterus and separate the amniotic sac from the walls of the uterus without breaking the amniotic sac.
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This separation of amniotic membranes from the uterus speeds up labor by producing the hormone-like substance called prostaglandin, cytokines, and phospholipase from the intrauterine tissues.
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Prostaglandin promotes the onset of labor by acting on the cervix to soften the cervix and start dilation. The stretching of the cervix initiates the release of oxytocin, increasing uterine activity. Oxytocin is a hormone that stimulates uterine contractions.
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The cervical changes and uterine activity stimulates uterine contractions leading to the onset of labor.
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This procedure can be done only when the cervix begins dilation and cannot be done in case of a closed cervix.
Is Membrane Sweeping Painful?
The procedure takes only a few minutes but can be slightly painful and uncomfortable. A slight discomfort should be expected during and just after the procedure. If the procedure works, then contractions begin within a few hours.
Can the Pregnant Person Go Home After the Procedure?
Yes, the patient can go home after the procedure is performed. This procedure is usually performed in a hospital setting. After the procedure, the patient will be sent home and asked to wait around seven days. Labor usually starts within 48 hrs for most people.
What Happens After Membrane Sweeping?
They might experience light bleeding after the procedure. Some people experience cramping, mild discomfort, or contractions afterward. It is essential to inform the doctor if severe pain or heavy bleeding occurs.
For most people, Labor starts within 48 hrs after membrane sweeping. Some common signs are pelvic pain, cramping, contractions, light bleeding or spotting, and water breaking. Since every person and pregnancy differs, the onset of labor cannot be predicted.
When Is Membrane Sweeping Not Recommended?
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Membrane sweeping cannot be performed in high-risk pregnancies.
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Pregnancies with premature rupture of membranes, previous cesarean section deliveries, or multiple pregnancies.
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Pregnancies contraindicated for vaginal delivery.
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Infections like cervical bacterial infection and active herpes infection.
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Conditions like placenta previa, where the placental layer covers the cervix opening, and vasa previa, where the unprotected blood vessels from the umbilical cord cover the cervical opening.
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In case of fetal abnormalities, abnormal fetal positions, or any pelvic abnormalities.
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A membrane sweep is also not recommended for a woman requiring a cesarean section due to other underlying conditions.
What are the Risks Associated With Membrane Sweeping?
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The sweeping membrane procedure is generally safe.
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Discomfort may be felt during the procedure, and there are chances of cramping afterward, which can be confused with contractions.
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Bleeding can also occur after the procedure.
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In some cases, there are risks of introducing bacteria from the vagina of the mother to the uterus, thereby increasing any chance of inflammations or infections (intraamniotic infection).
What Are the Benefits of Membrane Sweeping?
The benefit of membrane sweeping is that it can induce labor naturally, and a medical or planned induction can be avoided. A planned or medical induction entails receiving medications to start the labor process.
This procedure effectively induces labor when the pregnancy is past the delivery due date. Some women may require multiple sweeping procedures. Membrane sweeps are more effective if the cervix is already thin and dilated and the patient is already in the early stages of labor. However, membrane sweeping cannot be guaranteed to start contractions or induce labor.
Conclusion:
Membrane sweeping is a safe, effective, and nonsurgical procedure to start labor in most pregnant patients. The process involves moving the amniotic membrane using the surgeon's fingers; it does not affect the labor process or fetal and maternal health negatively. Separation of the amniotic membrane can speed up the labor process. While the procedure can be slightly uncomfortable, they are a great way to get into labor naturally.
