membrane stripping - group b strep +?

[mckittre]

What do folks think about the risks of membrane stripping vs. potentially more medical induction if you're Group B strep positive?

I have an appointment on Tuesday at 41+4, and the midwife is probably going to start talking about induction and offer a membrane sweep. 

Last time I was pregnant, I did have a membrane sweep with my son at 40w, but he wasn't born until 40+4, so I'm not sure it did anything useful.  I was group B strep + with him as well, but not well-informed enough to think about the risks of infection or declining the sweep. 

This time, I haven't had any internal exams at all, I was so sure baby would show up by now.  But I'm getting close to that 42 weeks that makes everyone nervous.  My midwives will go along with whatever I want I think, if I show up informed enough and forceful enough about it.  The infection risk of the sweep makes me nervous, but pitocin induction makes me nervous too, and I don't want to lose my last chance for something a bit less invasive to move things along.

[allisonrose]

Oh that's a tough one. One thing I would wonder about in your position is whether sweeping the membranes is associated with rupture of membranes early in labor.

I was GBS+ with my first and my water broke before labor really got going so ended up being augmented with pit. I didn't have my membranes swept: I'd declined internals as well and was 39 weeks when my water broke (no pressure yet to get baby out).

Crossing my fingers that you go into labor on your own between now and Tuesday!

[dejagerw]

Are you planning on receiving antibiotics during labor?  I personally would get the sweep to avoid the pitcoin if I was planning on receiving antibiotics for the strep b.  I'm not sure if I wasn't planning on getting the antibiotics during labor.

[47chromosomes]

I was in a situation virtually identical to yours with my recent birth.  I am also GBS+, and I was over 41 weeks, and totally shocked I did not yet have a baby in my arms--my other sons were born before their dates.

Well, my midwives and I decided not to do membrane sweep, despite how uncomfortable I was at the end of my pregnancy, until 41 week mark came and went, and then both me, my home birth midwives, and my hospital CNM agreed the benefits would out weight the risks.  I was swept at 41+2 and +4.  I went into labor the afternoon after the second time I was swept.

It ended up being a bad idea.  We transferred to the hospital when i was 10cm with a lip purely because I had a bad feeling.  Antibiotcs were started at that point because of hospital policy.  Good thing.  Soon baby was in major distress.  We had other things going on that were making baby unable to come out dispite full dilation and intense urge to push, but 4 hours later he was born in respiratory distress, and I had a high fever as well from uterine infection.  We were kept at the hospital for days after on antibiotics.  anyway, I'm fully a proponent of "don't stick anything up in your cervix when you are GBS+' now...  obviously.  It could have turned out really bad for both of us, and I am just so thankful for the intuition i had to get myself to a hospital. 

[mckittre]

Kim - thanks so much for sharing your story.  How scary!  I will be giving birth in a hospital, but obviously wish to avoid infection anyway.  Maybe the sweep isn't worth it, especially since it's not necessarily effective, and is risky.

Do you think the infection risks of a simple cervical exam are as bad as the sweep?  I'd like to know my bishop's score if I'm thinking about induction.  And what about sex?  My husband and I have been trying to "encourage the baby along" that way, but I suppose it might have similar risks?

[47chromosomes]

Originally Posted by mckittre 

Kim - thanks so much for sharing your story.  How scary!  I will be giving birth in a hospital, but obviously wish to avoid infection anyway.  Maybe the sweep isn't worth it, especially since it's not necessarily effective, and is risky.

Do you think the infection risks of a simple cervical exam are as bad as the sweep?  I'd like to know my bishop's score if I'm thinking about induction.  And what about sex?  My husband and I have been trying to "encourage the baby along" that way, but I suppose it might have similar risks?

Well, I can't answer your questions regarding cervical exams or sex, 'cause I just don't know.  I do know that when I was having my membranes swept the first time my midwife was in there for almost 5 minutes just stretching and sweeping... my cervix was dilating as she was doing all this so it seemed worthwhile to be very thorough.  The second sweep was by my CNM and much quicker.  At my 2 week follow up with the CNM we talked and processed for a long time, and she told me her and the OB that was called in to help with my birth felt the fever and baby's distress was because of chorioamnionitis, or an infection/inflamation of the the amnion and the uterine wall, so it makes sense to me that a finger up in my cervix separating the amniotic sac from the uterine wall would be the culprit in getting infection going there.  I guess I would think that simply dtd would be okay, especially with a mucus plug in the way, plus it's not like dh's parts end up inside the cervix?  But I would think that a cervical exam could introduce bacteria as the practitioner needs to insert fingers in the cervix in order to judge dilation, though I would assume it would not be as invasive as a stretch and sweep.  For myself, if we have more children I will refuse cervical exams unless I am in labor and on antibiotics, and the information is truly needed, but then I'm a little traumatized from our experience, so...  One other thing that probably lent to our infection was my membranes were ruptured several hours into our labor, and yet we had several hours left to go.  Anyway, sending labor vibes your way and hoping things just get going already!  (C'mon little baby)  :) 

[mckittre]

Thanks for all your thoughts Kim.  My midwives are willing to work with me even past the 42 weeks if necessary, so I think I'll just stick it out with nothing more invasive than an NST unless I see some medical reason to get induced.

[MegBoz]

I was GBS+ and chose to have a membrane sweep at 41W4D.

I don't think the risk of the sweep is all that much higher than the risk of a regular old vaginal exam. Yeah, it's better to keep VEs to a bare minimum if you're GBS+, but I really thought the risk of the sweep was just low, on the whole, and that it was worth trying. And certainly much MUCH lower than the risk of a pitocin induction!! (especially for a first-timer, as I was.)

It worked for me - I was already 3 cm, went to 4 as she circled to do the sweep. Ctrx started 2 hours later and he was born about 6 hours after that. I was going to go back for another sweep in about 12-24 hours if it didn't do anything since some studies show repeated sweeps can be effective (and one of my MWs said she has found that for first-timers, it takes 2 sweeps.)

I had a hospital birth with CNMs & their "policy" was induction at 42W0D, but at least one of the MWs outright TOLD me that she doesn't think it's a problem to wait a little longer if I wanted to. But, again, I figured sweeps were worth a try.

Originally Posted by 47chromosomes 
I do know that when I was having my membranes swept the first time my midwife was in there for almost 5 minutes just stretching and sweeping... my cervix was dilating as she was doing all this so it seemed worthwhile to be very thorough.

Oh wow, that sounds to me like much more than a "sweep" - & more like a manual stretching. My sweep was literally like 2 seconds, if that. I mean, she literally drew a circle with her finger and was back out again - super quick. Also didn't hurt (I had heard that it does) just uncomfortable because she has super tiny hands and was pushing hard to reach up into the cervix, LOL, for which she apologized.

[mckittre]

Well, I ended up choosing to wait it out, rather than try to hurry things along with a sweep (didn't have any exams until labor either).  She came at 42+1, all on her own, perfectly healthy, and not at all overcooked. 

[47chromosomes]

[breen]

Hi there have u had ur baby did u have a membrane sweep

[breen]

Glad u had ur baby and all worked out well... i would have advised against the membrane sweep as me and my wife had one and it was a big mistake.  CONGRATULATIONS.:)