membrane sweep at 38 weeks

[rareimer]

I'm hoping for a VBA2C, and my OB has recommended that my doctor do a membrane sweep next week (i'll be 38 weeks) and every week after if it doesn't work the first time.  I went to 41 1/2 weeks with both my other babies, and if I go to 42 weeks this time, it will be a scheduled c-section.  Originally, it was 41w3d, but I managed to talk the OB into waiting until 42 weeks.  My other babes were 8 lbs 2.5 oz and 9 lbs 3 oz, so I'd rather not go that long this time to maybe have a smaller baby.  (This baby also has a different dad than my first two, so I'm hoping that might make a difference too.)

With my last baby, my midwife tried to do a sweep at 41 weeks, but I wasn't dilated at all so she couldn't do it.  I don't know if I'm dilated this time or not, but baby has engaged (neither of my other babies every did.)  I've been drinking gallons of RRL, and taking EPO orally and vaginally. 

What are the chances that this will put me into labour?  I'm tired of being pregnant, and really want my VBAC, and know that my chances are better if I go into labour before my due date...but at the same time don't expect much to happen. 

[LisaSedai]

Well it didn't work for me at 38,39 weeks with my first child (c/s) and from my pathology report I had an infection of my uterus/placenta afterwards (they didn't mention it to me at the time). I don't know if the stripping membranes gave me the infection but it is one of the risks. I was GBS negative at that birth. I was GBS positive for my DD and there was no way I was going to let them strip me - in fact I refused cervical checks. Didn't want anything going up the vag to introduce infection.  Also, doing a sweep can accidentally rupture the bag of water and then you are on the clock.

I guess it does work on some people or OBs and MW wouldn't be doing it but I wonder if it just works on the ones who were about to go into labor soon anyway. If you have 2 babies who were over 41 weeks, a 38 weeker might not be done yet/ ready to come out. At least your OB isn't pushing C/S at 40 weeks.

Good luck!

[kltroy]

I'd do it.  Very little risk, may help.  Don't remember the reference offhand, but repeated weekly sweeps from week 37 or 38 onwards move up the actual delivery date by 3-4 days on average.  Good luck!  We tried sweeps with mine but was barely able to do anything even at 40 weeks.  Baby came on her own at 41+2, thankfully.

[justKate]

Personally, I would wait.  If there aren't any "signs" of progress closer to 40, then maybe, but I would give baby a chance to get to 40, esp. since she has a different dad.  Things could be totally different.  Although I don't think it's "bad" to sweep once you hit 40 weeks, but until then I would refrain to avoid the risk of infection.  Good luck with your decision and best wishes for your VBAC!

[holly6737]

I'd do it. It's not going to hurt anything, to be honest. With my second VBAC, I had a membrane sweep done at 39w0d and then again at 40w0d. Within 24 hours of the second sweep, I was in labor. It's a good thing too because my CNM's supervising OB was getting nervous! If I wasn't in labor by midweek, they were going to induce (this OB will induce a VBAC).

[jenninjapan]

Do it past 39 weeks or when you are at least 1cm or so.  It is uncomfortable and wont do anything unless your body and baby are ready.  So it could be the push your body needs or it could just be an uncomfortable 5 minutes.  By 40 weeks I had my membranes stripped as much as my dilation would allow every other night and got from a 1 to a 2 with a midwifes help.  It didnt make any difference 4 for me, unfortunately, but I know I did everything to get labour going before 42 weeks.  And even with all those fingers there wasnt any infection. 

Have you thought about going past 42 weeks?  I didnt and got a section after (naturally induced - you name it, i did it!) labour stalled at 42w1d.....but wish i would have given it more time.  Could you negotiate for NSTs and scans for placenta every couple of days once you have reached 42? (though i would only bring this up once you are past 41 weeks - the OB will most likely give you the doom and gloom speech no matter how well you and babe are). 

I dont understand why 42 weeks is such a terrible thing.  The more you look into it, the more common you find it to be.  Gestation tends to be 41weeks1d for most women which would make 42 weeks 1 week 'overdue' NOT 2......

[thorn]

Originally Posted by holly6737 

I'd do it. It's not going to hurt anything, to be honest. 

Unless, you know... it does.

http://www.aafp.org/afp/2003/0515/p2123.html (bolding mine)

"Stripping of the Membranes

Stripping of the membranes causes an increase in the activity of phospholipase A2 and prostaglandin F2α(PGF2α) as well as causing mechanical dilation of the cervix, which releases prostaglandins. The membranes are stripped by inserting the examining finger through the internal cervical os and moving it in a circular direction to detach the inferior pole of the membranes from the lower uterine segment.7,19[Reference9—Evidence level C, consensus opinion] Risks of this technique include infection, bleeding, accidental rupture of the membranes, and patient discomfort. The Cochrane reviewers concluded that stripping of the membranes alone does not seem to produce clinically important benefits, but when used as an adjunct does seem to be associated with a lower mean dose of oxytocin needed and an increased rate of normal vaginal deliveries.20 [Evidence level A, RCT]"

[holly6737]

Originally Posted by thorn 

Unless, you know... it does.

http://www.aafp.org/afp/2003/0515/p2123.html (bolding mine)

"Stripping of the Membranes

Stripping of the membranes causes an increase in the activity of phospholipase A2 and prostaglandin F2α(PGF2α) as well as causing mechanical dilation of the cervix, which releases prostaglandins. The membranes are stripped by inserting the examining finger through the internal cervical os and moving it in a circular direction to detach the inferior pole of the membranes from the lower uterine segment.7,19[Reference9—Evidence level C, consensus opinion] Risks of this technique include infection, bleeding, accidental rupture of the membranes, and patient discomfort. The Cochrane reviewers concluded that stripping of the membranes alone does not seem to produce clinically important benefits, but when used as an adjunct does seem to be associated with a lower mean dose of oxytocin needed and an increased rate of normal vaginal deliveries.20 [Evidence level A, RCT]"

Patient discomfort and bleeding should not even be considered risks. All cervical exams have patient discomfort and bleeding as a risk. Infection would be a very, very rare risk. AROM would also be rare, but if it does happen, then it accomplishes the goal, which is sending the woman into labor. I have stripped a lot of membranes. I have yet to have one patient have an adverse outcome. In fact, just last week I stripped membranes on a woman and she was in labor within 12 hours. Beautiful vaginal birth. When you are a VBAC, you have to be more aggressive with putting yourself into labor. It is true that going postdates in a VBAC birth puts you at an increased risk for uterine rupture (it just does, that's what the stats show). I'd rather strip membranes at 38 weeks onward than have to fight with an attending to get a woman a TOLAC at 41 weeks gestational age. But that's just me.

[rareimer]

I decided to go for it, that was last Thursday--and I'm still pregnant.  It was not uncomfortable or painful at all, and I had no spotting.  There was some cramping later, and the next night I had about 2 hours of painful but irregular contractions that then fizzled out.  I go back this Thursday, and will get another sweep done.  I hope it works this time!  I have the feeling that if baby is not ready, it's not going to work--and she obviously wasn't ready last week.  I really hope something happens before 3 weeks from now...it would be so disappointing to wait that long and then have a repeat c-section at the end of it.  Think labour thoughts for me please!

[LisaSedai]

ELV's to you! Good luck

[Ms. B. Sprout]

Thinking about you, Robyn, and hoping that labor starts for you very soon!

[mum2sarah]

Originally Posted by LisaSedai 

Well it didn't work for me at 38,39 weeks with my first child (c/s) and from my pathology report I had an infection of my uterus/placenta afterwards (they didn't mention it to me at the time). I don't know if the stripping membranes gave me the infection but it is one of the risks. I was GBS negative at that birth. I was GBS positive for my DD and there was no way I was going to let them strip me - in fact I refused cervical checks.

Oh boy, I never thought about the risk of infection with being GBS positive.  I just had my membranes swept yesterday and I'm GBS positive, though my levels are very low-presence (the midwives told me that under previous guidelines I wouldn't even be reported as positive because my counts were only about 1,000 and in the past they had to be something like 10,000 to be reported, but now they report any presence of GBS as being GBS positive).  Is my risk of infection increased now?  I'm just so impatient to have this baby--I'm 41w1d and have tried everything to inspire labor (rrl, daily sex, nipple stim, vigorous walking, etc.)... But I should I refrain from having any more membrane sweeps given my GBS status??

[LisaSedai]

But I should I refrain from having any more membrane sweeps given my GBS status??

Some say yes, some say maybe not

http://www.groupbstrepinternational.org/info_main.html

GBS can infect your baby before birth — even before your water breaks. Procedures such as cervical exams and stripping membranes or using cervical ripening gel to induce labor can all push GBS closer to your baby.^3-8

^{http://clinicaltrials.gov/ct2/show/NCT01180023}

A meta-analysis did not show a difference in neonatal or maternal infection rates between women who underwent membrane sweeping and those who did not. ACOG guidelines state "the risks of membrane stripping in GBS positive patients has not been investigated in well-designed, prospective studies. Therefore, data are insufficient to encourage or discourage this practice".

I was GBS in the urine and diabetic so that put my risk up. If you are low risk maybe that is why they swept you. Maybe ask them about hibiclensing the vag first?