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The Truth About Stretch and Sweep's

Today I scrolled on social media and one post in particular caught my eye, instantly fuelling a fire in my belly which has been burning inside of me all day. A woman had shared a photo taken in the waiting room of her GP surgery, an NHS GP surgery. A seemingly innocent, supportive and informative poster offering women a lifeline as they approach the end of pregnancy, tired, heavy and eager to meet their new baby. I wonder how you might feel seeing it, if you were in that waiting room at 39 weeks pregnant?

I'm sure to most people, maybe even yourself, it seems like a simple offer of support to encourage your baby Earthside 'naturally', but I need you to know the truth, and the truth is that the information on this poster is misleading, untrue and coercive.

How can you make an informed decision about yours and your baby's care when the information provided is unreliable? It is completely unfair to put women and their families in a position where they feel they are making an informed choice, to present an option as risk free and effective 80% of the time, when we have evidence which shows this isn't true!

What do you mean Steph - surely if it were untrue it wouldn't have been carefully laminated and displayed in a doctors surgery waiting room? Surely we can trust in the advice the NHS is providing to us during pregnancy? Well yes, a lot of it will be reliable information, but often new evidence takes a LONG while to filter down into maternity culture or policy, so in reality many recommendations in pregnancy are outdated, unproven or coming from a place of fear. But fear not, it's 2020 and you my friend have an arsenal of information and support at your fingertips, meaning you can go on to make the very best, informed choices about your care! So lets take a look at the evidence on stretch and sweeps...

What is a Stretch and Sweep?

A stretch and sweep is NOT a natural start to labour. A labour staring naturally means no interventions at all. There is NO SUCH THING as a natural induction, you either wait, or you intervene. A stretch and sweep is drug free option which *may* increase the chance of your labour starting without the need for a medical induction, but it's still an intervention.

You are likely to be offered a stretch and sweep from your midwife or consultant at the end of your pregnancy, usually at your 40 and/or 41 week appointment in the hope that your labour will begin earlier than it otherwise might, without the need for medical induction. You should have the procedure explained fully and both the benefits and the risks discussed. It is important to know this is an optional intervention which is often seen as a standard, or even essential, part of maternity care by many. You do not have to say yes - you may prefer to wait, research more first or decline entirely, or you may be delighted to accept one - every situation is unique.

How is a stretch and sweep performed?

To perform a stretch and sweep your midwife (I'll stick with midwife to keep it easy here!) will use clean, gloved and lubricated fingers to perform a vaginal examination, she will be assessing your cervix for changes such as softening and opening and if your cervix has begun to soften and dilate, she may be able to insert a finger into the opening (cervical OS) and 'sweep' it around the membranes at the opening of the womb, depending on the midwife this may be quite a vigorous movement. This stretching and sweeping motion can trigger your body to produce prostaglandins - hormones which encourage the cervix to 'ripen' and labour to start. Some women find the experience pain free, but for many it is uncomfortable or even painful.

Does it work?

The evidence here is mixed! A 2005 Cochrane review found that 8 women would need to undergo a stretch and sweep to prevent 1 from needing a medical induction - this is assuming all women would accept the medical induction of course - and a review of the available evidence by the British Journal of Obstetrics & Gynaecology found that overall, stretch and sweep is associated with a 24% increase in chance of delivering within 48 hours, a 46% increase in chance of delivering within a week and a 74% reduction in likelihood of going 2 weeks over dates.

It is important to remember here that your Estimated Due Date is just that - an estimate, and that healthy full term pregnancies range from 37-42 weeks as described by WHO and NICE, so it's quite reasonable to question if and why there is a need to hurry your baby's arrival.

I can't find any evidence to back up the claim that it is effective for 8 in 10 women, unless they mean the 74% of women going into labour before 42 weeks after a sweep, something which will be true for almost all women regardless of if they have a sweep or not.

What are the risks?

Despite what the poster above says, there are known risks to accepting a stretch and sweep, just as there are to all interventions, and most choices we make daily - it is extremely rare for something to be entirely risk free!

The risks of a stretch and sweep include but aren't limited to:

- Pain, discomfort or embarrassment during the procedure which can affect your emotional and hormonal balance which can in turn affect the chance of labour starting naturally

- Pain or discomfort in the hours or days after

- Niggling but unproductive or irregular surges (contractions) which can impact on your emotional state, ability to rest and trust in your body

- Light bleeding

- Infection (any vaginal examinations carry a risk of infection)

- Rupture of membranes (which brings about a risk of infection, possible cord prolapse, pressure to induce if labour doesn't start within 24 hours)

What are the benefits?

If it works, a stretch and sweep can prevent to need for a medical induction and can mean you meet your baby sooner than if you waited for labour to start naturally.

Why might a woman accept a stretch and sweep?

There are many reasons a woman may decide to accept a stretch and sweep, these include but aren't limited to:

- A desire to give birth before medical induction is recommended by her care team (usually around 41 weeks and 3 days)

- Due to pregnancy related discomfort or illness such as PGP, HG or sciatic pain

- Misinformation about the benefits or risks

- Pressure from medical staff, family or friends

- Simply being eager to meet their little one

Why might a woman decline a stretch and sweep?

There are many reasons a woman may decide to decline a stretch and sweep, these include but aren't limited to:

- A desire for a truly natural / physiological birth

- Previous sexual trauma

- A desire to avoid the risks listed above

- Previous experience of a stretch and sweep, or having heard the experiences of others

- Fear of, or a preference to avoid, vaginal examinations in general

How do I know what is right for me?

Nobody, including me, can tell you what is right for you and your baby - it is a complex decision which will be partly based on evidence, and partly intuition. There is never a one size fits all approach, so the best way you can know what is right for you is to prepare during your pregnancy. A Supernova Antenatal Hypnobirthing Course gives you the foundations - essential information about pregnancy and birth, skills to help with questioning and decision making, signposting to further relevant information and support and trust in yourself and the process of birth. The resources below will be helpful for this particular scenario, but being offered a stretch and sweep is just one of many decisions you will need to make about yours and your baby's care during pregnancy, birth and the early postnatal period, so get in touch if you'd like to find out more about preparing for the new centre of your universe!

Steph x

Resources for Stretch & Sweep:

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