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Wednesday
May162012

Did You Have Your Membranes Stripped?

I started this post eons ago, so trying to find it on my Facebook page would be all but futile. I still felt it was relevant so am sharing it now.

I really do love some of the questions I think of on my Navelgazing Midwife Facebook page. While some are frivolous, others like this one can provide so much information for those who don’t know this could happen. And we all need to come up with strategies to make it stop… or at least have it done as part of a discussion that begins with informed consent. This is one of my biggest hot button issues; I really want to see women’s bodies respected and their wishes honored.

I was just in a conversation with Jennifer Zimmerman who runs Solace for Mothers, a group for women who’ve been victims of birth violence, and I’d made the comment, “If you don’t want your membranes stripped, don’t take your pants off!” Except I YELLED it. Whew, that brought a strong reaction from several women, but Jennifer seriously admonished me. She first said I didn’t need to yell AT women and I defended myself saying I wasn’t, but I wanted women to have a mechanism to protect themselves. During our discussion, I could see the other point of view, that I was almost blaming women who took their pants off, that they “asked for it” just by that action. Believe me, that is not what I meant at all.

Further exploration nudged Jennifer and I in the same direction, believing (knowing!) that it is the medical folks that need to be re-trained to respect women’s bodies instead of women needing a shield during prenatal visits. The dilemma of course, is how to do that. Wouldn’t it be great to have the doctor or midwife ask, “You want me to do a vaginal exam, right? Do you also want me to strip your membranes?” That way mom is able to say, “What is that?” and “Is it going to hurt?” or “Please don’t.” And then, in the new atmosphere of client respect, the provider would do exactly –and only- what the mother asks for.

So what is “stripping the membranes,” or as others call it, “sweeping the membranes” and why would it be done?

There is a belief in obstetrics/midwifery that messing with the cervix, either rubbing it with Evening Primrose Oil or putting fingers inside the os and stretching the cervix stimulates the cervix to sit up and fly right. To do something. To hurry up and ripen or open.

An on-going Cochrane Review, in Issue 1, 2010, found:

“Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits. When used as a means for induction of labour, the reduction in the use of more formal methods of induction needs to be balanced against women's discomfort and other adverse effects.”

Yet, a study last updated 8/10/10 said:

“The efficacy of membrane sweeping is well studied, and has been shown to increase the number of patients in labor within 72 hours, reduce the frequency of pregnancy continuing beyond 41 or 42 weeks, and reduce the frequency of formal induction of labor. Thus, it is a safe and practical option for women who wish to avoid inductions of labor or postterm pregnancies.”

I’ve stripped membranes for years, but stopped about two years ago when I read a pretty convincing study that said the action doesn’t do anything but hurt the hell out of the woman and make the provider feel like s/he’s doing something to hasten labor.

“If you do have your membranes stripped, expect to be uncomfortable and slightly crampy during the procedure. You might feel mild cramps or contractions for up to 24 hours after your membranes have been stripped. You may also have slight spotting (a small amount of bleeding) for up to 3 days after your membranes are stripped.”

Mild cramps? That’s quite the understatement as these glimpses into women’s experiences with stripping demonstrate.

- We did with my last pregnancy. OMG it hurt so bad! It also caused exactly one contraction and that's it.

- Not too uncomfortable, kinda that weird pressure-y feeling.. didn't exactly work, but my understanding is that for a first it takes more than once :) I forgot to mention mine was by a very gentle midwife :)

- I had mine swept with both my kids- and I was in labor with both within hours. However, I was also 4cm with both, so who knows whether it was the procedure or whether I would have gone into labor on my own regardless. It was uncomfortable, but my midwives went very slowly and made sure I understood what was going on, which really helped. I wouldn't call it painful, but just a lot of stretching and maybe a scraping sensation.

- I had it done with my fourth baby, when i was 40w6d pregnant, and I was 4-5cm/50% --not in labor. I didn’t want induction, but consented to this. That was Friday morning. Didn't go into labor until Sunday night, so, no, it didn't work even though I was super-ripe.

- I had mine swept due to avoid a pharma-induction due to gestational diabetes, at 40w3d. It was pretty uncomfortable for a minute, but I was in labor an hour later, and 30 hours later brought my little (okay, not so little) man into the world peacefully and ecstatically.

- Felt like an aggressive pap smear, and it kinda worked. Kick started my labor, but my baby was not ready, so it was still almost 2 days of labor before my baby arrived.

- I did not, but I told the OB before she checked my cervix at my 40 week appointment that I did NOT want my membranes stripped (I heard rumors there was stripping going on without consent). She looked at me like I had a third eye and said..."WHY??" Because it's MY body, that's why!

- Had them swept with my second at 41 weeks/2cm/50%. It mostly felt like a lot of pressure/pushing/pulling. I had heard it hurt terribly and was bracing for it to be really bad, but I didn't think it was that bad. Unfortunately, it didn't do a thing.

- Not until faced w/ possibly being induced - I was rapidly approaching 41 weeks, with no cervical progress at all. It hurt like hell, and I don't think it worked anyway.

- Yes. I wasn't expecting it and it hurt - worse than any pains I could remember - so much so that I stopped breathing and [husband's description:] had a horrified look on my face. I think the ob said I was 1 cm. [& I've had a lot of injuries... due to accident-proneness to compare it to.]

Thankfully, it didn't work & son came when he wanted to - a couple weeks later.

- I did with my first (who was late, but also malpositioned, the only thing that dilated me in the end was having my water broken), but I don't think he was able to get far with it as I was really quite closed still. It hurt a bit, like a really bad menstrual cramp, but it wasn't excruciating or anything. Nothing came of it.

- Yes, with all 4 pregnancies. It just feels crampy… (unless you're high and tight, thank you OP buddy, then it feels like a tiny yet somewhat transition-esque contraction/cramp in your cerxix) and while I never just jumped in to labor, I'm convinced that it absolutely sped up the process with the first three labors.

- Had it done with #2 and #3. With #2 it wasn't much more uncomfortable than a normal exam. With #3 it was more uncomfortable. Both times started labor.

- ‎7 times with baby #2 and 6 times with baby #3r. Could've cared less if it hurt as I was past EDD and couldn't walk due to SPD. Did any of those times work? NO.

- I had it done without my knowledge or consent for my first. It was horribly painful, like a menstrual cramp only with somebody's hand up there digging around. I was horrified that my midwife would do such a thing when I wasn't even 40 weeks... yet, and she didn't stop when I was obviously upset by it. I was achey and sore all night, but had no contractions. My inner thighs hurt, my lower back hurt, everything hurt. I went into labor three days later on my due date. I read that it works up to three days later, so it could have worked I guess, but not instantly.

- Did anyone else experience a water-balloon-in-your-vagina feeling afterward? I'm certain I did, but I've never heard anyone else describe that. And, no, labor didn't start for another week.

- Twice with #1. Was done very gently by a midwife - didn't hurt at all, just pressure. Some cramping/pressure waves after but unsuccessful.

- First time I ever had it done was my most recent (3rd) pregnancy. I was only 37 wks 3 days and my OB didn't ask, but she was playing the big baby card the whole last third of my pregnancy. I was only 1cm dilated that day and had contractions and lost my mucous plug for the whole next week. At my 38 wk 3 day appt, I was dilated to 3 cm, but I requested she not do it again. Two days later, I delivered my little guy and I could tell he was earlier than he would have been had it all been left alone. I don't think he was finished gestating.

- Just felt like a *very* thorough pelvic exam, not painful at all really. I had it done this time around after several days of prodromal labor. The midwife asked if I wanted it done and I said yes. She said no one had ever consented with such enthusiasm before!

- Had it done about a week past my edd. I'd also agree that it felt like an aggressive pap smear (I always find those to be uncomfy, blargh, and have friable cervix). Think it woke us up...labor started gently a few days later and DD was born ...almost exactly 24 hours after I woke up with mild crampy contractions. If I were in the same position (stalled dilation, no other indication that labor is imminent and past dates by more than a few days) I'd do it again. I trust my doc (a family practice who began her career in birth centers-she joined this larger practice for the opportunity to teach new docs) very much, and she would never do something without discussing it first.

- My OB stripped my membranes at 39 weeks. I had been 3+ cm dilated, 75%+ effaced since 37 weeks. It was just a more vigorous cervical exam, not really painful for me. I ended up waking up in the middle of the night with steady contractions, had my husband stay home from work, because we thought this was 'it'. And then the contractions stopped cold. Didn't get another one for a couple hours- and I'm a girl that gets Braxton-Hicks from about 10 weeks on, so I contract a lot. Anyway, my daughter was born one week after the stripping, right at 40 weeks. Walking did nothing for me either. The one thing that seems to work with both my babies was sex. Twice in less than 24 hours produced a baby the next day.

- I did and the midwife was horrible and rough. It was at 40 weeks and 4 days when I went into labor. Felt like she was rubbing my cervix hard. Not fun.

- I think a sub OB (mine was out that week) stripped mine without telling me with my 6th baby. I had blood after the exam and contractions. I lost a big chunk of plug. I didn't want to be in labor and was getting mad thinking she did that without asking. They went for the day and interrupted my night. But they stopped the next day. I had that baby 3 days after my EDD.

- hmm... Did with my last as we neared 43 weeks gestation. It felt like she was trying to tickle my tonsils through my vagina... rather agressively... ouch... oh, and NO it didn't work. He stayed put for another 3 days.

- Yep...it was REALLY painful....won't do it again unless I'm facing a section. I went into labor within 48 hours.

- Ditto on the aggressive pap smear. Then cramping. My midwife swept me three weeks in a row. It thinned and dilated me a bit the first time (lost my entire mucus plug in just a short couple of hours). Second time, nothing but a couple cramps. Third time it kick started my labor and I started real labor the next day and gave birth just before midnight.

- I am sure my ob swept my membrane although he denied it! But from everything I've read I am certain he did. I was about 40 weeks at the time. Felt like he was digging through my cervix with his whole hand... it caused 1 contraction and other than that I was just sore with spotting. (I had already had cervical checks done before so there is NO way he was just checking my cervix.)

Nothing beats hearing other women’s experiences. Thanks to everyone who shared their stories.

I also had my membranes stripped with the first two kidlets. With Tristan, I was totally ignorant and thought it was a part of a standard vaginal exam in pregnancy. Ow! He was LGA, so am sure the doc was trying to get him out. The stripping didn’t work; he ended up being born at 41.3 weeks, induced after spontaneous prolonged rupture of membranes.

With Meghann, I was very educated, having attended Bradley classes and hanging out with La Leche League women, so even though I planned (and had) an Unassisted Birth, I was still going to the military’s OB. They blah blah blah’d about my big baby at every visit and at 41.1 weeks, insisted on a vaginal exam. I knew to keep my pants on, but didn’t… and ended up kicking myself for years over it, too. The doc said he just wanted to see what was happening and I specifically told him not to strip my membranes. When he did, I about crawled off the table backwards and started crying immediately, knowing he violated what I had asked him not to do. Barely able to speak, I asked why he did that and he said he did not strip my membranes, that he was merely trying to find my cervix. Liar. I began losing my mucous plug immediately and having that awful crampy feeling like period cramps.

When I explain early contractions, I tell women they often feel like period cramps, but they come and go, whereas period cramps’ coming and going is random. It can be comforting to know, in the middle of the cramp, that it’s going to end in a minute or so, but period cramps just keep coming and coming. These post-stripping contractions didn’t have any rhythm to them at all. They just hit hard, then stayed throughout the day and night… and day again. I was exhausted by the damn things!

I finally started active labor about 18 hours after the stripping, but still don’t feel it did anything but tire me out all those hours before labor really began. I was clear with the midwives in my third pregnancy and never had a rough vaginal exam and most certainly wasn’t stripped.

I wonder how much longer this intervention will be a part of standard obstetric and midwifery care. I hope not forever.