Is a ‘stretch and sweep’ a useful low-tech intervention which might prevent the need for induction of labour, or an unnecessary interference in pregnancy? A “marvellously effective way of preventing the need for medical induction of labour for post-dates … [or] ineffective at best, and, at worst, an invasion of a woman’s bodies at what is generally considered to be an intensely vulnerable time”?
So began the first article I wrote on this topic; Unpacking Sweeping Policies (Wickham 2006: 30), which was originally published in The Practising Midwife in 2006. Interestingly, the Cochrane review on this topic (Boulvain et al 2005) hasn’t been updated since I wrote that piece, so much of what I wrote in the article is still (at the time of posting) current. The prevalence of this intervention, however, would seem to have increased, at least according to many of the midwives who come to my talks and workshops. In addition, the point at which this is offered to women has moved forward. I know of some (employed) midwives who are expected to start discussing this from 37 weeks of pregnancy, and midwifery students have recently told me that the focus is more on teaching them how to carry out a stretch and sweep than on encouraging them to open a dialogue about whether this is right for the individual woman. (If the ‘how’ is your interest/focus, or you’d like to know more about what this actually entails, you can find a useful article on how to perform a stretch and sweep here).
The crazy thing about the stretch and sweep as an intervention is that, although it has side effects and doesn’t always work, which means not every woman who has one will benefit from it, some people (quite understandably) feel it justified because, overall, it can reduce the induction rate.
But what is a stretch and sweep?
In the busyness of practice, I think it is easy to think of it as being a means of preventing induction. But isn’t it a means of induction in its own right?
Admittedly it is less invasive than the whole prostaglandin / artificial rupture of membranes / syntocinon saga, but a stretch and sweep is still interference, and it is being applied to more women and at an earlier stage in pregnancy, when woman have barely reached ‘term’, let alone ‘post-term’. To my mind, all of this results in an overall increase in the interference rate.
I sometimes show the powerpoint slide at the beginning of this post in my presentation on induction of labour, because it allows me to share one of my favourite stories: that of the woman who, having heard the term ‘stretch and sweep’, not unreasonably thought that this related to her midwife’s recommendation to relax, follow her nesting (and housework) urge and alternate movement and rest according to how she felt during the last few weeks of her pregnancy. The woman doesn’t mind me sharing this story at all: she hopes it will encourage others to consider alternative forms of this practice! (I look forward to sharing the Cochrane review on housework and yoga to reduce the duration of pregnancy soon… 😉 )
But I really do think we need to get a lot clearer on the question of intention. When I say ‘stretching and sweeping isn’t benign’, I don’t just mean that it can cause bleeding and discomfort. I mean that it is an intervention which is used in a deliberate way to attempt to induce labour, and we thus need to present, discuss and evaluate it as such, rather than offering it as ‘just what we do…’, in the same way that we ‘offer’ routine blood testing, or routine abdominal examination.
We might also be wise to look at the stretch and sweep within the wider context of what happens around the end of pregnancy. One of the main reasons (in my humble opinion) that the use of this intervention is increasing is because the goalposts around normality at the end of pregnancy are being progressively narrowed. As a result, more and more women are being told they need medical induction, and stretch and sweep is seen in many areas as an attempt to avoid this. Indeed, many of those who are offering it are doing so because they know it is preferable to the alternative. But when the evidence on induction for post-term is not at all clear, the real question that women should be asked is whether they want their labour to be induced at all.
Because there’s something else that can reduce the induction rate as well: the word “no”.
Boulvain M, Stan CM, Irion O. Membrane sweeping for induction of labour. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD000451. DOI: 10.1002/14651858.CD000451.pub2
If you’d like to learn more about post-term pregnancy and build your confidence with the evidence, I’d love to welcome you to my online course on this topic 😀 And you can keep up with my research postings via my free updates and monthly Birth Information Update.