Stretch the cervix
Stretch and sweep | Pregnancy Birth and Baby
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What is a stretch and sweep?
A stretch and sweep or membrane sweep is a relatively gentle way of trying to start labour. It is a simple procedure that sometimes initiates labour, reducing the risk of babies being born over the due date (42 weeks of pregnancy).
When is a stretch and sweep offered?
Your midwife or doctor may offer to perform a stretch and sweep when you have reached full term (38 weeks) to try to start labour. Some hospitals and doctors recommend the procedure only if you are 40 to 41 weeks pregnant in an attempt to prevent an overdue delivery, which may place the baby at risk.
What to expect from a stretch and sweep
The procedure is carried out by a midwife or doctor as part of an internal vaginal examination. They put a couple of lubricated, gloved fingers into your vagina and insert their index finger into the opening of the cervix or neck of your womb
They then use a circular movement to try to separate the membranes of the amniotic sac, containing the baby, from your cervix. This action, which releases hormones called prostaglandins, prepares the cervix for birth and may initiate labour.
Your midwife or doctor will:
- check the estimated date of delivery
- ask you to empty your bladder and lie down
- detect your baby’s position by feeling your abdomen
- do an internal examination to find if your cervix is closed or open
- massage around the neck of your womb if it is soft but closed — this 'stretch' can stimulate your body to release prostaglandins, which encourage the cervix to open
- insert an index finger into the neck of the womb, if it is open, and use circular motions to loosen or 'sweep' the amniotic sac membranes from the top of the cervix — this triggers the release of hormones and may start labour
If you find the procedure too uncomfortable, ask your midwife or doctor to stop.
Afterwards you might experience:
- discomfort
- mild or occasionally strong pain
- slight bleeding
- cramps or irregular contractions
Take paracetamol and have a warm bath if you are in pain. If your membranes rupture, the pain is bad or you have fresh, red bleeding, contact your midwife, doctor or maternity unit.
The process can be repeated if labour does not start over the next couple of days.
What are the benefits and risks of a stretch and sweep?
Stretch and sweep procedures at 41 weeks of pregnancy greatly reduce the percentage of women who deliver their babies beyond term. They may be offered as an alternative to inducing birth through medication or by rupturing the membranes.
The procedure is safe in a normal pregnancy. There is a slight chance the membranes may break during the procedure.
Ask your doctor or midwife about the benefits and risks before agreeing to a stretch and sweep procedure.
Sources:
BabyCenter (What is a membrane sweep?), Queensland Health (Queensland Clinical Guidelines, Induction of labour), The Royal Hospital for Women (Sweeping membranes to encourage spontaneous labour), Cochrane (Membrane sweeping for induction of labour), NSW Health (Pregnancy beyond 41 weeks)Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: January 2021
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Stretch and Sweep: Is It Safe?
Stretch and Sweep: Is It Safe?Medically reviewed by Debra Sullivan, Ph.D., MSN, R.N., CNE, COI — By Rachel Nall, MSN, CRNA on April 6, 2016
You’ve reached your due date or have gone past it, but still haven’t gone into labor. At this point, your doctor may offer you additional options to welcome your baby into the world.
One option is inducing labor with medicine that stimulates contractions. Another option is called a “stretch and sweep.” Stretch and sweep is also known as membrane sweeping, or stripping of membranes. This option is thought to stimulate labor without administering medications or performing a cesarean delivery.
Here’s what to expect during and after membrane sweeping.
Your membranes are another name for the amniotic sac. This is where your baby grows and develops for nine months. Doctors may perform a membrane sweep in a doctor’s office, at home, or at a hospital. The process typically takes less than 10 minutes. Your doctor will first apply sterile gloves.
Your doctor will then perform a cervical examination to determine if your cervix is open. If the cervix is open, they will insert a finger into your cervix and perform a sweeping motion. This will separate your membranes from your cervix. If the cervix isn’t open, a stretch and sweep can’t be performed.
A membrane sweep is intended to stimulate the release of hormones known as prostaglandins.
Prostaglandins are hormones that are associated with labor because they cause smooth muscle contractions. This includes contractions of the uterus that can lead to labor. The contractions are thought to “ripen” the cervix, or cause the cervix to soften so that a baby can more easily pass through the birth canal.
Doctors intend for a stretch and sweep to stimulate labor within 48 hours. But if a stretch and sweep doesn’t prove successful, a doctor may make further recommendations for inducing labor, depending on how far along you are and the health of you and your baby.
Some women shouldn’t have a stretch and sweep.
Doctors won’t usually perform a stretch and sweep if:
- baby’s head isn’t pointing downward
- you aren’t 40 weeks pregnant or more
- you have a vaginal infection
- your membranes have already ruptured (your water has broken)
- your placenta is low-lying
There isn’t any data to indicate that stretch and sweep increases the risk of infection to mother and baby when it’s properly performed.
According to a review of study data published in The Cochrane Review, stretch and sweep performed at term labor was associated with reduced labor duration and pregnancy duration. The review examined 22 studies that included nearly 3,000 women. However, the study did find that women who underwent stretch and sweep reported symptoms such as bleeding, irregular contractions, and discomfort during vaginal examination.
Stretch and sweep can cause side effects, including:
- bloody show or mild bleeding (may appear brown with time)
- cramping that can feel like menstrual cramping
- discomfort during the procedure
- irregular contractions
There’s also a risk that a stretch and sweep could break the amniotic sac. This is sometimes known as your water breaking. Some women can have irregular contractions, and they may not necessarily lead to labor.
If you experience side effects like bleeding bright red blood, your water breaking, or intense pain that doesn’t decrease with time, call your doctor.
You shouldn’t attempt to perform a stretch and sweep on yourself. Only a licensed professional should do it.
Stretch and sweep is a process thought to increase a woman’s likelihood for going into labor spontaneously, without the interventions of medications and/or surgery. Women who wish to go into labor naturally may prefer this option when compared to medical induction. If the stretch and sweep isn’t effective the first time, a doctor may repeat it at a later time, usually a week later. They usually won’t perform the procedure two days apart or less.
If your body doesn’t respond to this, medical induction or a cesarean delivery may be necessary. This is because there are risks if your pregnancy goes past 42 weeks. For example, the placenta may not be able to provide enough oxygen to your baby at 42 weeks. Talk to your doctor about options to stimulate labor, and the risks and benefits.
A:
Answers represent the opinions of our medical experts.
All content is strictly informational and should not be considered medical advice.
Last medically reviewed on April 6, 2016
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- How to perform a stretch and sweep. (2012, January 19)
- Inducing labor. (2015, December 2)
nhs.uk/conditions/pregnancy-and-baby/pages/induction-labour.aspx - Membrane sweep in pregnancy. (2016, January)
- Membrane sweeping for induction of labour. (2009, July 31)
- Stretch and sweep. (2015, May)
pregnancybirthbaby.
org.au/stretch-and-sweep - Stripping membranes. (2009). Journal of Midwifery & Women’s Health, 53(3), 259-260
medscape.com/viewarticle/703499
Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.
Current Version
Apr 6, 2016
Written By
Rachel Nall, MSN, CRNA
Edited By
Nizam Khan (TechSpace)
Medically Reviewed By
Debra Sullivan, PhD, MSN, RN, CNE, COI
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Medically reviewed by Debra Sullivan, Ph.D., MSN, R.N., CNE, COI — By Rachel Nall, MSN, CRNA on April 6, 2016
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Preparing the cervix for childbirth
Now your nine months of waiting are coming to an end, soon you will see your long-awaited miracle. And at this stage, the question arises of preparing the cervix for childbirth.
The readiness of the pregnant woman's body for childbirth, the condition of the cervix largely determine the course and outcome of childbirth. The most important hormones that determine the course of labor are estrogens, oxytocin, corticosteroids and prostaglandins. The concentration of estrogens and prostaglandins increases towards the end of pregnancy, and the concentration of progesterone begins to decrease, starting from the 36th week of pregnancy, which leads to the preparation of the cervix, its softening and shortening.
Assessing the readiness of the cervix for childbirth
Timely and correct assessment of the state of readiness ("maturity") of the cervix for childbirth is of great importance in determining the prognosis of the course of the upcoming birth. In the perinatal center "Maternity Hospital on Furshtatskaya", the assessment of the readiness of the cervix for childbirth is carried out by an individual obstetrician-gynecologist, who subsequently conducts your birth.
At 39 weeks, your individual doctor will conduct an internal obstetric examination and make a conclusion about the readiness of the cervix for childbirth. To assess readiness, the Bishop scale is most widely used, which takes into account such signs as: the consistency of the cervix, its length, location in relation to the wire axis of the pelvis, the patency of the cervical canal and the location of the presenting part of the fetus. Each feature is scored from 0 to 2 points. With a score of 0-4 points, the cervix is \u200b\u200bconsidered immature, 5 points - insufficiently mature, more than 5 - mature.
In the department of pathology of pregnant women of the perinatal center "Maternity hospital on Furshtatskaya", our highly qualified specialists will help assess the readiness of the cervix for childbirth using the modern rapid test Actim™Partus, the principle of which is to determine a specific protein (a phosphorylated form of protein-1 that binds insulin-like growth factor) in the mucus of the cervical canal, which is released shortly before the onset of childbirth.
Non-pharmacological methods of preparation of the cervix.
From 36 weeks, after consultation with your individual doctor and there are no contraindications, you can start preparing the cervix for childbirth on your own. Non-drug methods of preparing the cervix for childbirth after 36 weeks include regular sex life without a condom. Since the male seed contains natural prostaglandins that soften the cervix. Moderate physical activity (hiking, swimming, yoga for pregnant women) also contributes to the formation of a favorable hormonal and emotional background to prepare for childbirth. In the last weeks of pregnancy, the diet should increase the amount of fish, vegetable oils (olive, linseed), lactic acid products, reduce the amount of animal proteins and fats.
Medicamentous and mixed methods of preparation of the cervix
After 39 weeks of pregnancy, with insufficiently “mature” cervix, its preparation begins with various methods.
In outpatient practice, antispasmodics are widely used, which lower the tone of the smooth muscles of the internal organs and reduce their contractile activity.
They also use instrumental methods for preparing the soft birth canal (methods of acupuncture, massage, intranasal electrical stimulation, acupuncture).
In the conditions of the department of pathology of pregnant women of our medical perinatal center, preparation of the cervix is carried out after a complete clinical and laboratory examination of the mother and assessment of the condition of the fetus (fetodoplerometry and cardiotocography). Preparation is carried out by introducing kelp, prostaglandins and the use of synthetic antigestagens.
Natural and artificial kelp are used in obstetrics. Natural kelp is a seaweed that is found in the northern and Far Eastern seas, two types of kelp are used: Laminaria digitata (finger-dissected) and Laminaria japonica (Japanese). Sticks 6-7 cm long and 2-3 mm in diameter are made from specially processed kelp. A strong silk thread is passed through the stick, for which the used dilator is removed. Due to its hygroscopicity, already 3-4 hours after entering the liquid, kelp swells in diameter, reaching a maximum expansion of 3-5 times after 24 hours, and its consistency from dense turns into much softer and resembles rubber.
An important positive feature is that, by expanding the cervical canal up to 9-12 mm, kelp after swelling remains unchanged in length.
Prostaglandins are a highly effective means of preparing the cervix. The introduction of prostaglandin E2 leads both to the "ripening" of the cervix, and causes contractions of the myometrium as a starting point for the onset of labor. Currently, intracervical administration of Prepedil gel and intravaginal administration of Cervidil gel are used. Mifepristone is a synthetic antigestagen that competes with progesterone at the level of its receptors and removes its inhibitory effect. The use of mifepristone provides a "soft" process of "ripening" of the cervix, does not cause hyperstimulation of the contractile activity of the uterus and does not adversely affect the condition of the fetus and newborn, in most cases leads to complete "ripening" of the cervix, which is the key to spontaneous childbirth with a favorable outcome .
The author of the article is Chorba Elena Mikhailovna, personal doctor for childbirth, obstetrician-gynecologist of the Center for the Correction of Pathology of Pregnancy of the Family Clinic "Maternity on Furshtatskaya"
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“Tore the cervix with your hands for nine hours”: a Siberian woman may be left without children after childbirth
Komsomolskaya Pravda
HEALTH news of medicine and health of Novosibirsk, Novosibirsk region
Alexandra BRUNYA
180 October 2018
Elena plans to sue the hospital and the doctor because she will have to amputate her cervix after giving birth. Photo: family archive.
Zhenya is seven months old. All in "strings", with might and main buzzing and watching with interest his parents and older brother and sister. Very soon, all three children will remain with their father, because their mother, 29-year-old Elena Meleshkina, needs to undergo a serious operation to remove the cervix.
- My cervix was torn during childbirth for nine hours, and as a result I had a rupture up to the very arch of the uterus, which no one in the maternity hospital sewed up, - immediately says what is the reason for her condition, Elena.
In March of this year, she arrived at the maternity hospital at 25 Pirogova Street.
Planned delivery. Experienced mom. Already have two children, was preparing to become a large family. As the woman admits, she was faced with something that you can’t even imagine in terrible thoughts.
- On the day of delivery, labor began, but the cervix did not dilate. And the examinations showed that something was wrong with the child. Yes, I myself felt that he was busy in the stomach, and there was not enough water. And so it turned out. The baby had an entanglement of the umbilical cord like a harness, and with each contraction, because of this, he got worse. It was necessary to give birth urgently. And at nine o'clock in the evening they pierced my bladder, - the woman recalls.
Elena and her husband Alexei wanted a big family, but whether a woman can become a mother at least once again is a big question. In the photo - Elena, Alexei, eldest son Alexei, daughter Veronica and baby Eugene. Photo: family archive
An hour passed, the second, the third - Elena began to worry.
- The baby's pulse was lost, and I asked for a caesarean section, because the cervix did not even think to open even under special anesthesia, which was put in order to somehow soften it. Doctor Anna Kim said that here she decides what to do, not me, and ordered her mouth to be shut, as she does not like talkative people. She was terribly rude to me all night. I have two older children from two other marriages. And she, apparently, read this in the medical record, so she scoffed during childbirth. She said: “She gave birth from everyone in a row. Your neck is not ready at all, why is it stuck here. She told me a lot of things. But most of all there were insults that I was somehow frivolous. And all night she took turns with another doctor with her hands tore my cervix. I didn't feel under anesthesia. But the next morning, Kim even told me that I got them out overnight - my fingers hurt so much because of me that I can’t clench my fist.
As a result, the baby was born at 6.
40. After Elena was given another medication.
- I gave birth, they did tests. My son is positive, mine is negative. Kim asked if I should get an immunoglobulin shot. I replied that I did not know if I would give birth, and that I was not a doctor, so I did not know if he was needed. After that, she said: “Well, of course, let's bet. She can still give birth from the fourth man, ”recalls Elena. - She was rude to every woman. I heard. Met me later in the hallway. I was in a thick nightgown, but without a dressing gown. It was insanely hot, the sun shone through the window, there was nothing to breathe. There was a toilet two steps away from my room, where I went. And even then she managed to pin me down: “You go around seducing men.” She has some kind of sick fantasy, apparently, about men. I dont know.
Elena and little Zhenya were discharged on the third day. There was pain in the lower abdomen, but after giving birth, who doesn’t have any pain? Three weeks later, Elena and the children left for Moscow.
The head of the family is a serviceman, he was assigned to the Moscow region.
Zhenya is a long-awaited, planned baby. Photo: family archive
- I had constant pulling pains in my lower abdomen. And I went to the perinatal center. And when the gynecologist examined me, her face changed. Sent for examination, - says the woman. - As a result, the surgeon said that plastic surgery would not save the situation. I have a huge rupture of the cervix of the irregular shape. And if it had been sewn up on the spot, then everything would have grown together neatly. And it turns out that he himself healed anyhow. How it turned out, I, of course, cannot say with accuracy - from the mechanical impact of the hands or from labor activity. But the doctor did not tell me anything about him and did not sew him up. I did not have any breakups with my first children.
The surgeon said unequivocally: now only amputation. Now Elena is preparing for the operation. Because of the stress, she lost a lot of weight, lost her milk, had problems with her kidneys.
..
- I cried so much. Such negligence, such rudeness. How much dislike must there be to simply not get stitches? She couldn't help but see the gap! Now it will be very difficult for me to bear a child after such an operation. My husband and I are young, and the older children are already adults - son Alexei is 11 years old, daughter Veronica is 8 years old. A few years later we planned another child. And most likely, I can no longer bear the baby. The head of the maternity hospital on Pirogov Street, when I complained to him, offered to resolve the issue so that he would amputate the neck himself. And I think that a doctor like Kim, with such problems... She is burnt out by the profession... She should not work and cripple women.
The family plans to go to court in the future, but only after surgery and rehabilitation in the hope that such a misfortune will not happen to any woman again.
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