membrane sweep to induce labour, does it even work?

A membrane sweep, or what many practitioners will call a ‘stretched and sweep’ involves the clinician inserting one or two fingers into the womans vagina in order to access the cervix and then uses a continuous circular sweeping motion to free the membrane from the lower uterus. research that we are looking at today is called ‘membrane sweeping for induction of labour’, its open access so I’ll provide a link for you so you can go and read it in full yourself if you are interested in more than what I have for you today.

The reason I have chosen this topic today is that I have been hearing a lot of feedback from women about how they are being offered membrane sweeps routinely prior to 40 weeks gestation. Care providers are offering membrane sweeps to women who are 38 and 39 weeks and I was confused by that so I started sniffing around for research. And here we are.

The objective of This systematic review was To assess the effects and safety of membrane sweeping for induction of labour in women at or near term (≥ 36 weeks' gestation). The authors included 44 studies which created a total of data on 6940 women and their infants. This might sound like a lot of women and a lot of data on which to make a conclusion but The authors state that when they measured what they call ‘Evidence certainty’, it was found to be generally low, mainly due to study design, inconsistency and imprecision of the studies that exist on membrane sweeping. So, although there are a lot of studies on membrane sweeping, the quality of them is low.

The main bulk of the data that they found which included 40 of the 44 studies and 6548 of the 6940 participants compared membrane sweeping with no treatment.

From this the authors comment that ‘low-certainty’ evidence shows that membrane sweeping may help in the commencement of spontaneous labour without induction and thus reduce the number of women undergoing induction of labour but that the quality of the evidence for this is low… the authors say that Membrane sweeping may be effective in achieving a spontaneous onset of labour, but the evidence for this was of low certainty. When compared to expectant management, it potentially reduces the incidence of formal induction of labour. Questions remain as to whether there is an optimal number of membrane sweeps and timings and gestation of these to initiate labour.

Now, a little disclaimer:

1. There are women who DO really want a membrane sweep – that’s totally fine and completely your choice. They are relatively low risk for complications and there is some low level evidence that they can prevent women gestating longer than 42 weeks. I know for myself as a private midwife I’ve had specifically request them and that is completely their choice. I’ve given them all the information I can and then its up to them what they want
2. Secondly, some women and babies have specific complications and genuinely medically NEED to have their babies earlier – what we can see from this research is that a membrane sweep or a series of sweeps from 36 weeks onwards may illicit spontaneous labour and allow women to avoid induction.

The reference for this article is:
Finucane EM, Murphy DJ, Biesty LM, Gyte GML, Cotter AM, Ryan EM, Boulvain M, Devane D. Membrane sweeping for induction of labour.

and the other studies I looked at when making this video were:

Gulmezoglu A, Crowther C, Middleton P, Heately E. 2012. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews CD004945.

Helen Avdiyovski, Melanie Haith-Cooper & Andrew Scally (2019) Membrane sweeping at term to promote spontaneous labour and reduce the likelihood of a formal induction of labour for postmaturity: a systematic review and meta-analysis, Journal of Obstetrics and Gynaecology, 39:1, 54-62, DOI: 10.1080/01443615.2018.1467388

[amylandry]

A friend recently had this, to avoid induction (even though personally I perceive a S&S to be a form of non-drug induction, because it's used to bring on labour), at 39 weeks... then sat on the couch for 3 days with early labour "period pains", and only progressing to 2cm. Her body then went into shock on that 3rd day, and she was rushed to hospital for an emergency caesarean. It was horrific for her. There was no risk to her and her baby at the time of the S&S either. She was just over 40 years, first baby. That's it. Baby is healthy and safe.... but of course that isn't all that matters. The experience was definitely traumatic.

[brendabenitez]

I just had one at 40+2 at 11am still no bleeding, no spotting and no cramping 16 hours later. Only 2cm dilated

[Jennawxyz]

Membrane sweeps make no logical sense though. Labour is not dependent on the cervix, pretty sure it depends on fetal lung maturity and they send chemicals out to initiate labour.

[suzannewebb]

My daughter baby is due 1 July so now 6 days late had two sweeps still nothing