Stretch and sweeps are often offered as an alternative to induction for women who are at term (or sometimes even early term).
Also called a "membrane sweep", the first very important piece of information you need to know is that stretch and sweeps are a method of induction, because the purpose is to encourage the start of labour. So if you are looking to avoid induction, please understand that a stretch and sweep is, at its most simple, a form of induction.
Now, let's talk about what a stretch and sweep actually is.
A stretch and sweep is a procedure that involves a care provider inserting their finger into your cervix through your vagina, and "sweeping" their finger around to separate the membranes (the sac around the baby inside your uterus) from the base of the uterus, or where your uterus becomes your cervix.
The idea is that the separating of the membranes from the cervix and stimulating of that area will increase the production of prostaglandins, which is one of the important hormones involved in labour and birth. Prostaglandins play a big part in the softening and dilating of the cervix, so the assumption is that by increasing prostaglandin production, you will also encourage labour to begin.
Okay, good to know. How effective are stretch and sweeps at starting labour?
The short answer? Not very.
A Cochrane review on the topic of stretch and sweeps looked at 44 studies involving almost 7000 women could only say women who have a stretch and sweep may be more likely to have a 'spontaneous' labour than those who don't. They state that the evidence is of low quality. Approximately 8 women would need to be given a sweep in order to avoid one induction by other means.
One of the biggest risks to stretch and sweeps that I feel is not given due credit, is the fact that it requires a vaginal exam. Vaginal exams prior to labour can be uncomfortable or even painful, but can also be emotionally challenging if a woman has been experiencing lots of prodromal or latent labour but is then informed she is barely or not at all dilated. And on the flip side, if a woman is told she is 2 or 3 centimetres dilated, she may expect she's about to go into labour, and be disappointed when she's still pregnant a week or more later. In fact, when someone has had their finger in your cervix, swishing it all around, it would hardly be surprising to see your mucus plug dislodge, which again, might give women the sense that labour is imminent, when it still be a long way off.
Vaginal exams and cervical dilation tell us absolutely nothing about when you will go into labour, but we often have very ingrained beliefs about how important it is. Same goes for losing a mucus plug.
Remember - it's actually your cervix's job to stay closed until labour to protect your baby. A cervix that isn't dilated before labour is one that is working effectively. That doesn't mean that a cervix that is dilating isn't doing the right thing either, it just means that there is a slow build to labour for the woman that experiences that.
Women who accept stretch and sweeps also report an increasing amount of cramping, and prodromal labour, symptomatic of an irritable uterus. This is another thing that I think is important to be aware of when considering a stretch and sweep.
For women planning a VBAC, for example, we are often at a greater risk of having distrust and a lack of faith in our body's ability to labour and birth effectively, simply because we experienced a need for assistance in birth by way of surgery in the past. For VBAC women accepting a stretch and sweep, there is the potential to feed this distrust in our body when it doesn't eventuate in labour, or causes or increases prodromal labour that can also shake any confidence we might have in our body.
Prodromal labour, or labour that starts and stops which can go on for days or weeks at a time and can be a very normal experience, is a massive mind game for any pregnant woman, much less one that is at a higher risk of losing faith in her ability to labour and birth. Prodromal labour frequently gives women the sense that their body doesn't know what to do and just can't seem to get into established or active labour. This isn't true, of course, but it is so easy to feel that way when you are exhausted from thinking, night after night, that labour might be starting, only to wake up in the morning with nothing happening. Prodromal labour can be your body warming up and just getting ready, or it can be indicative of a baby who isn't in the ideal position, but it is not an indicator that your body doesn't know what it's doing.
I feel that offering VBAC women a stretch and sweep because the care provider wants them to go into labour at a certain time and refuses to induce them with any other method, is setting them up for failure. Sure, there are a small percentage of women who would go into labour following a stretch and sweep, but there are many more who would not, and those women are more likely to feel that their body is failing them rather than takeaway that their body is working beautifully to protect their baby (which is the reality of what is happening if the body refuses to be forced into labour). Women planning a VBAC need to be encouraged at every turn that their body WILL work and labour WILL happen and they CAN birth their baby vaginally. Stretch and sweeps have the potentially to do the opposite.
Aside from these things, there are also physical risks to stretch and sweeps. In addition to pain, discomfort, and light bleeding, there is also a small but serious risk of accidental membrane rupture, which can then lead to infection, a need for further induction/augmentation, or in very rare, but equally serious cases, a cord prolapse.
However, if there's a need for induction, or induction is something you are considering or have already decided on, a stretch and sweep could very well be the right decision for you, and a vaginal exam may prove beneficial to determine the appropriate method of induction as well. It all depends on what you want to happen. What is most important, however, is that you have enough information to be able to make the decision that is right for you.
Returning to your BRAIN acronym is always a really good way to approach anything that's being offered to you, particularly something that you haven't had a chance to think about yet or are unsure about.
Some more reading about stretch and sweeps is available here:
My name is Katelyn Commerford and I am a doula and next birth after caesarean guide located in Western Sydney. If you want to know more about what I do and how I can help you, please visit my website (where you can also get your free cheat sheet of my favourite VBAC resources), or find me on instagram @katelyn.doulaandnbac where I answer commonly asked questions about planning the next birth after caesarean and share loads pregnancy, birth, postpartum and parenting content.
Katelyn Commerford - Doula and NBAC Guide
Phone: 0431 369 352
Email: hello@katelynthedoula.com.au
Instagram: https://www.instagram.com/thenbacguide/
Website: www.katelynthedoula.com.au
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