Some thoughts on ‘sweeps’ from a meeting of one of the Positive Birth Movement London groups:

“At last night’s positive birth group, a midwife explained to us the pointlessness of doing sweeps – the intervention whereby a woman’s cervix is manually stimulated in order to trigger contractions. With great precision, she demonstrated the two common outcomes:

1) if the cervix isn’t ready it will still be posterior, meaning the mw’s fingers have to go in very deep, down and under to arrive at their destination, and that her wrist bone necessary leans heavily on labia. She then has to ‘cup’/’scoop’ her fingers, leaning more heavily with wrist on labia to facilitate action, until she can start to walk the cervix, (which is out of reach), forward for her to do anything with it. Note, the cervix’ backwards-leaning position is self-protective. Sphincter-like in character, cervixes tend to avoid confrontation and again like all naturally tightly closed holes in the body, don’t like being prodded. The cervix’ position will have already told the mw that it likely to be tight and closed, because it is not ready, and as such nothing can be done.

2) the cervix is tipped forward, and possibly riper and softer. The mw now has greater access, and will insert fingers into available space and try to make space/separate the baby’s head from cervix, in an attempt to stimulate activity. In many cases, contractions are brought on, but as the onset was nothing at all to do with the baby’s readiness, the very common result is several days of latent labour, contractions that will lose a woman sleep, and leave her tired and ill-resourced for labour. Most importantly with this second outcome, the forward-positioned cervix is plainly readying for labour anyway, so the justification for continuing to interfere is highly arguable.

In 90% of cases where sweeps are urged upon a woman, it cannot be time and fear of things ‘getting too late’, as they are usually given at 41 weeks and even earlier – meaning there is plenty of ‘time’ to leave the body to continue what IT IS ALREADY DOING. Very often with this second scenario, the sweep is performed, and things do begin but that is because of above – because if the mw could reach, IT ALREADY WAS HAPPENING. More often of course, the onset is attributed to the sweep.

Finally, the mw said she has never heard of a woman being told that there is a significant chance of a sweep accidentally rupturing the membranes, and thus setting in train infection risk/ticking clock, OR exactly what a sweep involves, its aims, its effects, and the fact that is an intervention. I do completely feel for midwives who are under pressure themselves to ‘offer’ sweeps, who feel they have no choice but to follow guidelines.  I’ve no doubt there are midwives who truly believe it is worthwhile, who find it an invaluable ‘tool’ but even if that is the case, is every pregnant woman it is offered to, given all the information – the HOW and the WHY so that she can fully engage with what she is agreeing to. Because this is what maternity care that places mothers choice at it’s centre should mean.”

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