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Induction
of labor is a highly controversial topic and one that requires careful
consideration.
Stripping or sweeping of
membranes (the amniotic sac near the opening of the cervix) is one method care
providers often use.
How is it done ?
During
a vaginal exam, the care provider places a gloved finger into the cervical
os. The closer edge of the membranes is
detached from the lower uterine segment in a circular motion – not unlike
peeling an orange.
Why is it done?
Stripping
the membranes may begin labor by increasing local production of prostaglandins
(hormone that will soften the cervix) by stretching of the cervix. This intervention may shorten pregnancies of
women who are at term (41-42 weeks) and may also reduce the need for induction. However, some studies refute this finding3.
What the evidence
indicates:
According
to the most prestigious research database, the Cochrane database, stripping of
membranes, while possibly shortening pregnancy by initiating cervical softening
and irritating the uterine muscle, does not reduce cesarean rates in any
population (nulliparous or multiparous women).
There was also no significant difference in maternal or neonatal
infections. It may not be the most
effective means of inducing labor when there are medical indications.
Routine use of
sweeping of membranes from 38 weeks of pregnancy onwards does not seem to
produce clinically important benefits. When used as a means for induction of
labor, the reduction in the use of more formal methods of induction needs to be
balanced against women's discomfort and other adverse effects.
Discomfort associated with
stripping membranes includes irregular contractions, spotting/bleeding, cramping
and general discomfort – all of which may last for up to 24 hours.
Reasons You Would Not Want Your Membranes
Stripped:
According to the
American College of Nurse-Midwives (ACNM) Fact Sheet on Stripping Membranes1,
there are five reasons why an expectant mother may not want her membranes
stripped. They include:
- You have been told that it is not safe to have your infant vaginally.
- You have had unexplained vaginal bleeding during your pregnancy.
- You have been told that you need to have your infant urgently and it would be safest to have your labor induced by using medication.
- You want to let your pregnancy and labor unfold naturally and there is no medical reason to have your labor induced.
- If you have had a vaginal culture that says you have group B strep (GBS) in your vagina, you may not want to have your membranes stripped; there are no studies that have shown it is safe if you have GBS so this decision should be made with you and your care-provider making the decision together.
When might induction improve health outcomes
of mothers and babies:
According to two
studies4,5, three situations showed small improvements in outcomes
but left many unanswered questions.
These situations included:
- Pregnancy lasting beyond 41 weeks.
- Prelabor rupture of membranes at term.
- Increased blood pressure/preeclampsia at the end of pregnancy.
And a final word on reasons for induction
that are not supported by research:
- Preterm prelabor rupture of membranes.
- Twin pregnancy.
- Gestational Diabetes requiring insulin.
- Intrauterine growth restriction (IUGR) before 37 weeks or at term.
- Oligohydramnios (too little amniotic fluid).
- Concern that the baby will get to big (suspected macrosomia).
Stripping of membranes
and other mechanical methods of labor induction may begin labor but may also
lead to additional interventions and methods of induction (such as Pitocin/
Syntocin) or even Cytotec. It is important
for careproviders to share all information with expectant mothers so that a
well-thought out decision can be made.
References and Resources:
- ACNM (2009) Fact Sheet: Stripping Membranes. Journal of Midwifery and Womens Health.
- Boulvain, M. et al (2005) Cochrane Database: Membrane sweeping for induction. Last accessed 2/13/14 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000451.pub2/abstract;jsessionid=D4F9ECF1A89EEAB8143B5930D810A792.f03t02
- Kashanian, M. et al. (2006) Effect of membrane sweeping at term pregnancy on duration of pregnancy and labor induction: a randomized trial. Gynecologic and Obstetric Investigation. 62(1): 41-4.
- Koopmans CM, Bijlenga D, Groen H, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' gestation (HYPITAT): A multicentre, open-label randomised controlled trial. Lancet. 2009;374(9694):979-988.
- Mozurkewich E, Chilimigras J, Koepke E, Keeton K, King VJ. Indications for induction of labour: A best-evidence review. British Journal of Obstetrics & Gynecology. 2009;116(5):626-636.
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