The Membrane Sweep: Secret Weapon Or False Promise?

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Suzzie Vehrs is a Birth Arts International Certified Birth Doula passionate about helping moms create healthy, happy birth experiences + have a full recovery afterwards.

What Is A Membrane Sweep?

A membrane sweep is a way to encourage your body to go into labor on it’s own. Hopefully a sweep prevents a medical induction later.

A membrane sweep sounds like a very simple procedure. Your OB or Midwife can complete it in less than a minute. It starts with a cervical check. You lay on your back, and your healthcare provider will put on gloves.

Then, they will insert one or two fingers into your vagina and through your cervix. Here, they can feel the bag of waters your baby is suspended in inside the uterus. They will move their fingers in a circular motion around the top of the cervix to separate the bag of water (the amniotic sac) from the uterine wall. Hopefully without causing the bag of water to break.

The goal is that this will cause your body to create prostaglandins and start the hormonal dance of labor without having to use medications. In an ideal world, a sweep would start labor in 24 to 48 hours. Which sometimes happens and sometimes doesn’t.

But, as we know, nothing is really that straight forward. And in the world of labor, even a simple membrane sweep can have strong positives and very strong negatives.

Why Might A Membrane Sweep Work?

Let’s take a closer look at what is going on in a membrane sweep. Let’s start by exploring the fascinating world of the cervix! 🌟

The cervix is an ever changing part of your body. It is located at the lower end of the uterus and extends into the vagina. It’s a dynamic structure that plays a crucial role in fertility and pregnancy.

During your menstrual cycle, the cervix is like a chameleon, adapting to different phases. When you’re ovulating, it becomes softer and more open, producing sperm-friendly mucus to help those little swimmers reach their target – the ovum. However, when you’re not ovulating, it switches gears, producing sperm-unfriendly mucus, making it a bit of a challenge for sperm to pass through.

In pregnancy, your cervix acts as a protective barrier by filling with mucus to prevent infections from reaching the uterus. It remains closed and rigid, and is roughly 3-5 cm long. It feels just like the tip of your nose. But as you near your due date, things start to change in preparation for labor. Hormones come into play, causing the cervix to soften, resembling the inside of your cheek. This is all part of the natural process.

Your Cervix During Pregnancy And Labor

Your cervix is a mix of different types of cells, with about 5-10% being smooth muscle cells that help it stay closed and rigid during pregnancy. But as labor approaches, these muscle cells undergo a programmed cellular change, allowing the cervix to open up. It also starts developing more receptors for hormones like oxytocin and prostaglandins, which play significant roles in the dilation process.

Speaking of prostaglandins, they’re quite abundant in semen. Synthetic versions of prostaglandins are often used in medical inductions as well. They serve as natural “cervix-ripeners.” Prostaglandins help digest the mucus plug, promote softening, and shorten the cervix, getting it ready for labor.

That’s right, your cervix ripens as you are approaching labor. 🍏 Just like an apple ripens. Mother nature takes an apple through a makeover session the weeks before it’s ready to be picked. Turning it into a flavor-packed star ready for its delicious debut! 💄✨🍎 And mother nature takes your cervix through a makeover the days and weeks before labor (a process which continues during labor). This makeover leaves your cervix soft, open and safe for your baby to descend through.

As you approach and move through labor, your doctor can feel your cervix and get a picture of where you are based on how it changes. They can feel it to determine if it’s ripening, which means it’s becoming softer, shorter, and slightly shifting forward. If it is, it’s a sign that those end-of-pregnancy hormones are doing their thing. If it’s not, don’t worry; it doesn’t mean the hormones aren’t working; they might just need a little more time to work their magic at that precise moment.

My Experience With A Membrane Sweep

I had a membrane sweep the day before I gave birth to my daughter Hazel. At the time, I was a week and a several days over my due date (41+5 to be exact). Understandably, I was becoming anxious about hitting the 42 week mark. My midwife suggested that it might be time to do something to give my body a bit of a nudge and we agreed to do a membrane sweep.

She also recommended that sometime that day to have sex with my partner because sperm also has prostaglandins. The plan was a one two punch with a membrane sweep and semen to bathe the cervix in prostaglandins and encourage my body to get the labor dance moving.

The procedure was quick, but a bit painful. It left me feeling sore, a bit invaded and with a general crampy, period feeling the rest of the day. Following with sex when I was already sore was not pleasant at all.

However, even though the rest of the day was less than pleasurable, when I woke up the next morning, I had steady and consistent contractions. I had my baby at about 9 PM that night. Because everything worked out next to perfectly for me, I never questioned if I would do it again or take another approach. That is until I became a doula and realized that there are risks that we never even talked about.

Ashley’s Birth Experience With A Membrane Sweep

I recently attended a birth with another mom who also started labor with a membrane sweep. While my birth ended up being the ideal situation with a membrane sweep, hers was unfortunately the opposite.

She was just a couple days over her due date. Eager to meet her baby, her midwife suggested a membrane sweep. By that evening, her contractions were 5 minutes apart. They were strong-ish. Strong enough to make it so she couldn’t sleep, but, not strong enough to make any change.

She labored for about 30 hours. After another cervical check revealed she was only 4 cm dilated, she opted for an epidural so she could sleep. Unfortunately, sleep never came as her baby quickly began having heart rate decelerations after the epidural.

When these couldn’t be stopped with position changes, fluids or other measures she went back for a surgical birth. It was discovered that she had quite the infection in her uterus. Her baby spent several days in the NICU, but was ultimately okay.

Her start was the opposite of what she planned for her birth. For her, a membrane sweep caused inconsistent labor, potentially introduced bacteria that could have contributed to infection, and ended in surgery. Or it could be that the infection was already brewing – and that’s why her labor never picked up and progressed. The truth is sometimes, we just don’t know.

How Likely Is A Membrane Sweep To Start Labor In 48 Hours Or Less Vs. Waiting For Labor To Start On It’s Own

Recent studies have unveiled an intriguing connection between membrane sweeps and the initiation of labor within 48 hours. The research concludes that membrane sweeps DO increase the number of women in labor in the next 48 hours when performed on post term moms (40-42 weeks pregnant) . But, by how much?

A cochrane review determined for women who are at term and either have a membrane sweep or do not:

6 out of 10 women ended up in spontaneous labour within 48 hours without a membrane sweep (598 women in 1000).
Just over 7 out of 10 women ended up in spontaneous labour within 48 hours with a membrane sweep (723 in 1000).

I was surprised to find out that the increase was only about 10% of women entering labor due to the membrane sweep. I was also surprised by how many people it made no difference for – 30% of women.

One study also looked at how many membrane sweeps were needed. This study found that at 40 weeks of pregnancy, 86% of mothers only needed one or two sweeps to start labor, but 13% of women needed three or more to start labor. This is very curious information to me, as many providers offer sweeps weekly – meaning there’s a very big time difference between getting one or two sweeps. I wish we had more information here.

It’s important to know, that one sweep may make a difference, but if it doesn’t, you may need more interventions or more support to keep or get labor going.

Cons Of A Membrane Sweep

Though I’ve seen many articles state that there are no known drawbacks of membrane sweeps, I find that a bit deceptive. Let’s navigate the waters of the not-so-sunny aspects of membrane sweeps, providing you with a balanced perspective to make informed decisions on your birthing journey.

Are Membrane Sweeps Painful?

How people experience membrane sweeps is very different person to person. This makes sense as the softness and length of the cervix will be different for different moms. However, one study found that up to 70% of women found that this procedure was associated with significant discomfort. One third of these women complained of significant pain.

Another name for a membrane sweep is a stretch and sweep. In a stretch and sweep, if your cervix isn’t soft and open enough to get to the bag of waters. In this case, the care provider may attempt to manually stretch it. I have seen these, and they do cause significant pain.

Pain combined with the invasiveness of this procedure is especially important for survivors of sexual abuse to consider as the process can be a triggering event. This is especially true if a conversation about the procedure doesn’t take place and consent is not given.

Can A Membrane Sweep Cause Ruptured Membranes (Water Breaking)?

One study found that in about 9% of membrane sweeps the provider will accidently break a mom’s bag of waters. Breaking the bag of waters is one way that some providers will try to start labor.

However, the bag of water helps protect your baby from infections. After the bag has been broken for some time, your baby is at risk for developing infections that can be quite dangerous. Many providers want you to have your baby in 24 to 72 hours after your water breaking. To learn more about the impact of waters breaking before labor begins check out this article.

Also, from my observation once waters break, the experience of contractions seems to be more intense. This is definitely something to weigh in your decision to break waters, or take the risk of accidentally breaking waters with a sweep and stretch, especially if you are opting out of an epidural.

Can A Membrane Sweep Increase Risk For An Infection?

Many studies that look at membrane sweeps state clearly that doing a membrane sweep does not increase the risk for infections. Others don’t even look for this problem. However, all studies on membrane sweeps are quite small and are likely to be biased. The cochrane review which summarized ALL the studies on membrane sweeps only looked at a total of 6,000 women – and this was combined from over 40 different studies.

Some of the studies may have been the same women only analyzed by different researchers. Meaning, there isn’t enough data to say.

Infections could easily be missed or underestimated the way this data is compiled.

But, we do know that every single cervical check during labor poses an incremental risk to mothers developing an infection. Women with greater than 7 cervical exams are 2.3 times more likely to develop chorioamnionitis. This is an an infection of the placenta and the amniotic fluid.

According to Stanford Children’s Chorioamnionitis can cause a dangerous blood infection in the mother called bacteremia. This can cause the baby to be born early. It can also cause serious complications in the newborn. This includes infection (such as pneumonia or meningitis), brain damage, or death.

I would really like more studies to be done that look at the risk of infections that account for the number of cervical checks before labor and in labor. Until that is done, I don’t think we have enough evidence to claim that membrane sweeps can or can’t contribute to infections.

Inconsistent Contractions That Don’t Lead To Change

Another problem that can happen with a membrane sweep (or any ‘natural’ induction method) is that some moms will have enough cramping or contractions to prevent them from sleeping, but not actually be in labor. This is called prodromal labor. However, most studies do not look for this, while it was mentioned in the 2020 cochrane review as a potential side effect, there is no way to tell what percentage of moms have this outcome.

Signs Of A Successful Membrane Sweep

You’ll know a cervical sweep was successful when your body begins to respond in alignment with the natural progression of labor. Signs of success may include:

Contractions that Gain Momentum: The sweeping motion performed during the procedure can trigger contractions. If these contractions start to increase in frequency, duration, and intensity, it’s a promising sign that your body is preparing for labor. If they stay present but don’t get longer, stronger and closer together, it probably isn’t actually labor.
Cervical Changes: A successful sweep often leads to cervical changes. You might notice that your cervix starts to soften, thin out (efface), and dilate (open). These changes are crucial steps towards labor. While too many cervix checks are a no go, having one after several hours of contractions may help you decide if you are in labor, or experiencing prodromal labor.
Bloody Show: Some moms experience a “bloody show” after a successful sweep. This is when the mucus plug that seals the cervix during pregnancy begins to dislodge or have streaks of blood. It’s a positive sign that your cervix is responding to the sweep. But, if you have enough blood to fill a pad, call your doctor ASAP.

It’s important to note that while discomfort can be expected during and after the procedure, it should be manageable. If you start feeling mild cramping or discomfort that gradually intensifies, it’s a reassuring indication that your body is getting ready for labor.

Trust your body’s natural rhythm, and be sure to stay in close contact with your healthcare provider to monitor your progress. Your journey to meeting your baby is a beautiful and empowering process, and these signs are positive affirmations that your body is doing its incredible work. 🌟👶💪

Recognizing Contractions

Many moms often have concerns about contractions and wonder if they can handle them. 😬 But fear not! With the right tools, contractions can be a breeze. 💪 Join our fun childbirth class to learn some amazing skills to conquer contractions and recognize labor like a pro. 🎓💃🕺 And for some real-talk, check out our article “What Contractions Feel Like,” where other super-moms spill the beans on their labor experiences from start to finish. 📖🤰

And hey, if you’re currently experiencing contractions, it’s time to start the clock! ⏱️ Your care provider will want to know all about your labor pattern before you make that exciting trip to the hospital. For a stress-free guide on how to time contractions like a champ, don’t miss our article on “How to Time Contractions the Easy Way!” 🕰️👶

What To Do After A Membrane Sweep

After a membrane sweep, it’s important to stay positive and proactive on your birthing journey. First and foremost, listen to your body.

If you start experiencing contractions or any signs of labor, embrace them with confidence and excitement; your baby is on the way!

Stay hydrated, rest when needed, and communicate openly with your healthcare provider. Remember to surround yourself with supportive loved ones who can uplift your spirits and be there for you every step of the way.

This is a remarkable moment in your life, and you’ve got the strength and resilience to embrace it fully. Trust in your body’s natural process, stay positive, and soon you’ll be cradling your precious little one in your arms. 🌟👶💕

Are There Alternatives To Membrane Sweeps?

When I had my daughter’s I did not work with pregnant moms yet. There are things I would definitely do differently with the experience I’ve gained in the past several years. For one, a membrane sweep helps labor by helping the cervix ripen. That can also be accomplished by expressing colostrum, nipple stimulation, having sex and even taking castor oil.

If I were to go back in time, I would definitely express colostrum starting at 37 or 38 weeks of pregnancy. Not only would I have backup colostrum on hand, but this also helps the cervix ripen, just like an apple getting ready to be picked.

Then, if I made it to 41 weeks, I would begin exploring my other options to encourage labor. A membrane sweep did work for me last time, so even though it was uncomfortable, I may consider it again. But, If I wanted a combo I would probably follow the protocol of 3 days of nipple stimulation followed by a sweep instead of a sweep followed by sex.

Of course, that is what I would do. It’s up to you to decide which options feel right for you.

Is There An Ideal Time For A Membrane Sweep?

In the realm of membrane sweeps, most studies have their focus on women who have reached full term or even gone a bit past it, typically around the 40 to 42 week mark. However, an interesting twist emerges when I examine the experiences of the incredible women I’ve had the privilege of working with. Some healthcare providers are offering routine, weekly membrane sweeps as early as 36 weeks into pregnancy.

Membrane Sweeps At 36 or 37 Weeks

Now, it’s essential to emphasize a significant point here – there’s a notable absence of scientific studies on membrane sweeps performed before the 38-week milestone. So, if you find yourself being offered a sweep at 36 or 37 weeks, you’re essentially stepping into uncharted territory in the world of maternity care. There’s no solid or weak evidence to support such early sweeps. It’s crucial to be aware that this procedure does carry its fair share of risks. For example, waters accidentally being broken at 36 or 37 weeks would force your baby to be born in the next couple days – even though they would be premature.

Membrane Sweeps At 38 to 40 Weeks

Let’s dive a bit deeper: In a study involving 150 low-risk women who were offered a membrane sweep between the 38 to 40-week range, the findings were quite illuminating. It became evident that a membrane sweep during this timeframe didn’t yield the expected results.

These women were not more likely to go into labor within the next seven days.

Nor were they more inclined to give birth before hitting the 41-week mark.

Although this study may be on the smaller side, it’s a compelling piece of the puzzle, highlighting that membrane sweeps before full term simply don’t produce the desired outcomes. 🤔🔍👶

Are There Any Benefits To Entering Labor Around 41 Weeks?

You may be wondering if membrane sweeps have some downsides, and you don’t mind being pregnant a few days longer, are there any benefits to choosing one once you’re at 40 weeks or beyond? The truth is – there likely are.

A groundbreaking trial has provided invaluable insights into the timing of labor induction. Let’s focus on the SWEPIS trial, because it helps us conceptualize the risk and benefits of inducing at 41 weeks vs the benefits of waiting for spontaneous labor until 42 weeks quite clearly.

Sweden’s SWEPIS Trial

Sweden delved into the induction dilemma at 41 weeks versus 42 weeks in the SWEPIS trial. 📅🤰

Conducted from 2015 to 2018, 🕒🔬 this trial took a thorough look at the timing of labor induction, even though it’s customary in Sweden to avoid inductions before 42 weeks. 🏥👶

The truly astonishing part? The study was stopped prematurely due to a significant difference in infant deaths between the groups.

There were six perinatal deaths in the group that waited for labor until 42 weeks, while the elective induction group, moms who medically started labor at 41 weeks, experienced none.

The SWEPIS trial ultimately concluded that 230 inductions at 41 weeks could prevent 1 perinatal death.

These findings challenge previous assumptions and suggest that earlier induction, particularly at 41 weeks, might greatly reduce the risk of perinatal death, especially for first-time moms. 🙌👩‍👧

In the moms I work with, I see most moms being offered inductions anywhere between 38-41 weeks. More and more providers are moving away from waiting for labor until 42 weeks.

What Do We Learn From This Trial?

The SWEPIS trial definitely changed the way I think of inductions.

Talking about risk in pregnancy can be difficult. If the risk for something is 1 in a million, it seems impossible it could happen to you. On the other hand, if you are that one, it is 100% your experience.

All we can do is choose the risk that feels right for our families.

One way to look at the SWEPIS trial is that inductions at 41 weeks can help prevent rare, but real losses at the end of pregnancy.

On the other hand, it also gives us some very positive information as well.

229 moms out of 230 low risk, healthy moms will go on to have a healthy baby without an induction at 41 weeks. Another way to say that is that 99.6% of times, moms are okay to wait until 42 weeks for labor to start on it’s own and importantly, 99.6% of babies are fine to wait until 42 weeks too.

My hope for you is that whichever path you choose, you feel centered, grounded, informed and confident about your choice.

What Has Happened In Hospitals That Have Started Inducing Early?

So, does it make sense to induce everyone to try to protect that 0.4% of babies that won’t make it through 41 weeks to 42 weeks?

Let’s look at what happened when inductions increased at one of the hospitals known for some of the BEST outcomes in the country. Inductions at their hospital have increased from 10% of births to 27% of births.

But, has inducing moms early improved outcomes? Not really.

The rate of cesarean delivery among electively induced women increased from 6.5% to 14.8% in this group of electively induced women.

These women also had longer hospital stays, increased blood loss, and lower birth weights.

The increased likelihood of a surgical birth following a medical induction (think medication and pitocin, not a membrane sweep for these inductions) has been found in multiple studies.

Including this one, which found surgical birth rates went up from 10% to 19% from the group that did not attempt to induce labor, compared to the group that did induce labor.

Unfortunately, there is a clear trade off between risks and benefits of a medical induction at 41 weeks and waiting for labor to start on it’s own. Medical induction is not the easiest process on moms and babies, and can lead to an increased risk of surgical birth.

So if a membrane sweep can encourage the spontaneous onset of labor, it may be worth it for many moms. Of course, a membrane sweep isn’t risk free, but neither is birth. For many moms, it could just be the nudge they need to feel good about being proactive, without turning to a full on medical induction.

Membrane Sweep TLDR

In conclusion, when considering whether to undergo a membrane sweep as part of your pregnancy journey, it’s essential to weigh the potential benefits against the risks and discomforts. While membrane sweeps can help initiate labor, they may also be associated with pain and, in some cases, unintended consequences like ruptured membranes or infections.

The decision to have a membrane sweep should be made carefully, taking into account your unique circumstances and preferences. It’s crucial to maintain open communication with your healthcare provider and be aware of the signs of a successful sweep, such as contractions gaining momentum and cervical changes.

Remember that alternatives to membrane sweeps exist, such as colostrum expression and nipple stimulation, which you can discuss with your healthcare provider.

Recent studies have shed light on the potential benefits of elective induction around 41 weeks, suggesting it may reduce risks for both mothers and babies. However, these findings require further research and consideration of individual medical histories and protocols.

Ultimately, whether or not to have a membrane sweep or pursue other induction methods should be a personal decision made in consultation with your healthcare team. Your journey to motherhood is a unique and transformative experience, and your choices should align with what feels right for you and your baby. Trust in your body’s natural process, stay informed, and embrace this remarkable moment in your life with confidence and positivity. Your precious little one will soon be in your arms, and every step of this journey is worth it. 🌟👶💕

The Membrane Sweep: Secret Weapon Or False Promise?

What Is A Membrane Sweep?