Cervical Espionage


Espionage - spying to obtain information that is considered secret or confidential without the permission of the holder of the information.

Not trying to be a rabble rouser or anything, but I hear this all. the. time! A mama comes back from her providers appointment (both OBs and MWs appointments) and I hear about how their provider gave them a cervical check that hurt badly. Sometimes there's bloody show afterwards, sometimes there's mild cramping.

Yes, sometimes that's just how our cervix' feel when we are fully pregnant... When you are around 36 weeks, oftentimes a provider will perform an exam a little different from ones prior. During this exam, they will be feeling for:

  • your ischial spines
  • your cervix (how open it is, how soft it is, and what direction it's pointing)
  • your baby (how low or high they are and if it feels like they're head down

This can, at times, feel more invasive and uncomfortable... But more often than naught, especially if there is 'sharp' discomfort, the provider might be 'helping mom out' by stripping her membranes (also known as sweeping or stretching her membranes) in order to either get some of the dilation out of the way before labor begins, or to try to encourage labor.

A membrane strip/sweep/stretch is when the provider puts a digit (finger) or two inside the cervical opening and sweeps their fingers left and right, around the inside rim of the cervix. This stretches the cervix and breaks the seal that the mucosa has on the amniotic sac adhering it to the cervix. This can cause enough irritation and pressure on the cervix that it might put a woman into labor....

The problem is, both of these are often done without a woman's consent.

When most first time moms think 'cervical check' they're thinking it will be like prior exams... Providers assume the woman knows what will be happening and what to expect. But, when a woman is given a procedure without the provider discussing it or getting her consent, that's assault. There, I said it.

A routine exam can give provider and mom useful information prior to birthing, but it will not tell you how long your labor will be, how soon it will happen, or how short it will be. Some things to consider:

  • It can give you a false sense of discouragement - feeling that your body isn't doing what it needs to, when in fact it's perfectly normal to not make cervical progress until you're in labor.. and it's perfectly normal to go into labor anytime between 38-42 weeks
  • It can give you a false sense of impending labor - feeling that you are going to go into labor any moment can be daunting... a sense of excitement and anticipation, followed by let down if it doesn't happen (see point #1) within your providers projected time frame
  • It can increase your risk for infection
  • Sometimes your water is accidentally broken
  • Sometimes it causes discomfort or bleeding
  • Some women report a feeling of violation when you don't know what to expect

Sometimes a membrane sweep will work to bring on labor beautifully. Other times, it can:

  • cause cramping for 12-24 hours without any dilation or labor starting
  • cause cramping for 12-24 hours with dilation, but then stopping and no labor commencing
  • cause maternal exhaustion (inability to sleep) to occur more commonly because of the 12-24 hours of cramping that occurs prior to labor fully commencing 
  • cause bleeding
  • introduce bacteria, increasing the risk for intrauterine infection
  • accidentally break her water, with or without contractions
  • cause a woman to question her ability to go into labor on her own

A better option: providers, tell the women that you are serving (because that's what you're doing, serving her during her time of pregnancy and birth) what you want to do, hope to find, and the risks and possible benefits - and let her decide what she wants you to do to her body.

Were you given a membrane sweep? Were you asked prior to it being performed? Did it 'work' (within 24 hours of the procedure)?

Additional reading:
Effect of Membrane Sweeping atTerm Pregnancy on Duration of Pregnancy andLabor Induction: A Randomized Trial 
MedScape's Guide To Membrane Sweeping

1 comment:

KerstenKolacheProject said...

I was given a sweep without permission and told the provider to stop 3 times before she did. She was later reprimanded by the hospital, but no telling what that actually was. Probably just a supervisor going "now now, shame shame." She was a student, my ob her supervisor kind of blew it off, when I told her about it at my follow up. It still chokes me up. It didn't help at all.


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