stretch and sweep – would you like to have one?

What is a stretch and sweep exactly?

What exactly is a stretch and sweep? Why do women get offered a stretch and sweep in late pregnancy?

A stretch and sweep is essentially an intervention to help kick start/induce labour. Yes, I know, care providers sometimes say that it isn’t an intervention! They’ll say, “It’s just a little stretch!” I promise you, anything involving sticking fingers into a woman’s body during pregnancy, birth or postpartum IS an intervention! Furthermore, Just because it doesn’t involve synthetic drugs, tapes or gels, it doesn’t mean it doesn’t hold risks!

Side note: I follow Dr Rachel Reed’s (an incredibly skilled, woman-centred midwife) thinking on classification of interventions. I’m not sure I’m really doing her thoughts justice here, but what I took from it is that even being present with a woman in labour can be classed as an intervention! Suggesting a position change, changing your demeanour or even just *feeling* different can be classed as an intervention. Anything influencing the way labour plays out and the physiology of that woman in that moment is an intervention. To see some of her thoughts written much more accurately and eloquently, please check out her blog, Midwife Thinking. Or, if you’d like to hear her talk, The Midwives Cauldron podcast is equally amazing!

So what exactly is it? During a stretch and sweep a care provider inserts their finger into the vagina, ‘stretches’ the cervix, and ‘sweeps’ between the amniotic sac and cervix. By separating the amniotic sac and cervix the woman’s body will theoretically produce prostaglandins (hormones). These hormones help to prepare the cervix for labour. While this ‘works’ in some instances, it typically just pushes forward a process that has already begun! Which raises the question, why not just wait for the body to do it when ready? There are, of course, instances where a baby needs to be born asap and in these cases, stretch and sweep may be a good option.

Supposed Benefits of Stretch and Sweeps

Stretch and sweeps are often offered to women nearing the end of their pregnancy in order to ‘get things moving’. They hold the supposed benefits of:

1. Reduces formal induction of labour (assuming every woman who has a stretch and sweep would choose induction if it didn’t work; Cochrane Collaboration, 2020)
2. It almost halves the likelihood of a ‘post-term’, beyond 42 week pregnancy (Yildirim et al. 2010; as a side note, is NORMAL for some women to gestate to 42 weeks and beyond)
3. Doesn’t involve pharmacological management (no drugs)
4. The woman can go home after the comparatively quick procedure (unlike in ‘formal’ induction methods)
5. It can be repeated after 48 hours if there has been ‘no progress’ (NOTE: even if you can’t see/feel ‘progress’, your body and baby are still working behind the scenes to prepare for labour and birth)
6. It can be less invasive than other induction methods (noting that for some women, hands in their vagina is terribly traumatic and invasive)

What about other natural induction options? Click here to read more!

Risks of Stretch and Sweeps

First off, let me note that if your care provider doesn’t discuss the benefits AND risks with you of a procedure, then you are not providing informed consent. You always, ALWAYS have the right to decline any intervention! This is the case throughout pregnancy, labour, birth and postpartum, or any other time in your life.

1. In women whose cervix is already 1 cm dilated, stretch and sweep results in a 9.1% increase in risk of pre-labour rupture of membranes (Hill et al. 2008). After pre-labour rupture of membranes, care providers tend to expect women to birth within a set time frame (i.e. you’re put ‘on the clock’)
2. Most women (70%) find it significantly uncomfortable (Wong et al. 2002)
3. No clear difference in rates of unassisted births (i.e. it may kick off labour, but it doesn’t mean natural, unassisted birth will follow; Cochrane Collaboration, 2020)
4. Some women experience bleeding, ongoing pain, irregular contractions and increased mucous after the procedure (Wong et al. 2002)
5. There is not enough research to actually support routine use of stretch and sweeps for women and babies (Cochrane Collaboration, 2020)
6. Stretch and Sweep overrides your body’s (and baby’s) own mechanisms for initiating labour. Consequently, it increases the likelihood that one or both of you is not quite ready. As with any induction procedure, regardless of how devoid of medication it is, or how natural, they hold risks.

Conclusions

*Cue squishy babies to get the Oxytocin flowing!*

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So, what would I suggest women do? In short, whatever they feel is right! Trust your intuition, trust our gut and do what feels right for you. In saying that, I’d suggest that unless there is a medically necessary reason you need your baby to be born pretty soon, it makes sense to leave well enough alone.

I know it’s insanity inducing waiting patiently for your baby. Especially when you’re uncomfortable, expecting them to be here already, chasing other children, or *insert all the other reasons waiting for a baby is just-hard-work!* However, we’re learning more and more indicating that our babies are the ones initiating labour! If you can wait until your baby indicates they are ready then I encourage you to do that. No intervention is 100% safe or effective. Trusting your body, and surrendering to when your baby is ready to arrive, is the first in many lessons of trust and surrender that labour, birth and parenting can teach you! It’s a wild ride, but an incredibly enriching and transformative one.

If you’d like to read some birth stories of births that ‘progressed’ beautifully well without a stretch and sweep, check out Hamish’s and Evalie’s Birth stories! I’m hoping to blog about some situations where women have gone ‘post-term’ soon, so will try to remember to come back and add them here when I do!

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