Latest / The Birth Lounge Podcast / Ep. 452: Membrane Sweeps, Bishop Scores & Advocating at Prenatal Visits Solocast with HeHe stewart (Reair of Ep. 268)

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Ep. 452: Membrane Sweeps, Bishop Scores & Advocating at Prenatal Visits Solocast with HeHe stewart (Reair of Ep. 268) · The Birth Lounge Podcast

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  Membrane sweeps can be super helpful if they feel aligned to you, but you should never, ever feel pressure to get one.
• Let me ask you something.
• Have you ever had anxiety about the conversations that are coming up with your provider in your prenatals, or do you ever leave your appointments and think about all the things that you wish you had said while you're driving home, like, kind of after the fact? Maybe you know what you want in labor, but you don't really know how to actually say it to your provider to communicate your goals or your wishes, or maybe you keep running into the situation where people are saying, "Well, it's hospital policy," and you don't know how to kind of get out of that situation, but you know you don't have to follow that.
• There are no have tos in birth, right? You are free to do whatever you want.
• I want to make sure that you not only have the data and the science to back up the choices that you're making so that you are making decisions that feel aligned with you, but I also want you to have the words to communicate that with your provider.
• And so I've put together a PDF guide that has a ton of birth scripts in there, and I'm gonna take you through different conversations so that you can see how you can navigate these with your provider depending on your goals and your preferences during your labor.
• So you can download that at thebirthlounge.com/scripts-for-advocacy.
• You're gonna find the most common conversations that people bring to me to get information and data on, and phrases to help them stay in control of that conversation.
• So things like big baby, being induced, birthing positions, Pitocin use, prenatal decisions, and so many other conversations that you need to know when you are going into your prenatal appointments with your provider so that you can continue to have this collaborative decision-making conversation throughout your pregnancy so that when you're in labor, everybody's already on the same page, people know what to expect, we have a plan and this is what we're gonna do.
• So download that at thebirthlounge.com/scripts-for-advocacy,
• with hyphens in between, scripts for advocacy, and I'll see you in the episode.
• Bye.
• Hey, y'all.
• Welcome back to another episode of The Birth Lounge Podcast.
• All right.
• One of the most common questions that I get is, hehe, is a membrane sweep a form of induction? So we're gonna dive into that today.
• I'm gonna be talking all about the prenatal intervention, so before you're in labor, of sweeping your membranes in order to encourage labor.
• So let's start with what is a membrane sweep.
• Well, it's a non-pharmacological, so no medicine induction method.
• So to answer your question, it is an intervention.
• Any time that we're trying to encourage your body to do something it is an intervention, rather than just letting it kind of play out naturally.
• Now, it is low intervention.
• It's also comparatively low risk.
• Your provider's going to actually, they need to do a cervical exam You need to be one to two centimeters dilated for us to be able to get inside your cervix, and then your provider's gonna put their finger through your cervix and sweep around your cervix.
• Their finger is going to be in between your cervix and your, your amniotic sac, and this sweeping motion is gonna irritate the cervix and break the membranes that connect your amniotic sac and your uterine wall.
• So this is also not only gonna kinda like stimulate things by irritating it, but hopefully breaking everything will also produce prostaglandins, which we know are responsible for contractions.
• So hopefully you start to have little contractions.
• You know, it doesn't work, it doesn't work all that well.
• It's 50/50, so you, you have equal shots of it working or it not working, and we'll talk about kind of things that make it more successful.
• But one other thing that you should know is even if it doesn't work for you, it typically does progress or cause progression, uh, leading up to labor, meaning your cervix will efface, so it'll get a little thinner, cause a little bit more dilation.
• There's a lot of things we're measuring the success of a sweep with, rather than just looking at if it sent you into labor or not, so just keep that in mind.
• But do realize that 50% of the time it'll send you into labor, 50% of the time it won't, so consider what else it might have done for your body.
• Um, I mentioned that you need to be one to two centimeters dilated, so if your cervix is high and closed, then y- you won't be able to get a sweep 'cause your provider's not gonna be able to get up in there and get their finger in there.
• Um, sometimes your cervix is so far back, so high, so closed, that your provider can't even really get to it.
• In that case, I would look at why your body is sending you the message that it's not ready for birth yet.
• You know? Um, I've got a ton of different episodes on that.
• I go very, very in-depth in that in The Birth Lounge membership.
• Um, so if you're interested in that you've got plenty of resources to check that out.
• So I think we should also talk about what you can expect during your membrane sweep.
• A lot of people do report that it is uncomfortable, and some people do call it painful.
• It should be pretty quick.
• Um, it's not a long procedure for most people.
• They don't give you any sort of pain relief either.
• You just kind of breathe through it and relax your body and it is, it is fairly quick.
• If your cervix is ready.
• Remember, they have to get up in there, so they've got to get up in there and get through your cervix.
• We don't think it's gonna take long, but if we have to search around for your cervix, that might increase the time, obviously.
• After your membrane sweep, though, you should also be expecting things like light vaginal bleeding.
• Anything that is heavy vaginal bleeding or if you are filling up multiple pads or when you look in the toilet, your toilet's completely covered in blood, you should call your provider and/or just head to the hospital.
• That's not norm- That's not normal.
• We're, we're talking about light bleeding here.
• Um, you might have crampiness.
• Some people even feel kind of icky and, and just nauseous afterwards, and you might also notice that your mucus plug releases.
• So if that's something that hasn't happened yet and/or you've seen pieces of it, that might continue.
• One of the lesser talked about things in the literature and doctor's offices, but incredibly well talked about in the mom community, is the association of prodromal labor with membrane sweeps.
• So sometimes with that sweep, you know, the goal is to kind of wake up your cervix and be like, "Hey, come on.
• Do your thing."
• sometimes that cervix does not respond well to that.
• And instead of, you know, doing the typical bleeding, cramping, I guess I forgot to mention earlier, it, it typically lasts 24 to 48 hours.
• And by 48 hours, we're gonna know if that, if that membrane sweep is gonna send you into labor.
• If it hasn't sent you into labor in 48 hours after the sweep, then it, quote-unquote, "didn't work," but don't forget, we are also looking at other, other things in your body.
• So sometimes when we see people get sweeps, and thousands and thousands and thousands of anecdotal stories of people reporting they got a sweep and then it sent them into prodromal labor.
• If you don't know what prodromal labor is, it's like days and days and days and sometimes weeks of on and off, start and stop labor.
• It is super miserable.
• It's really, really tiring.
• It is mentally exhausting, and it really is, it's hard.
• It is super hard.
• And so I think that most people try and avoid prodromal labor at all costs.
• So just think about that when it comes to the risk of, Getting a, a membrane sweep.
• One of the good things about membrane sweeps is that they can stack, so you can have multiple membrane sweeps.
• Um, if you're really, really concerned about going into labor and/or you're facing a specific date for an induction, you can use membrane sweeps kind of strategically.
• So maybe you get one at 39 weeks, and then maybe you get one at 40 weeks, and then maybe you go back at 40 and 5 because you, you know, have an induction date for whatever reason that might be on the calendar for 41 weeks and you're really trying to go into labor.
• Think about all the risks that come along with it, but that is one benefit is that you can use this method multiple times, where not all induction methods have that option.
• You also get to go home after membrane sweeps.
• They're not anything that you need to be checked in for.
• You don't have to stay for monitoring.
• You literally get it in your prenatal visit, and you leave just as you normally would, which is also a really big benefit of that.
• It's something that, you know, we can do and then send your body home to rest and relax and let it, let it take.
• Let it take.
• Okay, so I mentioned earlier that there are some things that you can do to kind of increase the success rate of a membrane sweep.
• This is highly dependent on how receptive your body is.
• We are going to know that, like how receptive your body is, by getting a Bishop score.
• I talk about, uh, the Bishop score in episode 141 of the Birth Lounge podcast so that you can learn everything that goes into that score, but it does require a cervical exam.
• So what this most often looks like is your doctor will go up there, give you a cervical exam, come out and say, "Here's your Bishop score."
• And you in your head can...
• You'll know what makes up the Bishop score, and you can ask for each of your individual numbers.
• You can cross, kind of check your Bishop score, have a discussion about that if you disagree in what your Bishop score should be, and then from that Bishop score, you'll make a decision on whether your provider should do a, like go back inside and sweep your membranes, right? If you want to have this conversation before, before you do the Bishop score, talk to your provider and then say, you know, "If you find that my Bishop score is this number", or maybe you keep it to yourself and you just know in your heart or your head, "If my Bishop score is this, I'm going to decide to get a membrane sweep.
• If it's not-" I'm going to say no.
• And so when your provider goes up there to do your Bishop score, you have already told them, you've had a discussion before you have, you know, maybe you're probably undressed by the time they get in there.
• But before you've even laid back and everything, you say, like, "All right, I just wanna make sure that we're all on the same page here, and when you get up there, I'd like for you to do a check and then please don't move because I'm going to make a decision on whether I want a membrane sweep right there in the moment based on my Bishop score."
• And so whatever Bishop score your provider shares you can make that decision and say, "Okay, yes, please, would you mind just sweeping my membranes while you're in there?" Or you say, "Hmm.
• Okay, no thank you.
• You know, I wanted to be further along before I got a membrane sweep."
• Now, why would you wanna be further along? Well, because a more favorable cervix increases the chances that that membrane sweep works.
• See, your body's kind of just waiting for this tipping point when it comes to membrane sweeps.
• Your body kind of needs to be in the right place in labor that it's just waiting for that final little nudge to go into labor for a membrane sweep to work.
• This is both good and bad, right? If you're in that right space, you can have a beautiful onset of labor with just a membrane sweep and nothing else, nothing more.
• But if you're not part of that and your body's that part of the population, your body's not in that place in labor, then, I don't know, sometimes it doesn't work for you, and that can be kinda hard mentally.
• That can be kinda hard emotionally if you're, if you, if it sends you into prodromal labor, that can be kinda hard physically.
• So pros and cons.
• There is a 2020 study that looked at 40 studies and, uh, 6,500 participants.
• Now, not all of the studies looked at everything, but this 2020 article compares all of them really cohesively.
• I'll link that for you.
• And it was really fascinating to see all the things that they found.
• You can find that in the show notes.
• Everything else that I've cited today, you can find in The Birth Lounge app.
• Uh, you can find that in the Apple or Google Play app store Another question that I always get is, is a membrane sweep VBAC safe? Uh, yeah, generally it is considered VBAC safe.
• Talk to your doctor about your goals with the onset of labor and your VBAC.
• Maybe you're facing a hospital policy that says VBACs can't go past a certain date, so you have to be induced.
• Maybe you are facing a hospital policy that says, "If you don't go into labor, uh, by this time, we actually don't induce VBACs", and you would be forced to have a C-section at that point.
• Talk to your doctor about it.
• But yeah, typically, membrane sweeps are so low risk and so low intervention that, um, they are considered VBAC safe.
• All right.
• Before we wrap up, I did wanna tell you about two more risk that I am not sure all providers kinda remember to tell you about because they're so rare, but I mean, you, you still need to know them even though they're super rare.
• One is infection.
• Obviously any time we go up there, any time that we are kind of messing around with things or introducing someone else's hand up there there's a risk for infection.
• The hospital, you know, is, is kind of a dirty place.
• There's a lot of new germs that are new to you.
• You know, germs in your home are familiar germs to you.
• Not to say they're not dangerous, but it comes with a different level of risk.
• So infection is one.
• That's any time we go up there, so cervical exams, any sort of ultrasounds, any sort of checks, speculums, any tools, things like that.
• The second thing is accidentally breaking your waters.
• Now, this is super rare.
• We have seen it.
• It does happen.
• Again, any time you kind of go up there and the goal is to separate that amniotic sac from the uterine wall, there is a chance that the amniotic sac gets broken in that process and it gets released.
• With that, you would then, you know, kind of be on that time clock.
• A lot of hospitals use the 24-hour rule.
• We know that's a little bit outdated.
• If you don't know the science on that, cover it in the Birth Lounge membership, um, and it's coming soon to the Birth Lounge app.
• Data says 24, 48, 72 hours, depending on what is going on in your labor, but regardless, once your waters are broken, your baby does have to come out.
• We can't stop that process and we can't go back from there.
• So just think about those two as well.
• So to wrap up, your pros are it does, regardless of whether it sends you into labor or not, which is 50/50, it will progress your body.
• It may not always be in sending y- you into labor, though You can have multiple membrane sweeps, so that's super helpful.
• You can start to use them strategically, and with the knowledge that they help progress your body, maybe it's enough that you might even still need a medical induction, but you don't need as much medicine or as many methods to send you into labor.
• And then lastly, comparatively to all of our other options, it is very low risk and considered low intervention.
• The cons, though, are the uncomfortable part of the actual sweeping, so the actual procedure.
• The things that follow, like cramping and bleeding, it might send you into prodromal labor, and then you have the risk of infection and accidentally breaking your waters as well.
• These are all things to consider when you are thinking about the end of labor and how you're gonna manage those last few days and weeks leading up to the birth of your baby, and considering individual factors of what's going on in your pregnancy.
• All right, you guys, I think that kind of wraps up everything with a membrane sweep.
• It is totally up to you on whether you get one or not.
• It will never, ever be an enforceable hospital policy, so you never have to consent to one.
• And I gave you a little short script earlier of how you can navigate one of those conversations with your provider.
• I talked about previously in episode two about the scripts, uh, download that I have.
• So don't forget to download that.
• I'll put that in the show notes for you to grab as well.
• Membrane sweeps can be super helpful if they feel aligned to you, but you should never, ever feel pressure to get one.
• If you want more information about membrane sweeps, download the Birth Lounge app anywhere that you search for your apps, and you can join The Birth Lounge membership at thebirthlounge.com/join.
• All right, y'all.
• As always, it's been so much fun hanging out, and I will see you in the next episode.
• Bye.
• Thank you so much for tuning in today.
• I love hanging out with you, and it is an honor to be your go-to gal when it comes to preparing for your baby.
• If you've enjoyed today's episode, please leave a five-star review and tell others why they should be listening to the Birth Lounge Podcast too.
• You deserve to have a birth that you love with a provider that values your autonomy and respects informed consent without all the trauma that you so commonly hear about on social media.
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• I'm HeHe, and this is the Birth Lounge Podcast.