29. Facilitation of related childbearing skills
membrane sweep
CHAPTER CONTENTS
Role and responsibilities of the midwife198
Summary199
Self-assessment exercises199
References199
LEARNING OUTCOMES
Having read this chapter the reader should be able to:
• discuss the indications for membrane sweeping
• discuss the current evidence available
• describe how the procedure is performed
• summarise the role and responsibilities of the midwife.
This chapter considers the skill of sweeping or ‘stripping’ the membranes. As the cervical os is gently dilated (stretch) and the amnion is digitally separated from the lower uterine segment (sweep), intrauterine prostaglandin synthesis commences and so labour may be induced (Boulvain et al 2005). It is generally used prior to formal induction of labour (Enkin et al 2000). However, while the woman may appreciate assistance to commence labour without further intervention, sweeping the membranes is an uncomfortable procedure that may induce bleeding per vaginam and discomfort. Informed consent should include these aspects as well as expected outcome (see Chapter 30 for supporting information).
The evidence
The Royal College of Obstetricians and Gynaecologists (RCOG 2001) indicates that sweeping the membranes increases the likelihood of spontaneous birth within 48 hours and birth within 1 week. It does, therefore, reduce the incidence of birth after term and formal methods of induction, e.g. prostaglandin (PGE 2), both of which have associated risks. The woman and baby do not appear to be at an increased risk of infection (Boulvain et al 2005). Although some studies suggest prelabour rupture of membranes is more likely to occur with membrane sweeping, de Miranda et al (2006) found this not to be so. Operative delivery figures are unchanged with the use of membrane sweeping. It is noted above that the woman may experience pain and bleeding with and after the procedure and some intermittent uterine activity in the hours and days following. The recommendation is that membrane sweeping should be offered to all women (except placenta praevia and any situation where labour or vaginal birth is not indicated) over 40 weeks gestation, prior to formal induction of labour. Nulliparous women should be offered the opportunity of a membrane sweep at 40 and 41 weeks; for parous women this should be offered at 41 weeks and both groups may be offered additional sweeps if labour does not begin spontaneously (NICE 2008).
