# Stripping membranes at 41 week appointment



## lovelymama2 (Jul 17, 2009)

My 41 week appt. is this afternoon and I'm considering having my membranes stripped. I have nothing really going on except for a little crampy feeling. My cervix might be too high and closed in which case I won't have them do anything, but if it's opening up a bit, would it be a good idea to get them stripped? I'm getting desperate


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## fruitfulmomma (Jun 8, 2002)

IME it doesn't do anything. The only time it "worked" I was already 3-4cm and had been having prodromal labor for a couple of weeks. It also increases risk of infection.


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## alegna (Jan 14, 2003)

I wouldn't allow it without medical reason for induction. All too often water is "accidentally" broken when stripping membranes.

Babies come when ready. Ds was 43 weeks 5 days.

-Angela


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## nashvillemidwife (Dec 2, 2007)

Can you quantify exactly how often "all too often" is? Do you have a source for it?


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## alegna (Jan 14, 2003)

I don't have a source I just have a lot of anecdotal stories.

-Angela


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## Lineymom (Mar 14, 2009)

I'd do it. Both my ds were born after a labor that started within 12 hours of a membrane strip. The first was by my midwife at 41 wk 2 days and the second by dh at 39 wk 4 days. I was about 2cm with both.


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## nashvillemidwife (Dec 2, 2007)

Quote:


Originally Posted by *alegna* 
I don't have a source I just have a lot of anecdotal stories.

-Angela

So no actual evidence? Thanks for answering.


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## columbusmomma (Oct 31, 2006)

Could you start on some evening primrose oil? Just a thought...


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## soposdedi (May 9, 2005)

Please keep in mind that Angela is not a medical professional of any kind, and merely has anectdata and what she has decided is true, as 'evidence'. If it would make you feel better, do it. Babies certainly do not always come when ready, despite her magically long pregnancy. Sometimes things do happen, and sometimes a little help is necessary and beneficial.


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## Liquesce (Nov 4, 2006)

I see this was yesterday ... if you had it done (or even if you didn't), lots of good labor vibes your way.


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## fruitfulmomma (Jun 8, 2002)

Huh, I wasn't aware the OP was asking for professional medical opinions and quantified studies.

Yes, our experiences are anecdotal. That doesn't make them false.

Quote:

If it would make you feel better, do it.
So, she should make the decision based on how she feels about it? You're not going to offer up any studies which show a true benefit of membrane stripping in her situation?

Quote:

Babies certainly do not always come when ready, despite her magically long pregnancy.
I have "magical" pregnancies too. 4 out of 5 of my babies have been born after 41 weeks, 2 of those were at 44 weeks. I have tried all the "natural" methods, including membrane sweeping. Whether they did anything or not is totally questionable in my mind. I WILL NOT submit to a membrane sweeping again. It is not worth it in my opinion. It hurts, it makes me crampy, and it is incredibly stressful because I am basically expected to perform some magical feat and go into labor automatically and when it doesn't work I am assumed to be broken, that something is wrong with my body and it just isn't! And not only that, there are SO many variables from woman to woman, unless the OP was charting and knows exactly when she ovulated, she has no way of knowing whether or not she is really "late".


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## nashvillemidwife (Dec 2, 2007)

Quote:


Originally Posted by *fruitfulmomma* 
it is incredibly stressful because I am basically expected to perform some magical feat and go into labor automatically and when it doesn't work I am assumed to be broken, that something is wrong with my body and it just isn't!

If you're seeing a practitioner who really puts that kind of expectations on you then it's time to find a new one.


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## Mccmama07 (Mar 19, 2007)

Quote:


Originally Posted by *alegna* 
I don't have a source I just have a lot of anecdotal stories.

-Angela

Within the anecdotal stories, did their membranes rupture immediately?

My own anecdotal evidence (my own births...I've had three) show no link between membrane stripping and membrane rupture. 2x it did nothing-my membranes were broken during the second stage of labor, and with DD, my membranes ruptured a good 55 hours after a "strip."

I'm just curious as to how you measure stripping membranes with rupture? How close in time proximity do the events need to occur in order to for the rupture to be blamed on membrane stripping?

Just curious.


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## roxyrox (Sep 11, 2006)

I think it's a good idea. A sweep at 41 weeks is standard in UK midwifery care. I had a sweep at 41 weeks (which didn't work). I then had one at 41+4which did work. They were both painless.

Quote:


Originally Posted by *alegna* 
I wouldn't allow it without medical reason for induction. All too often water is "accidentally" broken when stripping membranes.

Babies come when ready. Ds was 43 weeks 5 days.

-Angela

Why is "accidentally" in inverted commas? Maybe in a very, very small number of cases sweeps may accidentally break someones waters but that would be very rare. Do you mean you think midwifes break women's waters on purpose? I really highly doubt they do. Why on earth would they, what would they gain by doing that?


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## fruitfulmomma (Jun 8, 2002)

Quote:

If you're seeing a practitioner who really puts that kind of expectations on you then it's time to find a new one.
It is has nothing to do with my practitioner, whom I love dearly and wouldn't trade for anything. There are numerous pressures a woman who carries longer than "normal" faces from outside forces such as the law which demands I transfer care after a certain point and friends and family, all of whom assume something must be wrong when you don't fit the norm. As a matter of fact, my husband got an ear full from a fellow homebirther during my last pregnancy because this woman assumed my midwife was "doing nothing" and that I needed a new one, that something was wrong with me and we just weren't doing enough.

Quote:

Do you mean you think midwifes break women's waters on purpose? I really highly doubt they do. Why on earth would they, what would they gain by doing that?
I suspect she was talking about doctors. The American birth model has a lot to gain by starting the chain of interventions, including convincing a woman that she now needs a medical induction if the stripping doesn't "work" because now the baby is in danger of an infection with the waters being broken. Do I think that it is the norm to do this? No. But it does happen.

ETA: 41 weeks isn't late. Why are we suggesting medical interventions for a mother who isn't even postdates yet? Why is this intervention part of the norm in the UK midwifery model???


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## roxyrox (Sep 11, 2006)

Quote:


Originally Posted by *fruitfulmomma* 
ETA: 41 weeks isn't late. Why are we suggesting medical interventions for a mother who isn't even postdates yet? Why is this intervention part of the norm in the UK midwifery model???


NICE guidelines recommend offering sweeps because they make spontaneous labour more likely and reduce the need for formal inductions. They are also not associated with any increase in maternal or neonate infections. I guess there is the small risk of AROM, but really, it is a very, very small risk. I think the risk of an actual induction is far greater (suggested from 42 weeks). They suggest women are given "every opportunity" to go into natural labour. You don't have to have one, but they are offered.


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## HappyMommy2 (Jan 27, 2007)

I would NOT do it. I will never again get on that slippery slope of interventions that end is c-sections. Also - I heard it hurts really bad a couple hours later. Baby will come when the time is right for the baby to come.


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## fruitfulmomma (Jun 8, 2002)

Quote:

NICE guidelines recommend offering sweeps because they make spontaneous labour more likely and reduce the need for formal inductions.
I guess we have a different opinion on what constitutes spontaneous labor.

Quote:

They are also not associated with any increase in maternal or neonate infections.
None at all? I find that hard to believe since vaginal exams themselves increase the risk.

Quote:

I think the risk of an actual induction is far greater (suggested from 42 weeks).
True enough. But maybe it is policy towards women who are "late" that needs to change, rather than trying to force babies out before they are ready.


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## finn'smama (Jan 11, 2006)

Here are my experiences with sweeps, fwiw OP.
With #1 I had one at 40 weeks on the dot and ds was born approx. 12 hours later at home.
With #2 I refused one at 39 weeks and then my water broke a few days later and I didn't have any contractions, so I allowed a sweep to see if it would get contractions going. Again, ds2 was born about 8 hours later.
Talk to your cp. If you feel comfortable letting things go longer and baby is fine, than leave things as they are. If you feel well informed and want one, than go for it.
Whatever you decide I hope you're holding your new baby in your arms very soon!!









eta: just wanted to add to my story about ds2. When my water broke it was THICK with meconium and he had done some crazy acrobatics in utero the night before, which ultimately ended up with us giving birth in the hospital (completely intervention free). I often wonder if I'd had that sweep maybe we could have avoided the hospital. But probably not, since I personally don't think a sweep does anything if baby isn't ready.


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## pumpkinhead (Sep 15, 2003)

I probably wouldn't do it at 41 weeks myself, but mostly because I've had it done (twice with my 1st pregnancy) and it did zippo. Ds was born at 43ish weeks after a pit induction. It did hurt a lot and I bled lots but no labour.


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## alegna (Jan 14, 2003)

Quote:


Originally Posted by *Mccmama07* 
Within the anecdotal stories, did their membranes rupture immediately?

My own anecdotal evidence (my own births...I've had three) show no link between membrane stripping and membrane rupture. 2x it did nothing-my membranes were broken during the second stage of labor, and with DD, my membranes ruptured a good 55 hours after a "strip."

I'm just curious as to how you measure stripping membranes with rupture? How close in time proximity do the events need to occur in order to for the rupture to be blamed on membrane stripping?

Just curious.

Most I read ruptured then and there- as in - "oops" They read as though it was intentional...

-Angela


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## xelakann (Jul 30, 2007)

For those ladies who have had their membranes sweep and it did put them in labor you were at all dilated before?

Sorry to thread hijack here but I am 4-5 cm dilated and almost 41 weeks (though I have been this way since 36 weeks), my midwives haven't brought it up or anything yet, but I admit I am getting curious about it.


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## terrabella (Oct 19, 2005)

Quote:


Originally Posted by *lovelymama2* 
My 41 week appt. is this afternoon and I'm considering having my membranes stripped. I have nothing really going on except for a little crampy feeling. My cervix might be too high and closed in which case I won't have them do anything, but if it's opening up a bit, would it be a good idea to get them stripped? I'm getting desperate



















I haven't had it done, but I remember each time that I strongly considered it!!!
































Quote:


Originally Posted by *alegna* 
I wouldn't allow it without medical reason for induction. All too often water is "accidentally" broken when stripping membranes.

Babies come when ready. Ds was 43 weeks 5 days.

-Angela

You used acupressure to urge Gregory out, correct? You had an appointment on the afternoon of 6/2/08, and he was born on the morning of 6/4/08. Therefore would you recommend she use acupressure instead? Do you feel that it helped move things along? The timing seems promising.

I must admit, I'm more comfortable with the idea of acupressure, or even acupuncture, than I am stripping. I know striping is generally considered safe, but I personally feel it's rather invasive.







Just my own hang up.
















I remember when my first baby was late (I went 42weeks, but began labor naturally), I did all sorts of squats and lunges.







I think there may have even been some squat jumps in there too.
















I'm not that impatient anymore.


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## pumpkinhead (Sep 15, 2003)

Quote:


Originally Posted by *alegna* 
Most I read ruptured then and there- as in - "oops" They read as though it was intentional...

-Angela


With respect, I suspect that if the amniotic sac could be ruptured with a gloved finger, it was probably going to break very soon on its own. Most OBGYNs I know are not in the habit of committing their patients to delivery without their consent. I'm sure it happens occasionally, but I don't think it's the gold standard.

Like I said upthread, I had mine *vigorously* stripped twice and my membranes were not ruptured. I actually don't know anyone whose membranes were ruptured during a membrane sweep, but that's anecdotal on my part. I was 41 weeks the first time and 42 the next. I was 4 cm dialated and about 80% effaced. Both times it did absolutely nothing to put me into labour.


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## abigail_b (May 3, 2007)

I had my membranes swept with my first, it wasn't that uncomfortable, I didn't bleed afterward, and I had my baby 4 days later. So I am not sure that it did anything.

I have since discovered that there have actually been multiple randomized control trials done on membrane sweeping. I was looking at the links last week, but I haven't been able to easily relocate. I know that I saw 2 studies, both fairly recent (post 2000), both unfortunately showed no reduction in gestational age in the sweep groups. One showed no increased risk of PROM, one showed an increased risk of PROM if the mother was dilated greater than 2 cm.


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## finn'smama (Jan 11, 2006)

Quote:


Originally Posted by *xelakann* 
For those ladies who have had their membranes sweep and it did put them in labor you were at all dilated before?

Sorry to thread hijack here but I am 4-5 cm dilated and almost 41 weeks (though I have been this way since 36 weeks), my midwives haven't brought it up or anything yet, but I admit I am getting curious about it.

Both times I was about 1cm, no more than 2cm for sure. But the second time my water was already broken.


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## Lineymom (Mar 14, 2009)

Quote:


Originally Posted by *xelakann* 
For those ladies who have had their membranes sweep and it did put them in labor you were at all dilated before?

Sorry to thread hijack here but I am 4-5 cm dilated and almost 41 weeks (though I have been this way since 36 weeks), my midwives haven't brought it up or anything yet, but I admit I am getting curious about it.

Yeah, you have to be about at least a 2, I think, because they have to get a finger thru the cervix to do it.

As for it hurting, it was not bad at all to me. As soon as I am past 38 weeks and dialated enough, I will get DH to do it again. It worked so well the other two times. Thats 4 weeks from today!!!


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## Vespertina (Sep 30, 2006)

Assuming Henry doesn't arrive before, my midwife will be sweeping my membranes after DH gets here so he won't miss the birth since he'll only be here for a couple weeks on R&R. I'll be getting acupuncture treatments as well. Sometimes it takes 2-3 treatments. It has a 70% success rate. My midwife doesn't usually sweep her clients unless there's a medical reason, like potentially being risked out of her care due to late onset of PIH. She understands our situation.

With me, sweeping does not start contractions, but it does cause me to dilate pretty far -- 7-7.5 cm without contractions. Once contractions do start my labor is very rapid.

I'm pretty certain the OB I saw with DD1 sweeped my membranes without my knowledge when I was 37 weeks. It was more aggressive than previous exams and the midwife I saw after said that's likely what he did. I was 3 cm when I went in. I went to L&D the next day about the pelvic pressure I was feeling and found out I was 5 cm. Saw my usual midwife five days later and was still 5 cm and my bag was bulging. My midwife sweeped me again. It didn't bring on contractions. I was induced with pit at 6.5 cm. Contractions started when I was 7.5 cm.

With DD2, I went in to see my midwife and was 2 cm and 70% effaced. I was in triage in L&D for a few hours. She checked me and sweeped my membranes just before I left. She said my cervix was mushy and I was 3 cm, easily stretched to 4. She suggested I go walk around the mall for a couple hours and come back. That they'd admit me if I was a solid 4. We did just that. I came back and waited like 30-45 minutes to be seen and was 5 cm. She was puzzled. No contractions. Just a ton of pelvic pressure and lower backache. Was admitted and all that jazz. I walked the halls for a little over an hour trying to get things going and came back. She checked me again and I was 6 cm. Still no contractions. I walked around my room some more and used my birth ball. The next time I was checked I was 7 cm, but still no labor. I didn't start labor until transition after I was done taking a shower.

She later said I have a very pliable cervix that dilates very, very easy with pressure (baby's head) once the membranes is separated from the cervix.

DH planned his R&R around the time he's due. If he wasn't gone or coming home for that time then I wouldn't consider the sweep just shortly after my 'due' date.


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## marrymeflyfree (Jan 5, 2008)

I am 41 weeks also and chose to have it done at my most recent appointment. For me, the decision was mostly circumstantial...my hubby has to go out of state for 6 weeks soon for a training thing, and I'm fearing that this baby will decide to show up just prior to his leaving. We have a 16mo as well, no family nearby to help out, and its important to me that we all have some bonding and adjusting time before he leaves. I'm really dreading being alone with a newborn and small toddler!

That said, I didn't really expect it to start labor, and it didn't. Hopefully it at least did something for dilation, though. I tried it 3 times with my first pregnancy (which went to a day shy of 43 weeks), and never had any spectacular results. It never started labor. My thought process was that if we really get down to the wire before DH must leave, I will regret having not done anything. Are there risks? Certainly. Everything has a consequence (or potential consequence). Are they low? Most likely, for most women, in normal pregnancies, yes. For me personally in my own circumstance, the risks of attempting to stretch the membranes are less worrisome than doing nothing at all, and ending up recuperating from birth alone with two highly dependent small children.

I think it is unrealistic to say that no woman or practitioner should ever attempt this because it is always problematic...the truth is that it isn't always problematic, and there may be circumstances that make those small risks acceptable. We've all got to weigh those pros and cons for ourselves and make our own decisions.


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## ShadowMoon (Oct 18, 2006)

I had it done at 41 wks and I immediately went into labor with strong contractions. I didn't ask for them to be stripped, my OB did a "rough" exam and did it because I was absolutely refusing inductions since 30 wks and she was trying to "help" me get my natural birth. Luckily she's not practicing anymore, though she was ok with other things. I digress...
I don't know if I would intentionally have them stripped because, in my case, the contractions came on too fast and too strong. But, it's an individual choice and I can understand why some may choose to do it.


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## nashvillemidwife (Dec 2, 2007)

Sometimes it's impossible to fully assess dilation without doing some sweeping.


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## pumpkinhead (Sep 15, 2003)

Quote:


Originally Posted by *nashvillemidwife* 
Sometimes it's impossible to fully assess dilation without doing some sweeping.


Okay, I'm confused. I thought membrane sweeping meant that you stuck your fingers inside the uterus throught the cervix and swept the amniotic sac away from the lining of the uterus. Why would you need to do that to assess dilation? Do you mean that the sac is buldging through the cervix so you need to push it out of the way?


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## nashvillemidwife (Dec 2, 2007)

I'm saying that sometimes in order to get your fingers far enough in the cervix to feel the inner os, and then to spread them out to assess dilation, you are bound to dislodge the membranes. The membranes are laying over the cervix, not way up in in the uterus.


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## pumpkinhead (Sep 15, 2003)

Thanks for the clarification


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