# Stripping the membranes and breaking the water- NOT the same thing?



## Celticqueen (Feb 17, 2007)

Ok, I feel dumb now.

They're not the same thing?

I just realized this because I called my midwife to ask her if they would be willing to break my water at some point if I go a lot more overdue. But I used the phrase "stripping the membranes" instead of breaking the water because I thought it was the same thing.

There was a long pause and she said, "I did that on Wednesday, remember?"

That "cervical exam to encourage labor" was stripping the membranes? Would that explain all the massive amounts of bloody mucus I've had for the past 4 days?

So, them breaking the water is totally different then, right?

Oie. Now I need to call her back and tell her I MEANT to ask her if they would be willing to break my water later on if I haven't had the baby.

Help me out on my terminology here please!!!

Thanks in advance.

-Caitrin


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## alegna (Jan 14, 2003)

Yes. Different things. I wouldn't allow either in most situations without medical indication. I would be more likely to allow a membrane strip. It would have to be medically imperative to induce for me to allow my water to be broken.

-Angela


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## Celticqueen (Feb 17, 2007)

K, thanks.

It's really interesting to me too though- why didn't the midwife use the term "stripping membranes" at the appointment? It would have saved me so much confusion!

-Caitrin


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## alegna (Jan 14, 2003)

Beats me. Seems odd to me. Did you ask for her to do it? Did she ask before doing it?

-Angela


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## Sijae (May 5, 2006)

Yeah, that's a good question. Did she explain the procedure, inform you of the risks and get permission to do it?









Laura


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## laohaire (Nov 2, 2005)

Anecdotally, just reading here, it seems like few HCPs tell a woman what they are doing before (or after) stripping membranes, much less asking permission.


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## sbrinton (Jul 17, 2008)

I don't know if I would suggest having the midwife rupture your membranes (break the amniotic sac) to try to start labor. In my experience with my boys, breaking the water was helpful in active labor (around 4-6 cm) to help things move along.

Stripping/sweeping the membranes is basically separating the amniotic sac from the inside of the cervix and lower part of the uterus. It releases lots of prostaglandins that can cause labor.


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## kltroy (Sep 30, 2006)

I've heard lots of HCPs refer to membrane stripping as:
"stirring things up"
"encouraging labor"
"moving things around to move things along"
etc etc. they usually ask consent to do it, as in "do you want me to see if I can get your labor started by stirring things up a bit?" but may not directly ask if a membrane sweep is ok.


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## angelpie545 (Feb 23, 2005)

Quote:


Originally Posted by *alegna* 
Yes. Different things. I wouldn't allow either in most situations without medical indication. I would be more likely to allow a membrane strip. It would have to be medically imperative to induce for me to allow my water to be broken.

-Angela

Yea, me too. With my second daughter there was a medical indication for stripping the membranes and it worked like a charm (she was born the next day and was thankfully just fine, although a little over baked). I think your body has to be near ready to go into labor for stripping the membranes to have much of an effect, although I could be wrong. I was four cm dilated when my midwife did my membrane sweep (I think I was pretty effaced as well) and mild contractions started almost immediately. My friend however who is currently 40 weeks pregnant had her OB sweep her membranes and while she thinks she lost her mucous plug, her cervix is still very think and no labor yet (this is her first baby). I personally would leave breaking the bag of waters to an absolute last resort, because in most cases if you don't deliver in 24 hrs they will want to do a c-section due to the risk of infection.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *angelpie545* 
I think your body has to be near ready to go into labor for stripping the membranes to have much of an effect, ....

I personally would leave breaking the bag of waters to an absolute last resort, because in most cases if you don't deliver in 24 hrs they will want to do a c-section due to the risk of infection.

Ditto! I had my membranes stripped (also sometimes called "sweeping" membranes) at 41W 4D. I was already 3cm, went to 4cm as she did the sweep. MW didn't tell me what % effaced she thought I was, but she said, "Its' a perfect cervix! Really perfect, I think you'll have this baby today." She was right! Cntrx started 2 hours later & DS was out 6 hours after that!

Yes, true on the c/s if membranes are ruptured for 24 hours & still no labor.

Other reasons not to have AROM (artifical rupture of membranes):
-Cord can prolapse (requiring IMMEDIATE CS)
-If baby isn't positioned properly, will be harder for him to get into position without that water to float around in
-The water is a cushion - makes cntrx less painful for Mom
-The water also cushions things for baby too, making cntrx less stressful to him (less squeezing, so he's less likely to have his cord compressed, depriving him of oxygen)
-if you're GBS+, DEFINITELY don't want AROM (again, risk of infection)

Caitrin,
Is there a medical indication for induction in your case?

If not, and you're just getting impatient & frustrated, I empathize!!! My advice is to hole yourself in your house with TV, internet & books & avoid nearly all other humans!







I joked during those days from the [stupid] _"due date"_ until DS was born that I was "not fit for human contact." If one more person commented on, "Oh, no baby yet?!" I was going to S-N-A-P


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## MamaKickyPants (Sep 21, 2008)

I had my membranes swept at 40w 4d. I asked for it, as it can have a cumulative effect, and I really wanted a home birth, so I didn't want to find myself at 41w 6d and just starting to do thins to encourage labour - we would have ended up in the hospital with an induction! I agree, though, that sweeping teh membranes probably won't do much to encourage labour if you're not already almost ready. I was 3 cm dilated, stretching to 4, and 50% effaced. I had cramping after the procedure and went into labour about 15 hours later (wonderful homebirth! Yay!).
My water didn't break, and my midwives asked me if I wanted them to break it about 10 minutes into pushing, and I said yes, it didn't do much at that point! I was already on my way. If labour hadn't been progressing after I was in active labour, I would have considered it, though.


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## Malva (Nov 2, 2005)

I started having my membranes swept weekly at 36 weeks during my last pregnancy. I still had the baby at 41w5d and my water didn't break until I was ready to push (less than 10 minutes before the baby was born).

So yeah, unless you're ready for labor, it won't help much.

I wouldn't consider breaking the waters to hope to start labour. Sounds like a recipe for a c/s to me.


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## TzippityDoulah (Jun 29, 2005)

some people don't use the phrase "stripping the membranes". maybe b/c it sounds kinda nasty? (I think it does anyhow!)

there is no proof of this actually working. infact it an cause an increased risk of infection when your water does break....


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## nashvillemidwife (Dec 2, 2007)

There was actually a study recently that said it has no effect, but there's a whole lot of anecdotal evidence to the contrary.


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## MegBoz (Jul 8, 2008)

Actually, I thought there was some research to support membrane stripping.
Here are some links:

Quote:

Sweeping of the membranes, performed as a general policy in women at term, was associated with reduced duration of pregnancy and the frequency of pregnancy continuing beyond 41 weeks ... After sweeping of the membranes, there was a 17% risk reduction in the use of more formal methods for labour induction.
One more

Quote:

Sweeping of the membranes, when performed at term, reduced the duration of pregnancy and the proportion of women continuing pregnancy beyond 41 and 42 weeks. When sweeping of the membranes was performed, a reduction in the use of formal methods for labour induction was observed


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## Full Heart (Apr 27, 2004)

Actually it doesn't provide any benefit:

Quote:

AUTHORS' CONCLUSIONS: Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits. When used as a means for induction of labour, the reduction in the use of more formal methods of induction needs to be balanced against women's discomfort and other adverse effects.
It also stated that to avoid induction in 1 woman you needed to strip the membranes of 8.

I have had my membranes swept at 42 weeks a couple of times and been at least 3 cm each time. Once I was 5. Never worked for me. Not once.


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## nashvillemidwife (Dec 2, 2007)

This is the one I was thinking of (and the most recently published).

Quote:

CONCLUSION: No benefit in gestational age at delivery or reduction of postmaturity occurred from membrane sweeping.


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## MegBoz (Jul 8, 2008)

Yes, i saw this quote:

Quote:

Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits.
But that says ROUTINE use of sweeping. What about sweeping _only_ for those women who are about to be pharmacologically induced?

Quote:


Originally Posted by *Full Heart* 
It also stated that to avoid induction in 1 woman you needed to strip the membranes of 8.

That's what I dont' get:
1. Why would you even strip the membranes of a woman who wasn't staring down a phramacological induction anyway?
2. Even if stripping only reduces the need for phramcological induction by 17%, isn't it worth trying anyway since, so far as I know, the risks are negligible? (maybe risk of accidental AROM & risk of infection, particularly if you're GBS+, but still... this is nothing compared to risks of pharmacological induction.)


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## Celticqueen (Feb 17, 2007)

Quote:


Originally Posted by *HennyPenny* 
there is no proof of this actually working.

I could believe this because it's been 5 flipping days since she stripped the membranes and I am still big pregnant, typing this.

The only thing I have to show for it is every single bloody time I wipe (pun intended), I have globs of bloody mucus. Ever since the exam. That's pretty much all day every day for 5 whole days.

With no contractions.

Yay for the stripping membranes being so darn effective, eh?

-Caitrin


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## Celticqueen (Feb 17, 2007)

Quote:


Originally Posted by *Sijae* 
Yeah, that's a good question. Did she explain the procedure, inform you of the risks and get permission to do it?









Laura

No, she just said, "Do you want me to check you?" I said "YES!" since I lost my plug few days prior. Then she said, "Do you want me to do a cervical swipe that might encourage labor?" I told her yes- but I didn't know it was stripping the membranes because well, we can all see I was confused about the term.

So did I give her permission? Yes, but I didn't know what she was referring to. To be honest, I trust her and at that point I was so desperate for something to get started that I didn't even care to ask her to explain it. Probably way too eager if you ask me.

-Caitrin


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## A_Random_Phrase (Mar 27, 2008)

OP, thanks for the question b/c I was wondering the same thing. I asked once, quite a while ago, and got no replies so I thought I must be pretty stupid if everyone but me knew what it was.


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