Labour and Birth, Pregnancy, Pregnancy Problems

The Magic of Membrane Sweeps

Membrane sweeping or membrane stripping is often mentioned at the end of pregnancy as a way of starting labour. It certainly sounds rather uncomfortable but what does it really involve and does it actually make any difference? Here are the facts to help you decide whether membrane sweeping is the right choice for you.

First, the physiology of membrane sweeping.

The very bottom of your uterus is called the cervix. The cervix sticks out slightly into the top of your vagina. When you aren’t in labour the cervix is pointing around towards your back rather than forwards directly towards the exit. This is good, because it reduces the risk of infections and damage to the cervix from anything entering the vagina.

The cervix is about 3cm long and has a firm consistency rather like the end of your nose. As it is 3cm long, it is like a tube with one entrance in your vagina and the other one opening into the uterus where the baby is.

The body is really clever and protects the baby from infection by filling this tiny tube with a mucousy jelly which catches any nasty bacteria trying to enter the uterus and cause an infection.

The baby is also surrounded by a bag of waters which sits against the lining of the uterus and protects the baby from infection, small bumps and jolts or pressure changes due to contractions.

The purpose of membrane sweeps

Although we don’t know lots about what starts labour, we do know that levels of natural prostaglandins rise in your body when labour begins. We also know that putting artificial prostaglandins up into the top part of your vagina can soften the cervix and start opening it up. These artificial prostaglandins are used as part of the induction of labour process at most hospitals when we want to start labour for any reason.

Natural prostaglandins can also be released by peeling the bottom part of the bag of waters gently away from the wall of the uterus. This is known as membrane sweeping or membrane stripping.

Research currently suggests that membrane sweeping can reduce the length of a pregnancy by about one week. This means women who have sweeps often go into labour earlier than they might have done without a sweep. If a sweep is successful, you are likely to go into labour within 48-72 hours of the process.

Policies differ between hospitals and care providers about when sweeps are offered and how many can be done for each woman. Please check with your midwife or health care provider for your local information.

The process of sweeping the membranes

Sweeping the membranes involves a vaginal examination. You will need to take off your underwear and lie down on the bed, covered with a sheet. Partners are welcome to stay with you, sitting at the head end of the bed and holding your hand if you wish.

The midwife or doctor will ask you to bring your ankles together and your heels up towards your bottom so that your knees bend. You will then be asked to let your knees flop open to either side.

The midwife will then insert two fingers of her gloved hand into your vagina using lubricating jelly to reduce the discomfort. She will need to reach the cervix, so if it is still pointing towards your back, she may ask you to put your hands into fists and put them under your bottom. This tilts your pelvis and makes it easier to reach a cervix that is pointing backwards.

When the midwife reaches the cervix with her fingers, she will try to put her finger through the tube of the cervix and into the uterus, where she will be able to feel the baby’s head through the bag of waters! She will then move her finger in a circular motion between the bag of waters and the wall of your uterus. When she does this, she peels the bag away from the wall which makes the body release natural prostaglandins.

What happens if membrane sweeping isn’t possible?

Sometimes, the midwife may not be able to reach the cervix. In other cases, the cervix may be so tightly closed that she can not reach through it to get to the bag of waters and sweep it away from the wall of the uterus. Unfortunately, we don’t know what we will find until we try. However, if the midwife can’t reach the cervix or through it to the uterus, giving the cervix and the area around it a gentle massage with her fingers may be helpful in softening and stretching the fibres of the cervix. This may make it more responsive to any tightenings or contractions you may have. It may also start the cervix softening so that in another few days the cervix is open enough to sweep the membranes.

After the membrane sweep

Once the examination is over, you may notice some heavier vaginal discharge, so it’s worth bringing a maternity pad with you to your appointment to wear home. You may also note a tinge of blood in the discharge. This is very common as when the midwife puts her fingers through the cervix it opens slightly more and small blood vessels called capillaries break. This bloody discharge should only be a small amount, so please contact your care provider if it seems heavy to you or you are worried.

It’s important to stay as upright and as active as possible after a membrane sweep. This pushes baby’s head down onto your cervix, which will already have been stimulated by the sweep. More stimulation will help your body produce more prostaglandins and start the hormone oxytocin flowing. Oxytocin causes contractions, which is exactly what we want! Perhaps try a good long walk, or bounce around the house on a birthing ball.

While you wait for the membrane sweep to work, why not read some of my other posts? You can find out my top tips for early labour here. The NHS website also has great information on induction of labour and choices when labour reaches 41 weeks. Read that here.

Please follow and like us:
error
Labour and Birth, Pregnancy, Pregnancy Problems

When Pregnancy isn’t Pleasant

I want to let you in on a secret. It’s one that the press and social media and even your friends don’t want to tell you.

Sometimes pregnancy sucks.

You might be looking at all these stylised photos and posts telling you how wonderful women are finding their pregnancy. They describe how they feel as if they are glowing and finding fulfilment and a new purpose.

If you read those posts and feel inadequate or upset by them, you are not alone! I can’t tell you the number of women who come into my clinic each week feeling tired and exhausted and fed up and very unglamorous!

They have aches and pains in very private places, they can’t sleep and can’t eat and are too exhausted to do more than crash on the sofa after work. Some of them are physically sick every day well beyond the expected 12 weeks. For some, migraines sometimes get better during pregnancy but sometimes they get much much worse. Other women develop crippling pelvic pain which leaves them on crutches for weeks until the baby is born. Still others suffer with heightened levels of anxiety and fear over the what if’s and unknowns of pregnancy, labour, birth and parenthood.

The problem these women face is that society expects them to be glowing. It expects them to be radiant and smiling and excited. Society might make you think that any other reaction to pregnancy makes you a bad mother.

Things to remember

A miserable pregnancy does not automatically lead to a miserable life as a new parent. You will probably feel a whole lot better once you aren’t carrying 8 to 15 pounds of extra baby and placenta around inside you.

Any feelings of frustration or dread don’t mean that you don’t or won’t love your baby. It simply means that pregnancy is hard for you, and that’s ok to admit.

There are things your midwife or health professional can do to help you. Don’t suffer in silence for fear of judgement. What you feel is valid and won’t be the first time they’ve heard someone struggling with pregnancy.

What you can do

Talk to someone you trust. It might be a close friend or family member you know had a difficult pregnancy themselves. Sharing your feelings enables people to encourage and reassure you that everything will be alright.

Speak to your GP or midwife. If you have sickness, pelvic pain, migraines or some other physical symptoms, they may be able to suggest treatments for you. If you are struggling with anxiety around your pregnancy, birth or parenthood, they can refer you to local counselling services where trained professionals can guide you through the anxiety to find your calming and coping strategies.

Take time to rest and give yourself some grace. You don’t have to live up to society’s expectations and post a glowing selfie every day! Just getting out of bed might be a major success for you, so celebrate it!

Keep your eyes on the prize! However hard this pregnancy might be, focus on the baby and your parenthood to come. It will be worth it. They say parenthood is the hardest job in the world, which I definitely agree with, but it is also the most rewarding. There are so many stages to look forward to. If you aren’t keen on newborn babies, that’s ok. You might feel more confident looking after children when they reach the toddler stage. I promise that time will fly and that favourite age you like most will be here in no time!

Please follow and like us:
error
Newborn Care, Pregnancy, Pregnancy Problems

Group B Strep in Pregnancy

You might have heard of it, you might have seen a Facebook post about it or read a poster somewhere. Group B Strep is becoming more widely known about and talked about in pregnancy. So what is it and what impact can it have on your pregnancy, your labour and birth and your baby?

Mum and baby

What is Group B Strep?

Simply put, Group B Strep is a bacteria which is found in about 30% of women. That’s one in three of you and your friends. Most of the time, this bacteria causes no problems whatsoever. It’s like those bacteria in your digestive system which help you to break down your food. Group B Strep bacteria (GBS) are most often found in your vagina or rectum, although occasionally they can transfer to your urine. This can cause a urine infection, which should be treated with antibiotics as soon as it is found.

bacteria in petri dish

How do I know if I’ve got Group B Strep?

Most women discover they have Group B Strep because it appears in their urine during pregnancy.  They may or may not have any symptoms of a urine infection. Your midwife may find it in the urine sample you provide at your booking appointment. Alternatively, you may be aware of a urine infection and Group B Strep is identified as the cause.

With the increase in awareness of Group B Strep and the implications it has on pregnancy, some women ask to be tested. This testing is best done between 35 and 37 weeks of pregnancy. Your own midwife can usually do this at your GP surgery. You will need to sweep a long-handled cotton bud around the inside of your vagina. You put the cotton bud into a tube with a tiny amount of solution in it and the tube and cotton bud are sent to the laboratory. In a day or two, the laboratory can tell you if the sample has grown Group B Strep.

The newest type of test for Group B Strep is the enriched culture medium test which may or may not be available within your local area. Please ask your own midwife for details.

Implications of Group B Strep on Pregnancy

Finding out that you have Group B Strep during your pregnancy does not have a large impact on your care during the pregnancy itself. If the bacteria is found in your vagina or rectum, you will not need any antenatal treatment. If it is found in your urine, we recommend that you have some antibiotics to treat the urine infection.

capsules

Implications of Group B Strep on Labour and Birth

You will be advised to have antibiotics in labour if you have been identified as carrying the Group B Strep bacteria, whether that is during the current pregnancy or at any point in the past. These will be given via a drip in the back of your hand or in your arm. You will get a dose every 4 hours for as long as labour lasts. It’s really important to mention to the hospital that you’ve had Group B Strep when you phone them in labour. The midwife takes into account the time it takes for you to get to the hospital as well as the time it takes to provide the antibiotics when they invite you in to be assessed.

Providing antibiotics in labour has been shown to reduce the risk of the baby getting Group B Strep. It is a pretty simple procedure which can keep your baby safe. That is why it is recommended practice in the UK. Please discuss this further with your midwife or Obstetrician if you have any other concerns.

Implications of Group B Strep on Your Baby

Baby sleeping

Whilst most babies are fine even with exposure to Group B Strep, a small minority can get an infection from it. An even smaller minority can have serious consequences from that infection.

For that reason, if we know that you have carried Group B Strep in the past or in the current pregnancy, we recommend the use of antibiotics in labour. We also recommend that you stay in hospital for at least 12-24 hours after the birth. This enables us to monitor your baby’s heart rate, breathing, temperature and general condition every couple of hours and ensure no infection occurs.

If any signs of infection occur, such as an increase or decrease in temperature, breathing rate or heart rate, your baby will be referred to a neonatal doctor to assess what treatment may be required. Sometimes the baby will need a course of IV antibiotics, which usually lasts between 5 and 7 days. In most cases, you will still be able to care for your baby yourself while the antibiotics are given. A small number of cases may need extra support from a Special Care Baby Unit to help them fight the infection.

Further Reading

Please try not to read every internet story on Group B Strep. There are very heartbreaking cases out there and the internet would have you believe they are the most common kind. The reality as seen in the midwifery, obstetric and neonatal world is that most cases of Group B Strep infection will respond quickly to a course of antibiotics with no long-term effects.

You can read more in the Royal College of Obstetricians and Gynaecologists patient information leaflet, available here.

 

Group B Strep

Please follow and like us:
error
Pregnancy, Pregnancy Problems

Urine Infections in Pregnancy

Burning, stinging, smelly urine? Yeah, pregnancy is all about the glamour! Unfortunately, women are more likely to get urine infections when they are pregnant. Find out more about what causes them, what you can do to prevent them and what treatments are available.

woman wc sign

Why urine infections are common in pregnancy

During pregnancy, you have many different hormones at different levels in your body. These hormones help your body to nurture and develop your baby. They also help prepare your body for birth. One of the hormones involved is called Relaxin. This hormone is brilliant at relaxing (yes, really) the small vessels in your body. These vessels might be blood vessels or the tubes which carry your urine from your kidneys to your bladder or from your bladder to the exit! Relaxed blood vessels make it easier to send more blood flow to the baby to help them grow. Relaxed tubes for urine make it easier for bacteria to enter these tubes and cause urine infections. You can also find more information on the effects of Relaxin in my article on pelvic pain in pregnancy.

How do I know if I have a urine infection?

urine pain

The symptoms of urine infections include:

pain when passing urine;

smelly urine;

cloudy urine;

lower back pain on one or both sides of your back;

feeling generally unwell;

and needing to pass urine urgently but only passing small amounts when you do.

That last one can simply be because your baby is bouncing about on your bladder and making you think it’s full. However, if you have any of the symptoms of a urine infection, you should get a urine sample checked by your midwife or doctor. You can also have a urine infection without any symptoms, which is why your midwife checks your urine sample at every appointment just in case.

When the midwife checks your urine, she is looking for things like proteins, nitrites and leucocytes. Proteins can show up because the bacteria are made of proteins, nitrites because some bacteria produce these, and leucocytes because your body is producing them to fight off the infection.

Treatment for urine infections in pregnancy

The standard treatment for a urine infection is antibiotics. You will be asked to provide a urine sample which will be sent to the hospital laboratory. They will check which antibiotics work best to kill the bacteria. However, you can be started on antibiotics before the results come back, as there are general groups of antibiotics we can start with. The doctor will contact you within a couple of days if we need to change the antibiotics or if your sample actually showed that you have no infection.

It is important to complete the whole course of the antibiotics and to provide a sample at the end of the antibiotics to confirm that the infection has gone. Untreated urine infections can occasionally spread up into your kidneys and make you very ill, even possibly needing hospital care, so please ask for help if you think you have an infection.

Ways to prevent urine infections

toilet roll

So how can you reduce your risk of a urine infection, even if you do have that troublesome Relaxin hormone floating around your body?

  • Good Hygiene.
    • Make sure that you are keeping clean. When you go to the loo, wipe from front to back. You can even get wet wipes to use after you’ve used the toilet just to keep everything fresher.
    • Change any pad or liners regularly. You do tend to have a heavier discharge during pregnancy, so you may be using liners or pads to keep your underwear clean. Just remember to keep changing these if they become wet or soiled.
  • Keep drinking
    • Drinking plenty of fluids is really important. It keeps you and baby hydrated, which regulates your own and the baby’s heartbeats. It also means that you are passing urine a lot. This might be inconvenient but passing lots of urine means you are flushing out any nasties before they can start an infection.
  • Good sexual health
    • Mother told you to wee after sex and she was right. Any sexual intercourse can introduce bacteria into the area, some of which might want to set up shop and cause you an infection. By passing urine, then perhaps using a wet wipe or two, you are going to help flush them out of the area before they do.

Other things to consider

Some women find out during their pregnancy that they have a bacteria called Group B Strep in their urine or around their vagina. If it is in the urine it should be treated as usual but this bacteria can also impact upon your labour, birth and baby. I will be writing another post on Group B Strep and will link to it as soon as I have, but in the meantime, here is the link to the Royal College of Obstetricians and Gynaecologists patient information on Group B Strep.

 

Urine infections

Please follow and like us:
error
Pregnancy, Pregnancy Problems

Pelvic Pain in Pregnancy

Just when you thought pregnancy couldn’t get any more glamorous, you find yourself struggling with pelvic pain. You start walking with a John Wayne waddle and even the simplest of tasks is accompanied by sharp stabs of pain in your pelvis. What is going on, and how can you solve it or at least soothe it?

WHY PELVIC PAIN HAPPENS

Woman in pain

Your pregnancy causes an increase in various hormone levels in your body, and the hormone responsible in this case is Relaxin. Relaxin does exactly what the name suggests. It relaxes things like your blood vessels and your ligaments.

Relaxed blood vessels are great as because they relax they can hold more blood and send that blood to the baby to help him or her grow. Relaxed ligaments is also a good thing when you consider the process of labour. You have to get a baby out of an area not used to dealing with things that size! By relaxing the ligaments which hold and stabilise your pelvis, the exit area gets wider and giving birth gets easier.

Unfortunately, the downside of relaxed ligaments is the reduction of stability in your pelvis. If this happens very early in pregnancy, it can bring a lot of pain and discomfort. This pain might be around the edges of your pelvis or at the back near your coccyx. Pelvic pain commonly occurs at the front of your pelvis, where the two bones are joined by a pad of cartilage called the pubic symphysis. The only cure is the end of the pregnancy when the Relaxin hormone levels drop back to normal.

Pelvic bones
Pelvic Bones

HOW TO MANAGE PELVIC PAIN

If giving birth is the only cure for pelvic pain, then the key is learning to manage it while it lasts. Here are some tips and tricks I know women have found helpful.

Be ladylike

Woman sitting at window

Have you ever noticed how the Queen sits so elegantly? She is a great example of good pelvic alignment. Since the focus of pelvic pain for many women is the pubic symphysis, keeping your hips aligned and stable is really key.

Try to keep your knees together and your hips at the same level. This is something most of us forget to do on a daily basis. We put one leg into the car, then sit then pull the other leg in, or get out of bed one leg first then the other. We sit on the sofa with our knees curled under us.

Instead, try to sit sideways on the car seat with both legs outside. Then once you are seated, swing your legs in together. When getting out of bed start by keeping your knees together and rolling onto your side. Drop both ankles over the side of the bed and push yourself up using your arms. Sit on the sofa with your feet both touching the floor or out on a footrest in front of you.

Speak to the Professionals

Physiotherapists are the experts in healthy movement and support of joints and ligaments. There are always local specialist physiotherapists who have a great deal of experience in treating and helping pregnant women. They have great advice for back and pelvic pain, separated abdominal muscles and pelvic floor exercises as well as so much more. Please speak to your Midwife or GP and get a referral to the physio service in your area. Even if the pain isn’t too bad at the moment, sometimes the referral can take a couple of weeks and things may be worse by then.

Heat helps

Heat can be very soothing for pelvic pain. Use it as an excuse for an extra long shower or an extra daily long bath. You can also use heat packs or hot water bottles. These are good for positioning directly over the painful points. However, please be careful not to burn yourself and give yourself short breaks without the heat packs so you don’t overheat the area.

Feet in bathtub

Extra support

There are lots of options for extra support to help reduce pelvic pain. These include tubigrips, support belts and taping. All of these offer different levels of support and none will cause any harm to the baby.

Tubigrips and support belts can be supplied by a physiotherapist or sourced online. Tape can also be bought online and applied by yourself or a partner.

Tubigrips can help you feel like your hips are being held in and comfortably surround your whole tummy and back.

Support belts can be found on Amazon in various styles. Some will sit just underneath your bump and give the feeling of lifting it up off the pelvic bone. Others are adjustable with straps across or over your bump. Which style is best for you is a matter of personal preference.

Taping is another option for providing abdominal support. This involves using kinesiology tape in various lines across or around your abdomen. Kinesiology tape is used by sports people and physiotherapists to help provide flexible temporary support to joints, ligaments and muscles. The Rock Tape brand has suggestions for tape positions in pregnancy on its Youtube channel here. Try searching on Pinterest for kinesiology taping in pregnancy as this will also provide lots of great positioning suggestions. Have a look at Amazon for a selection of tape options to buy.

Pain relief

Although taking painkillers regularly throughout pregnancy is not ideal, you may need to consider this if the pain is very bad.  ALWAYS discuss this with a pregnancy professional such as an Obstetrician, Midwife or GP.

Worst Case Scenarios

It is very uncommon for pelvic pain to be completely overwhelming. Usually, measures such as those outlined above will help you manage until the baby arrives. Unfortunately for a very small minority of women, the pain is so bad that they need to use crutches or a wheelchair to get around. If this is you then please keep in touch with your pregnancy professional and make sure you are linked in with the local physiotherapy service. For a small number of women, the obstetrician may be willing to discuss starting labour off early to stop the pain. This is always only done after long discussions regarding the health and well-being of both mum and baby.

Other information

Why not have a look at the helpful physiotherapist videos at Best Beginnings or on your Baby Buddy app?

You can also find more sources of information on the useful links page, including the NHS website and the Royal College of Obstetricians and Gynaecologists website which has guidance on many subjects.

Please follow and like us:
error