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.

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Labour and Birth, Pregnancy

Gifts for Midwives

Block letters spell thank you

Maybe you’ve had a baby recently and want to express your thanks to the midwife who cared for you. Maybe you are a student midwife who has come to the end of a placement and wants to show appreciation to your midwife mentor. Perhaps you have a friend or family member who is a midwife. Whatever the occasion, here are some ideas for gifts for midwives that may help if your mind has gone blank.

General Gifts for Midwives

Cards

Midwives love getting ‘Thank You’ cards. It helps us to feel we are making a difference and helping people, which is definitely our ultimate aim. Even if it is just a small card with 3 lines written in it, it can make a difficult day seem not so hard and put a smile on a stressed face. We love to remember your birth or experience with you. Cards can also be used as part of the revalidation process. Revalidation is how midwives renew their professional registration with the Nursing and Midwifery Council. It requires us to provide evidence of feedback on our work, so your card can help us to do this.

Mugs

Stethoscope next to coffee cup

Who can survive the day without a bit of caffeine? Midwives are no exception, so coffee cups or mugs are always a great idea. We may not get a chance for lunch or tea, but sometimes we do get to stop for a drink. Finding a suitable mug in the work kitchen can be a challenge, so a unique mug which is easy to find is a big plus. Some people like thin china mugs, while others prefer enormous chunky mugs. There are so many options in terms of designs such as pictures or slogans. Let your imagination run free.

Chocolates

Chocolates are always a good idea. When we have a busy shift and no time to stop for lunch, a quick scoff of a truffle or fudge can stop the hunger pains for a short time. There are also so many options, from biscuits to selection boxes and more. You’re bound to come up with some original choices.

Fruit

Let’s be honest, we shouldn’t really survive on caffeine and chocolates. Most of us want to try something healthier so a basket of fresh fruit is a refreshing option and can be pretty quick too for those busy shifts.

Equipment Gifts for Midwives

Ever a practical person, a midwife is always happy to receive practical gifts.

Person taking blood pressure

Wheels

I’m sure you’ve seen your midwife with a wheel in her pocket. These tiny plastic whirlygigs can help us figure out when your baby is due or what your Body Mass Index is. Because they are used so often, they do wear out or crack and break. Why not see if you can find a new one for your midwife? Try searching for a pregnancy calculator wheel or BMI calculator wheel on Amazon, the Goodies for Nurses website or the Funky Midwife website.

Pens

I have no idea where all the pens of the NHS go, but there seems to be an epidemic of disappearing writing utensils! We write a lot. Sometimes it feels like we write more than we provide care, which isn’t good at all. However, it does provide you with another gift option. We will always appreciate a lovely pen and if it is not just a standard biro, we’re more likely to chase it if the doctor tries to walk off with it! In order to meet our standards for record keeping, it needs to have black ink and a rollerball or ballpoint pen is less messy than a fountain pen.

Watches

Although Infection Control policies prevent us from wearing any wrist watches, we still need to be able to count seconds and minutes. You’ll probably have seen some midwives with fob watches, which are pinned to our uniforms. Most of the time we buy the cheapest as we have to provide these ourselves. However, there are so many amazing designs out there for fob watches! Having a unique one would always make putting on the uniform a little more fun. Watches need to have second hands on them so that we can measure you and your baby’s heartbeat if our other equipment isn’t available. If we work night shifts a glow in the dark or backlit watch might be really useful.

Hand Creams

Woman applies hand cream

Hopefully, you’ve seen us wash our hands. A lot. As an integral part of care and infection control, we wash our hands more often than you can count. This is good for you, but not great for our skin. It doesn’t have a chance to replenish those lovely nourishing oils between washes, so our skin is often dry and can even crack, peel and itch. Not so glamorous. This is why gifts of good quality hand creams can be a lifesaver for a midwife. Little bottles we can keep in our pockets or bags or larger ones we can leave by the sink are all very much appreciated.

Alcohol Gels

Another thing you might see midwives use is alcohol-based hand gels. These are really useful for disinfecting our hands quickly if soap and water and a clean towel aren’t available. There are actually quite a number of different brands offering hand gels these days. Some have lovely scents, whilst others are said to be more gentle on skin, or even just a pretty colour. As a small but much-appreciated gift, they are definitely worth considering.

So there we are. Just a few suggestions for simple and inexpensive gifts for midwives. Thank you for thinking of your midwife and considering a gift for her. Please know that we really do love sharing the whole pregnancy experience with you and are very happy if we know you have had a good or great pregnancy and birth.

Any other gift ideas I’ve not mentioned? Why not write me a comment below?

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Labour and Birth, Pregnancy

5 Pro tips for surviving early labour

So, the time has arrived.

Baby is now past 37 weeks and could arrive at any time.

You’ve had some tightenings and even very painful Braxton Hicks contractions but then everything stops.

Your hopes are dashed.

The following night, things start up again.

Painful tightenings get closer and closer, sometimes taking your breath away.

You’re up pacing the house in the wee small hours but then morning comes and the contractions fade as the sun rises above the horizon.

You can feel like you’re going crazy. No sleep and no progress can really bring you down.

What do midwives recommend for those long relentless hours?

  • Rest:

This is really really important. There is no easy way to tell how long this will last but in the worst case scenario, you may still have some days to wait until labour becomes consistent. Take whatever rest you can, in large and small amounts spread throughout the day. If you have older children, enlist family and friends to entertain them for a while so you can nap. It’s not easy, but perhaps it is mother nature’s way of preparing you for the sleepless nights to come when baby arrives!

  • Eat:

Get plenty of good nutrition on board. Labour is extremely hard work and you need to have a good supply of energy to help keep your contractions strong and effective. When labour really kicks in, you might not feel like eating so think like a marathon runner and eat as preparation.

  • Try out your pain relief strategies:

Some people go into labour knowing exactly how they will cope with the pain. Others have no idea what they want to try or what will or won’t work. There are so many strategies to choose from, it’s an entire post of its own (coming soon). However, these early painful episodes can be useful in figuring out whether your partner is any good at massaging, or whether the TENS machine you hired online is just going to drive you crazy.

  • Bathe or shower:

Water is well known to relieve labour pain, although you may have to wait until you get to hospital to try out the wonderful wide, deep birthing pool. Luckily, you can definitely try a comforting bath or stand under a cozy warm shower at home at this early point. For some, this may settle the pains down, which will give you a chance to rest. For others, the warm soothing waters can relax them enough to help the contractions get stronger.

  • Check your bags are packed and ready:

Another good idea is to take the time to make sure you’ve got everything packed ready for the hospital. There are tons of great lists online of what to pack and my own list is on its way. While the pains are reminding you of their purpose in bringing baby ever closer, use that focus to ensure nothing gets left behind.

However long these times last, please remember that the baby at the end is definitely worth everything you’re going through. You are stronger and fiercer than you know and you can do this!

Are you worried that the pains are too early or might be real labour pains? Please contact your local maternity unit as soon as possible.

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