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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Archived User

    I'm at a bit of a loss.. kind of bummed out about the following situation.  Maybe you can help me!  (you helped a lot when I needed support on refusing the glucose tolerance test- and I'm really glad I refused it so thank you)

    I am almost 37 weeks pregnant and I just started seeing my midwife last week, although I first met with her last August and have been in touch with her since.  I just moved across the country and had been seeing an OB for my prenatal care in my old city.  I had a good impression of my midwife in my early interactions with her and I still trust her knowledge, but I'm starting to wonder if she's a little too interventionist for me.  Or maybe it's just the way things are in the world..

    Anyway, here's the situation: I am planning a homebirth.  Here in Washington State, there's a law that if a pregnancy goes beyond 42 weeks the birth has to take place in a hospital.  I was born at 43 weeks (completely naturally and normally with no complications in a hospital, and I'm very healthy), and I have a feeling I may go past 42 weeks myself.  I've always been a bit of a late bloomer, and I seem pretty small for 36+ weeks (though everything measures on target- I'm just really long).  My midwife says that she routinely starts doing a membrane sweep around 37 weeks to encourage labor to start a few days early, because of this 42 week deadline.  She is fine with me refusing, and says that if I start to get nervous around 41 weeks we can start then but in her understanding/experience it's best to do it every week starting at 37 weeks.  She promises that she does it gently and will stop if I ask her to.  I brought up the fact that I heard it could introduce infection, and her response was that she wears gloves- I know that is not a good answer, and I have read that it's generally best to keep any contact with the cervix to a minimum.

    My midwife also said that she thinks this is the gentlest way to encourage labor to start earlier, without resorting to drugs or castor oil.  She also encouraged me & my husband to have lots of sex, which I know is not proven to help but at least it doesn't have any side effects!

    My instinct is to refuse the membrane sweep, based on what I've read about it.  I know that my midwife will accept my decision and not argue with me.  I guess I'm still nervous about the 42 week deadline though, and I'm wondering if I'm making the right decision.  I'm also thinking about revising the date of my LMP if they'll let me.. it is possible that it is 2 days later than I thought (I was never 100% positive) but I'd like to give myself 5 extra days to be most helpful.  I've heard of other people doing this, but I'm not sure how the midwives will respond.  What do you think?  Do you think a membrane sweep is not worth the pain/risk?  Does it really make a difference?  Does it make sense to do it at 38 weeks just to avoid going past 42 weeks?  I'm thinking not... but wondering.  It doesn't help that my husband thinks it doesn't sound like that big a deal- but in the end it's my body, not his. 

    One good thing about my midwifery practice is that the midwife I saw today is only one of 3 midwives there, and I have seen one of the others and she seems a little less pushy on the interventions.  The one who I saw today is the oldest and the principal, but the other one is somewhat new to midwifery.  I was a little concerned about her before I met her, but she seems like she might be more in line with my way of thinking- a little less interested in messing around with things.  And she's extremely smart, calm, and decisive- I liked her a lot (she's also an ND, which I like).  I haven't met the third, but she's the one I'll be seeing next week.  Any one of these midwives could attend my birth, depending who is on call.

    Henci Goer

    Your experience sounds really frustrating. I hate to be the bearer of bad news, but sweeping membranes may not be as innocuous as this midwife thinks. It may increase your likelihood of prelabor rupture of membranes. The Oct 2008 volume of Lamaze's research summaries summarizes a study finding this.

    Perhaps it would help if you had a conference appointment with the midwife who seems most in line with your approach to discuss your concern that you may go beyond 42 weeks given your family history. One thing you may wish to explore is the rule against having a home birth after 42 weeks. Is it really a state law or midwifery regulation?  What would be the repercussions for the midwifery group if they broke it? Where is your right to informed consent and refusal in this? If you understand any risks that you may be running by refusing hospital delivery after 42 completed weeks, why should you be prevented from having a home birth? Hospital delivery also entails some excess risks, so it is not a matter of safe versus risky but of the balance between the two. I recommend too that you discuss the pros and cons of each of your options for trying to stimulate labor in a more structured way than seems to have happened so far, namely:

    • What exactly is involved? 
    • What are the advantages?
    • What are the disadvantages?
    • What are the potential harms? How likely are they to occur?
    • What other interventions may become necessary as a result of having this one?

    Ask the same questions about doing nothing. I would add as well that the list of options you have mentioned is not complete. There is also breast stimulation, acupressure/acupuncture, and moxibustion.

    Please let us know how things work out for you.

    -- Henci

    Archived User

    Just a note of experience here, not expertise.

     

    I had my membranes swept with all three of may babies.  It put me in a miserable state of constant contractions with no benefit, the contractions literally were not producing anything - no dilation, nothing at all.  I ended up being induced because I was too overdue for the Doctors I was working with, but I was more willing to go along with it because I was tired and miserable after days of unproductive contractions.  I know that this is not everyone' s experience, but it was mine - and all three times.  I think that when it does work, it is because the woman's body was ready anyway.  Mine wasn't.

    Henci Goer

    In most cases, it is best to let nature take its course. As has been said, "When the fruit is ripe, it falls from the tree."

    -- Henci


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