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Sweeps: How They Might Help (And Hinder) Your Birth

I’ve been talking a lot this week about cervical sweeps with different people and for different reasons.

I’ve been struggling with writing this post and how to angle it as I’m aware it could come across quite negatively yet many women will tell you they’ve had a brilliant experience with sweeps. And yet the evidence around them is insubstantial at best.

Let me tell you about some of the conversations I’ve had recently.

A woman in her first pregnancy had 15 attempted sweeps. That’s not a typo. Understandably she’s traumatised from the experience.

Another woman begging for a sweep from 35 weeks. She got one at 39 weeks. She was left crying, frustrated and defeated because it didn’t work and she’d pinned her hopes on it bringing her baby earthside.

A group of women joking about finding the midwife with the biggest hands to poke their babies out because they’re done with this pregnancy and babies are born before 40 weeks who are fine so why does it matter if theirs comes without waiting for spontaneous labour?

My first baby. Accepted a sweep even though I didn’t want one because I was told it would turn the niggles of early labour into something ‘proper’. The soreness and relinquish of control over what I really wanted set the tone for the rest of my labour and I was left traumatised.

My third baby. Accepted a sweep and on the face of it, it did what it was supposed to do and my baby was born not long after. But I was 42w5 and had been having contractions for weeks – she was coming soon. I accepted as a concession to the SOM who had to pick up the pieces of a registrar telling me my baby would die if she didn’t come out NOW in front of my 2 young children.

( I’ll digress slightly on that note. My baby was transferred from home to nicu shortly after birth to be treated for meningitis and sepsis. The amount of guilt I feel over potentially dismissing the warning signs at monitoring earlier that day will probably stay with me forever. Had the doctor actually listened to me and engaged in a meaningful, transparent conversation with me things may be different. I’ll never know because she didn’t. She will never know the impact she had but I’ll live with it forever.)

Back to sweeps. When did they become so prevalent and synonymous with birth? Why are women being offered – if you’re lucky, the ‘while I’m down here I’ll just give you a sweep’ mentality still exists – without being told they’re the first stage of the induction and intervention process? Why do we not encourage and practice patience when it comes to birthing babies?

They have their place, as all interventions do. But whenever we start interrupting the body’s physiological processes we start introducing risks.

So, let’s talk research.

They can reduce your chance of your pregnancy going over 42 weeks. For some women this is important because that’s the cut off that they’d accept induction of labour. For others who wouldn’t accept induction just for being post term then this isn’t important.

For women between 40-41 weeks of pregnancy there’s a 24% chance of your baby being born within 48 hours of the sweep being done.

They can shorten pregnancy by 1-4 days. Again, these few days might be really important for some women, whereas for others in the scheme of things it doesn’t seem worth it.

70% of women find them painful.

They can cause irritation to the cervix, bleeding and uncertain contractions.

There’s a 9% chance that your waters will break as a result of the sweep. If this happens you’re on infection watch and will be offered further interventions if your body doesn’t spontaneously go into labour within a certain timeframe.

As I said earlier, sweeps have their place. But why are they so commonplace? Why are we encouraging people as a matter of course not to trust their bodies to work as they’ve been designed to, but telling them that they need help? Why are we starting women’s pregnancies, sometimes at booking in appointments, by telling them that they need a medical procedure to go into spontaneous labour? Why is this for the many and not the few whose individual circumstances suggest it might be a good idea?

Image of cervical dilation because I didn’t think you’d want to see a picture of a sweep being carried out

You and Your NICU Baby

Having a baby in nicu is a strange old time in ways that many people don’t get.

You become fiercely protective of them but you have to put your trust in others to look after them.

You often have to inhibit your natural instincts to hold and comfort them because they need more treatment than you can give. You’re often told when to cuddle, when to feed, when to visit…but they’re YOUR baby and they need you there more than ever.

You need to be looked after because you’ve just given birth but you don’t want to spend time thinking about yourself, only your baby.

Life moves on outside the artificial environment of nicu and you don’t feel quite like you belong with all the bright lights, noises and people…but you don’t feel quite like you belong among the doctors, nurses and equipment either.

We were lucky. Our time in nicu was short and either through family-friendly practice or our own sheer bloody mindedness we didn’t leave the unit. Other people aren’t in the same position and the impact on their lives, minds, attachment is immeasurable.

Ten Years Ago I Became A Mother. And I Became Friendless.

Becoming a mother was one of the hardest things I’ve ever done. Not just birth, although that left me wishing the baby would disappear halfway through the experience and I could go back to not having a baby at all thank you very much. But the act of becoming a mother, that transition time between having a baby and being a competent parent (ok, I’m still not sure I’m that ~~some~~ most of the time), the time where we grow into our roles. Jeesh that was hard.

I was overwhelmed. We had no family support close to us. We had no friends with children to learn from. We only had books like The Baby Whisperer and Gina Ford to tell us what to do. We had the narrative from society that babies should be seen and not heard, but only sometimes, when it was convenient and as long as they didn’t interrupt your plans. The rest of the time it felt like they were supposed to be shut into a drawer and forgotten about so you could go back to doing the things you used to do in that mythical time BC. We were promised we would make lifelong friends at NCT classes and Early Days groups but they passed in a blur of trying not to cry because you’re exhausted, wishing desperately our babies were sitting quietly like the others, and wondering if you left early could you time the nap with lunchtime so you could actually eat that day.

The initial flurry of visitors post-birth soon stopped. The token gestures of still being invited out with childless friends came to an end. The resentment that they didn’t understand that I had a 4 week old, or a 2 month old, or a 4 month old, or a high needs baby, and hadn’t slept properly for more than a hundredbillionty years built. The photos of them going out enjoying themselves without me appeared. I didn’t want to see them ever again. Dumped and ignored. Meeting up with other new moms happened, but these passed in a blur of poo and sleep issues and much as friendships with colleagues stall as soon as you leave the company, there was an expectation that these wouldn’t last either.

The reality was my life HAD changed from what it was before, and going backwards is never an option. Their lives hadn’t. My world had ripped apart and theirs was exactly the same. And that wasn’t their fault. And it wasn’t mine either. Becoming a parent can be hugely overwhelming but it’s compounded by the expectation we put on ourselves. We expect babies to slot right in and for us to carry on as normal. We expect a week of no sleep and then it becomes a problem to be solved. We expect to feed our babies a lot but we only have what the side of a tin tells us is the right schedule. We buy cots and Moses baskets and we expect our babies to sleep in them. From before a baby is even born we’re sold the idea that babies will be satisfied with milk, burp and a nappy change before going to sleep (like a baby ) and we can continue our lives with wild abandon.

And when we find out that we need to do more than that, and it’s relentless and gruelling and lonely, when we need friends more than ever just to get through the hardest part of our lives, just as we’re finally ready to raise your head above the parapet and come blinking into the world again, that’s when the cruellest trick happens and we realise that the world has carried on turning and although our own plot line has changed dramatically everyone else is still playing out their own movie. And their movie doesn’t have babies. Being the mature, resilient person I am I didn’t talk this through with my friends, who would no doubt have been devastated to hear what I was feeling and would have done what they could to counter it but a tired and traumatised brain doesn’t think logically.

Finding out I had a lifelong chronic condition at the same time, exacerbated the loneliness, hurt and worthlessness I felt. It felt like my body was doing it just out of spite but the reality is it was my body’s way of dealing with the trauma I’d gone through. The reality is if I’d not shut down, if I’d opened up a bit I’d have found it all easier. But that’s the quirks of the human brain, isn’t it?

Telling someone in the throes of this that it doesn’t stay like this forever is useless. But it doesn’t. Slowly you realise that those fabled friends-for-life that you make at NCT really are becoming your trusted confidantes and are willing to step into whatever emergency you throw at them. Slowly you understand yours and your baby’s rhythm and can adjust to it. Slowly you start getting sleep on a regular basis and can commit to an evening that doesn’t feature an 8pm bedtime. If you’re lucky you’ve thrown the baby books away and are parenting peacefully with the baby you have, not the baby the books tell you that you should have. And those friends who have loved you since school and who have suffered you pushing them away when life got hard will accept the baby steps you make back to friendships and welcome you with open arms.

It gets better. Open your heart and let people in. And if you’re on the other side of it, check in with your friends who have had babies – they might just be glad of that friendly text (even if they do bail on plans at the last minute and sleep instead!)

What On Earth Is The Fourth Trimester?

I wrote this blog post for The Daisy Foundation all about what the fourth trimester is and how you can help yourself in that time.

The chances are that if you’re a new parent you’ll have uttered one or more of the following phrases; “my baby will only sleep on me!”, “my baby hates their cot!”, “my baby will never be put down!”, often alongside an existential crisis and the idea that you don’t know what you’re doing, you can’t do this, you’ve broken your baby and that you’re a rubbish parent. You ask and search around for help and the nagging doubts you have of yourself – that you’re not parenting in the right way – are cemented because so frequently these questions are packaged as a problem to be overcome, to be worked on, to fit in to the “good baby” narrative that is so frequently forced on new parents (and yes, from which many so-called ‘experts’ exploit new parents into shelling out many, many pounds).

Yet picture, if you will, the life your baby has had while growing inside the womb. Dark within the confines of your uterus, warm and protected by your body, comfortably hammocked, rocked by your movements, the swoosh of amniotic fluid in their ears. Their every primal need met instantly by your body that they’re connected to. Then they are born. The world is a vastly different place to everything they have known to this point. Temperature changes, the feel of nappies and clothes on their skin, sights, smells, feelings of hunger and thirst, all these wonderful things we take for granted in this world are brand new sensations for babies. When you appreciate this, you suddenly take in the enormity of life as a newborn and understand why babies cry to be held close by you, to be nestled in your warm embrace, able to smell you and hear your familiar heartbeat. Wanting to be with you is not a problem to be fixed; what baby is biologically designed to need is often not what our environment and culture encourages.

If we look at and treat the first three months of a baby’s life as a transitionary period, the so-called fourth trimester of pregnancy, a lot of the heartache and pressure we place upon ourselves as parents can be reduced. If we understand antenatally that when baby appears we must treat them as though they’re still in utero, that terrific pressure of wondering why our baby won’t be put down, why won’t he sleep in his cot, what am I doing wrong will disappear. You are not doing anything wrong. Your baby is behaving exactly as he should. You’re doing a great job. Let’s repeat that, because it’s so very important. You are doing a great job by tending to your baby’s needs.

There are some great ways of replicating that womb-like environment for a baby, many of which help to soothe him, reducing crying, and reducing the effect of their crying on you. Because let’s not forget how important you are in this picture. A phrase which is uttered almost as often as “my baby won’t be put down” is “a happy baby is a happy mom” and it’s certainly true that if a baby is crying your own stress levels will rise, making it more difficult to understand and react to what your baby is trying to communicate with you. But remember, none of these are guaranteed to work all the time for all babies because every baby is different and will react in different ways at different times.

Movement: Your baby is used to moving when you move. Which is why so many will be soothed to sleep by the gentle rocking motion of a car or pram, and why so many parents have developed their own baby-sway which is often so well-used that you can see it in practice when baby isn’t even with them!

Noise: Forget the lullabies and soft music: anything that mimics the swoosh of amniotic fluid will help soothe your baby best. So some serious SHHHHHHing, the hoover, Ewan the Dream Sheep or one of the multitude of YouTube videos.

Water: A nice deep bath mimics the feeling of the amniotic fluid around your baby while they were inside you, and can soothe (or at least distract!) from a troubled soul. Even better if you or dad can get in the bath with them as the skin-to-skin contact will do wonders for both of you.

Sucking: Sometimes a baby is cross because they’re hungry, so it’s important to be led by their feeding cues rather than a schedule, whichever way you choose to feed them. But sometimes babies crave non-nutritive sucking, similar to when they suck on their own fingers in utero. If you’re breastfeeding offer the breast even if you don’t think baby is hungry, and if you’re bottle feeding try a dummy or a clean finger.

Babywearing: Slings and carriers aren’t just a good way of not getting the pram muddy when you go for a walk! They’re a really useful tool to enable you to keep your baby close-by while you go about your day. Research has shown that babies who are carried in slings cry less than their non-slinged counterparts, not just while they’re being carried but throughout the day. That’s a pretty compelling reason to babywear, right?

Skin-to-skin: Not just for the golden hour after birth, but helpful at any age. Skin-to-skin contact can help regulate your baby’s temperature, regulate their breathing and heart rate, reduce stress hormones (in both of you!), and can boost oxytocin (the love hormone) production in you both.

Co-sleep: 50% of babies in the UK bed-share at some point before they are 3 months old. Many because their parents recognise that they will both get better sleep when they’re close to each other. Make sure that this is planned, and safe.

Many of these methods of recreating the womb-like environment for baby can be used in conjunction with another. Sometimes one will work where it didn’t yesterday. Dad may find one works best for him while you find another works best for you. All of this is ok. These are tools to add to your growing parenting toolkit and nothing will unilaterally work for all babies and all parents in all situations. And that’s ok. Enjoy your fourth trimester <3

Vaginal Examinations: What You Need To Consider

During your pregnancy it’s a fair bet to say that a stranger will, at some point, request to examine your vagina. What fun! A vaginal examination is a relatively quick procedure where your midwife or other caregiver will insert their fingers into your vagina to feel your cervix. As with all things birth, whether you have them or not is entirely your choice. And as with most things there’s some real pros and cons either way.

Let’s have a look at the facts.

Number one on the con list is that someone is having a thorough rummage in your vagina. It’s a physically invasive procedure, sometimes painful, often disruptive to the flow of labour and can put you into a vulnerable state. Now, hopefully you’ll have some rapport built up with your caregiver by this point in the proceedings, but they’ll still be a relative stranger in the scheme of things and what’s more likely to send your adrenaline rising and oxytocin plummeting than being put in that situation? And as we know, you need a good supply of oxytocin – the love hormone – in labour to keep your uterus contracting nice and efficiently; when something happens that makes us uncomfortable, stressed or fearful, the amygdala part of your brain triggers your fight or flight response which releases a burst of adrenalin, inhibiting both oxytocin and the endorphins which are acting as your body’s natural painkillers.

Vaginal examinations are physical, and so present an infection risk. Perhaps not a huge risk in the western world where caregivers have access to plenty of soap, water and gloves, but a risk all the same. Bacteria can be pushed up the vagina, pass through the cervix and enter the uterus. The risk increases if the amniotic sack has displaced already, and some infections can be quite serious for babies in utero. Shockingly, in one study it was found that women who have had a vaginal examination in labour have 80% greater number of different bacteria in the cervix than those who hadn’t.

When a vaginal examination is carried out they can be useful storytellers to your caregiver, telling them important information, more on that below. However, they can also give you and your caregiver misleading tales. There are few rules in labour, no definitive timings, no guarantees that they will progress in exactly the way you have planned. So what happens if you’ve been in latent labour for hours and hours and get told you’re ‘only’ at 3 centimetres dilated? What if you’ve been in active labour for half an hour and you’re told you’re at 8 centimetres dilated? Do either of these things mean that your baby will be here at a specified time? Nope…in both situations baby could still be hours away from making their arrival, or they could be here within the hour. And yet your care pathway may very well be altered to fit the story that your caregiver believes your cervix is telling them. Not only that, but your own expectations can become hinged on the number you’re told and if the story doesn’t go the way you’re expecting then your flow of labour can be interrupted and throw you off kilter. If things happen more quickly or more slowly than you anticipated you could experience panic and fear, and fear leads to pain. And don’t forget distance measuring with only fingers for guides is subjective – if more than one person carries out the examination you could be in the position where measurements are miscalculated!

So what, then, are the pros from having a vaginal examination? Well they can give your caregiver information that they can use to build a picture of what’s happening in your labour. How far dilated you are alongside other factors can give an indication (but not a guarantee!) of how close to baby’s arrival you are.

Vaginal examinations can also tell your caregiver what position your cervix is in. As the cervix dilates it moves from a backwards facing position which protects baby, to a forward-facing position allowing an easy descent down the birth canal for baby.

The examination will also assist in ensuring you know your baby’s position. Again, this isn’t unique to vaginal examinations but in certain conditions such as malpresentation it’s important to have a clear picture of the situation so appropriate care can be given.

Vaginal examinations can be really useful if things aren’t progressing quite how you’d be expecting them to be. If they seem to be taking a wee while longer than expected to make their arrival an internal examination by a midwife can check their descent and position. This will tell them if baby’s position means they might need help to come along (such as asynclitic, breech or occiput posterior). It can also tell them if an intervention such as rupturing of the membranes would be appropriate to carry out. So where does this leave you and your choices? Vaginal examinations can be an important part of your care but should be used alongside other practices from your caregiver as a diagnostic tool. How judiciously they’re used is entirely up to you and your comfort level with them.