STOP STRIPPING MEMBRANES!!

 

What is stripping membranes?
117431-004-FD591591Inside the uterus, there are membranes (the “bag of water”) that run from baby’s belly – down the umbilical cord- across the placental plate – and around the border of the inside of the uterus. Inside the membranes are baby and amniotic fluid. These membranes are ‘sticky stuck’ with a special type of protein “glue” much like a tape that’s stuck to your skin. Stripping membranes is when a care provider inserts their finger(s) into a vagina and through the cervical opening to then sweep their finger in a circular motion inside the cervix in an attempt to separate the membranes from the internal cervix and lower uterus (as far as their fingers can reach), unsticking the ‘glue’ holding the membranes. It would be like holding an orange that had a small hole in the peeling, inserting a finger through that small hole and separating the orange from the peeling.images

Why is stripping membranes performed?
Stripping membranes is often done (even without consent) during a vaginal exam when a mother is 37+ weeks along in her pregnancy. The reason that stripping membranes is done is an attempt to encourage labor to begin. It is often done at every single prenatal appointment during unnecessary prenatal cervical exams.

What’s wrong with it?

1. My first concern with Stripping Membranes is that it shows a general distrust of your body’s innate ability to birth a baby. Why are you interfering when no problem exists?

2. It requires a vaginal exam  in order to perform this procedure – along with all of the physical and emotional risks associated with vaginal exams.

3. It’s effectiveness is highly controversial – studies are inconclusive at best, with some showing that it is not effective at all , and some showing that it may possible kinda sorta maybe make women birth a little less late than they would have – maybe, since who knows how long they would have been pregnant if they’d been left alone.

4. It is uncomfortable – with many women complaining that it is even painful.

5. Women are more likely to report negative effects after having membranes stripped – bleeding and cramping are common side effects.

6. It is not supported with research with this study concluding that SEVEN women must have their membranes stripped before ONE formal induction of labor is avoided!

7. Stripping membranes increases the risk that bacteria will weaken the membranes, leading to premature rupture of membranes (“waters breaking” before the onset of labor) – it even runs the risk of the care provider accidentally breaking the bags during the procedure.

gbs8. There’s an increased risk of infection – from multiple bacteria, including GBS.

GBS stands for Group Beta Strep (or Group B Strep). GBS is a bacteria that is commonly present in our gastro-intestinal tract. If it colonizes to a high enough level, women are said to be “GBS Positive”. It is standard in the United States to offer a GBS culture to women who are 36-38 weeks pregnant to screen for GBS infections prior to labor. If a woman is found to be GBS+, she will be offer IV antibiotics while in labor in order to dose the baby with antibiotics before s/he is born through that bacteria with the hopes of preventing the baby from becoming ill (and even possibly dying) from a systemic GBS infection. (Please see MY PREVIOUS BLOG POST for more information on GBS)

So what does GBS have to do with sweeping membranes? The idea is that GBS bacteria remains in the vagina and therefore doesn’t pose a risk to babies until labor (and even moreso until their waters are broken)….but that hasn’t proven to be the case. Bacteria can and DO pass through the cervix (even with an intact mucus plug) and can pose a risk to the baby. Here is an excellent youtube video which I hope you will take the time to watch – it shows through time-lapse ultrasound the migration of bacteria during pregnancy up inside the uterus….

Think about all of the obstetrical procedures that one might be subjected to at the end of her pregnancy that might increase the risk to her baby from GBS infection – serial routine cervical exams, sweeping membranes, cervical ripening agents/inductions (such as cervadil, foley bulb induction), artificial rupture of membranes, internal fetal monitoring, intrauterine pressure catheter….

How many women birthing in America are likely to birth her baby without ANY of these action being performed on her? Most births in the US have at least 1-2 of these interventions performed. I wonder why obstetrical care providers don’t put more effort into PREVENTION of problems? I would dearly love to see a study on women who haven’t received these interventions and find out what the GBS infection rate in the neonates is compared to those who have received these interventions but also got IV antibiotics in labor.

Obstetricians know that it is a risk as well, and one that puts them at a risk of litigation as the clinical review, “Membrane sweeping and GBS: A litigious combination?” clearly states – and there is current discussion about Prenatal-onset Group B Strep (POGBS) Disease” (although POGBS has not yet been adopted as a standard diagnosis).  Repeatedly you will see questioning of sweeping membranes (and even internal exams) and their safety – especially when it comes to GBS infections.

It’s not just GBS, but E. Coli and other bacteria commonly found in and around the body that can put baby at risk.  The following flow chart was created by “Group B Strep International“, and I found it to be a very useful chart…

Why-membranes-should-NOT-be-stripped

So what are the possible benefits of Stripping Membranes?
1. you might maybe possibly be more likely to have your baby before 41 weeks if your care provider strips your membranes every week starting at 37 weeks – or not, depending on what study you read.

Lets make birth as safe as it can be by not introducing obstetrical interventions “just because”. Stripping membranes increases risks with very little POSSIBLE benefit, so lets just STOP!

2 Comments

  1. Sandra Munoz wrote:

    Thank you for posting this information. I will use it in my class of childbirth education.

    Tuesday, February 23, 2016 at 11:51 pm | Permalink
  2. Maggie Krueger wrote:

    I came across your page when a patient expressed concern over stripping membranes and GBS.
    I want to point out a contradiction to your statement that it doesn’t work to induce labor. Several studies have confirmed that patients are less likely to go post-term and will deliver sooner if they have their membranes stripped.
    As far as GBS-related neonatal disease- this is extremely rare, even in those patients who PPROM prior to antibiotics being started. To compare the risk of RARE GBS disease with the risk of VERY COMMON complications that arise in post-term pregnancies and resultant inductions, it doesn’t seem accurate to say “NEVER STRIP MEMBRANES”, as there are times when it is appropriate and the risks/benefits can be discussed in an appropriate setting between the healthcare provider and patient.

    Thursday, June 23, 2016 at 3:01 pm | Permalink

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