Membrane Sweeping

24 yo G2/P1 w/post history of post date pregnancy and macrosomian 37. 5 at time of this vist. Membrane sweeping suggested/performed per CNM:

“DOD/VA Clinical Guideline for Pregnancy Management” recomends offering membrane sweeping to all pregnant women at each vist beginning at 38 weeks. The procedure is comprised or using a gloved finger to separate the membrane from the inside of the uterus, which causes a release of prostaglandins and is believed to facilitate uterine contraction. Membrane sweeping may help to avoid post date pregnancy complications including post partum hemorrhage and shoulder dystocia. Additionally patients may be less likely to require induction of labor or caesarian section.
A possible disadvantage is that bacteria may translocated into the uterus. However, studies focusing on GBS have not shown this to be the case. Note that the DOD guideline indicates that there is not sufficient evidence to encourage or discourage the practice in women who are GBS positive. Some women find the practice quite painful. Additional literature reviews indicate membrane stripping is relatively safe, and indicate that there are fewer post date pregnancies when the practice is applied; although clinical significance of the difference not demonstrated. Attitudes among the group of mid-wives at Ft Benning/MACH varies, with one individual who strongly recommends the practice, one who offers membrane stripping but is somewhat less aggressive with her application and a third who falls somewhere between the other two in her recommendations and practice.