What are the positive signs after a membrane sweep? We speak to the experts to reveal all

If you're wondering what a membrane sweep is, whether you have to have one, and how painful it is, we've asked the experts, and the mums who've gone through it, and have everything you need to know.

Pregnancy naturally throws up so many questions such as what are the early signs of pregnancy, can you use nub theory to predict gender and what pregnancy cravings mean. And one such question you might have as you progress into the later months of your pregnancy is about the membrane sweep - a phrase you might have heard your midwife mention if you are past 40 weeks.

A membrane sweep, also known as a pregnancy sweep or cervical sweep, involves your midwife or doctor gently separating the membranes around your baby from your cervix. This aims to encourage the release of prostaglandins, which are hormones that can help bring on labour.

Membrane sweeps are offered to women in their first pregnancy from 40 weeks of pregnancy. Having a sweep is entirely your choice and is not routinely recommended. It's just one method you'll be offered for bringing on labour.

We look at the research and speak to expert midwives to understand the pros and cons of membrane sweeps, what they involve and how successful they are in triggering labour,

Pregnancy can be a transforming, confusing, exciting, and scary time for many women. That's why our guides are there to support and inform you through the journey, from the early signs of pregnancy and the cravings you can expect to our explanation of what causes that strange dark line on your pregnancy bump - the linea nigra.

What is a membrane sweep?

A midwife or doctor will use their finger in a sweeping motion to separate the membranes of the amniotic sac surrounding your baby from your cervix. The idea is that this will help to release hormones that will hopefully kick-start your labour. 

Whoever is doing the sweep will ask you to lie down with your feet together and your knees to each side. They then insert a finger and pass it around your cervix opening.

Sometimes, your midwife or doctor will suggest a 'Stretch and Sweep'. This means you're not quite ready for a membrane sweep, so the midwife will stretch and massage your cervix instead. This may begin to 'ripen' your cervix before a full sweep at your next appointment. 

If you're going for a sweep, wear a pantyliner or maternity towel in case of any spotting afterwards.

Anthonissa Moger, Founder of The Hypnobirthing Midwife and author of Holistic Hypnobirthing, says that the body must be ready for a successful sweep: "A sweep is the least medical of the induction pathway. It may be worth trying in order to avoid induction, but you can decline if it doesn’t feel right for you. A sweep will only work if your cervix has already started to soften, open, and come forward because your body is getting ready to go into labour. If your body hasn’t started to change the midwife may not be be able to reach your cervix at all."

What are the positive signs that show a membrane sweep has worked?

We spoke to registered midwife Lesley Bland, of My Expert Midwife, to find out what other signs. apart from labour starting, of course, shows the membrane sweep has been successful. 

"It is always difficult to say if a membrane sweep has worked because we don’t know if labour signs would have begun without it," says Lesley. "However, a sweep is said to have worked if either labour begins or pre-labour signs start within 48 hours of the procedure."

Signs Lesley suggests looking out for include:

• period-type pain or cramping, usually in the lower back or lower abdomen
• losing the mucus plug or having a blood-stained show
• contractions starting

Find out more about the most early signs of labour starting so you know when to get ready to meet your baby.

Lesley Bland

Lesley began her career as an Events Manager at some of the UK's most prestigious sporting events and as a Recruitment Consultant for senior HR Managers and Directors before starting her midwifery training in Leeds. Throughout her career, Lesley has worked in both large teaching hospitals and local District Hospitals, rotating throughout the delivery suite, the wards and the community and specialising as a Clinical Educator. As well as working for My Expert Midwife, she is also a qualified Train the Trainer in both PROMPT and Maternal AIMS.

Does membrane sweep causes mucus plug loss?

Yes, a successful membrane sweep can lead to a 'show' or losing your mucus plug. 

Midwife Lesley says, "The mucus plug is a jelly-like substance which forms in the cervix to stop harmful bacteria and infections from travelling up the birth canal to your unborn baby."

"As the cervix starts to soften in the period leading up to labour, that mucus can start to come away. Sometimes it comes away as a single whole plug, while other times it may come away bit by bit. It might look like a clear or lightly bloodstained snotty substance in your underwear, or you might notice it when you wipe after a wee."

However, Lesley warns that the mucus plug coming away isn't always a sign that labour is starting. "There is no indication that losing the mucus plug means labour is imminent, but it can be an early sign that things are starting to change."

In fact, you may not even notice a mucus plug at all, even if labour is starting, according to Lesley. "It can be common for a mucus plug to be reabsorbed into the body once it has been dislodged from the cervix, meaning the woman will never see it. Our bodies are incredible, aren’t they?"

When will I be offered a membrane sweep?

Your midwife may suggest having a membrane sweep once you're more than 40 weeks pregnant if you're a first-time mum and at 41 weeks if you've had a baby before. However, they may discuss having a membrane sweep with you at one of your antenatal appointments, usually at around 38 weeks of pregnancy. Your midwife may offer you two or three sweeps before they suggest inducing your labour.

If you decide against a membrane sweep, you can wait for labour to start naturally or use a more formal method of induction if your midwife or doctor offers it, such as prostaglandin. 

However it's important to remember that any such medication is also optional. Induced labour can be more painful than a labour that begins of its own accord, because the body receives a relatively swift dose of hormones rather than a gradual increase naturally. Some mums find induction labours are more intense and painful. 

Remember, you can ask for a sweep, but you can also say no if you'd rather wait. If you do decide to wait, the midwives may want to keep an eye on your progress and the baby's health - but your main priority should be relaxing and not worrying about the fallacy of due dates.

Do I have to have a membrane sweep?

No, membrane sweeps are not compulsory and they do not form part of a routine examination. Medical staff should always ask your permission before conducting a sweep. They should also explain the process and implications to you. A midwife or doctor should never pressurise you into having a sweep.

"It’s absolutely your choice," says Milli Hill founder of the Positive Birth Movement and author of the bestselling Positive Birth Book. "You don’t have to feel any pressure to have a sweep if you don’t want one. But if you are happy to have one, then that’s also up to you."

What is the success rate of the procedure?

Research over the past 15 years suggests that membrane sweeping can be successful in inducing labour within 24-48 hours in approximately 20-30% of women at full term.  However, it's a hard stat to pinpoint. Registered midwife Lesley says, "It is almost impossible to attribute success ratings to a membrane sweep because we can't know whether it was the sweep that kickstarted labour or if the woman was going into labour spontaneously anyway."

"It’s one of those areas where we don’t have enough evidence,’" says Milli Hill. "A Cochrane review (which is a very reliable source) suggests that sweeps ‘might' reduce induction, but more research is needed on timing and efficacy."

Rebecca Dekker, the founder of Evidence Based Birth says that membrane sweeps potentially reduce the length of your labour, but only by four days: "If your membranes are swept at 41 weeks, this can lower your chance of having to go past 42 weeks and needing an induction at 42 weeks. It decreases your chances of going to 42 weeks from 41 percent down to 23 percent."

Because the cervix has to be slightly dilated to conduct a membrane sweep, the body is already in the process of initiating labour. So, some experts believe it's an unnecessary intervention.

Lesley agrees. "The closer to your due date you are, the more favourable your cervix is - meaning a membrane sweep is more likely to work." She also points out that if you've gone through labour before, your cervix may be more responsive to a sweep. 

You should always feel fully informed and supported about your decision to have a membrane sweep or not as part of your birth plan. It's important to understand the implications for having a caesarean too.

"We always advise women to discuss the procedure, if offered one, with their own caregivers using the BRAIN acronym," says Lesley. 

• B – Benefits associated with having a sweep.
• R – Risks associated with having a sweep.
• A – Alternatives to having a sweep.
• I – Intuition/Instinct – what is your intuition telling you?
• N – Nothing – what happens if you do nothing? In this case, if you don’t have a sweep.

Are membrane sweeps painful?

Unfortunately, yes. Membrane sweeps can be painful. One medical study found that 70 percent of women found that membrane sweeps were associated with significant discomfort, and one third of women complained of significant pain. Membrane sweeping can also cause slight bleeding and make your uterus irritable and with irregular contractions. Women have described the discomfort as something similar to a painful smear or period pains, to stronger cramping sensations.

Sam Nightingale, clinical academic midwife at University Hospitals Coventry and Warwickshire NHS Trust and researcher at women’s health research charity, Wellbeing of Women, warns that sweeps can sometimes trigger trauma too: "Some women find sweeps very uncomfortable and distressing. This is more likely if the neck of the womb is still quite far back, or also if a woman has experienced sexual trauma or previous birth trauma." If you are concerned about birth trauma, you can contact The Birth Trauma Association.

Mum Jo tells us, "I had one membrane sweep, which was really painful. To top it off I felt really sick afterwards - they had to put me in a bed to recover for half an hour until I could stand up and not feel like I was going to puke! It didn't work either - I ended up being induced and then had an emergency caesarean. So it doesn't work for everyone."

How long after a membrane sweep does labour start?

"How long labour may take after a sweep is impossible to be exact about," says Sam Nightingale. "It varies depending on how ready the neck of the womb is to be fully thinned out, central, soft and starting to open. These are all physiological processes that happen prior to labour and this is what the sweep aims to encourage."

You would expect positive signs of labour within 12 to 48 hours of having a membrane sweep, however. If it takes longer than this, it likely to mean that the membrane sweep hasn't worked and your body is not yet in labour.

What are the pros of having a membrane sweep?

Here are some potential pros, or benefits, of having a membrane sweep:

• You may avoid having a formal induction: Sweeps can allow labour to begin naturally, avoiding medical interventions like artificial rupture of membranes or prostaglandins.
• You may avoid a prolonged pregnancy: A successful sweep may prevent you from going too far past your due date, which increases certain risks to you and your baby. 
• No serious medical risks: When done properly, membrane sweeps are considered very low-risk compared to other induction methods.
• It may help you feel empowered: Having the option may help you feel more in control of your labour.
• It takes just a few minutes: There's little to no downtime compared to other options.

What are the cons of having a membrane sweep?

Here are some potential cons, risks or downsides, to having a membrane sweep, including:

• It can be painful: A membrane sweep can cause cramping or irritation as the membranes are separated from the cervix. Some women find this uncomfortable or painful.
• You may have some bleeding: There may be light bleeding or spotting afterwards.
• It might not induce labour: Sweeps don't always kickstart labour. The success rate of inducing labour within 48 hours is around 20-30%. So you may go through the process with no results.
• It might trigger ineffective 'tightenings': According to registered midwife Lesley Bland, sometimes a sweep can result in "exhaustion, multiple hospital admissions and, potentially, increased levels of intervention."
• You might need multiple sweeps: If labour doesn't start, some doctors and midwives recommend repeating the sweep 2 or 3 times, which can increase your discomfort. 
• It can be an invasive procedure: Some women feel membrane sweeps are an uncomfortable and invasive procedure they prefer to avoid.
• Your waters might be inadvertently broken during the sweep: "If this happens and you do not go into labour within 24 hours, most NHS Trusts will advise you to have an induction of labour – which you may consent to or decline," says Lesley.

Your midwife is there to reassure you. While some spotting and cramps are normal after a membrane sweep, you should contact your midwife or GP if you experience any unusual bleeding or severe pain. If you experience heavy bleeding, call 999. 

"You will be provided with information about things to look out for before you consent to a membrane sweep," says Lesley. "These include bleeding, your waters breaking, baby’s movements, pain, or signs of infection. You should alert your caregivers if you experience any of these red flags or have any other concerns following a sweep."

Still unsure? Watch this video to understand the pros and cons of a membrane sweep:

What happens if I don't have a membrane sweep?

If you have a healthy pregnancy it's OK to not have a sweep and wait until you go into labour. If your baby is breech or there are other complications, then you should speak to your doctor or midwife. You might want to try one of these 20 ways to have an easier labour too.

What other mums told us:

'I was dubious over whether a sweep would work or not. But I went in for the procedure and a few hours later I was in labour. It was a quick one, and in less than 24 hours I had my baby girl.'

Jo B

'I had two or three sweeps with my first baby and it was useless. A very unpleasant experience too. Some say it works but you never know if the baby was just ready.'

Lorna C

'I considered having a sweep for my first pregnancy, but I waited a little bit longer. Our gorgeous baby boy was born of his own accord just a few days later.'

Charlotte J

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