What is it, and why should you consider it?
Cervical stripping is one way to induce labor. But what exactly is cervical stripping? When can it be done? And perhaps even more importantly: is it effective?
Your cervix is the part of the uterus that remains closed during pregnancy. Partly because your cervix is closed, the baby stays in place inside your uterus and can develop safely there. Your cervix is a firm, long tube on your uterus, located inside your vagina. Toward the end of your pregnancy or at the start of labor, your cervix softens and shortens, and it will eventually open: this is called dilation! It’s possible that, even without having had contractions or simply because you’ve had pre-labor contractions, your cervix is already 1 to 3 centimeters dilated.1 Unfortunately, this doesn’t indicate when you’ll give birth, but it does make it possible—if you wish—to have your cervix stripped.
We only perform cervical stripping with your consent and preferably not until you are 41+0 weeks pregnant. To perform cervical stripping, we need to conduct an internal exam. During this exam, we gently feel for your cervix using two fingers inside your vagina. As soon as we feel the cervix, we can tell you whether it has already softened and shortened (we call this the ‘effacement’ of your cervix) and whether you’re dilated. If you’re dilated by 1 centimeter or more, we can perform a cervical stripping. We’ll let you know if you’re dilated and ask you again if you’re okay with us performing a membrane sweep. During the stripping procedure, we’ll try to loosen the membranes from your cervix. We won’t rupture your membranes. Your cervix will also be ‘massaged’—or stretched—by the movement of our fingers as we work to loosen the membranes. Stripping releases various hormones, including prostaglandins. These hormones contribute to the further ripening (= softening, thinning, and opening) of your cervix and can trigger contractions in your uterus. Massaging the cervix can also release oxytocin, a hormone that contributes to the contraction of your uterus.2,3 If contractions begin within 20–24 hours after cervical stripping, we suspect that the procedure was indeed the ‘nudge’ that triggered the onset of labor. It’s also possible that you’ll experience hard belly contractions or practice contractions due to the stripping, but that these subside and labor doesn’t start yet. After the stripping procedure, you may experience (mucous-like) bleeding. This bleeding is harmless and is caused by the massaging of your cervix.2 We’ll explain this to you after the procedure. If the cervical stripping does not yet lead to labor, we can repeat the procedure after 2 days. In general, we do not repeat the procedure more than 3 times in total.
Women experience stripping differently: some women find it sensitive or uncomfortable, while others find it truly painful. Please know that you are in control of your body at all times, and that we will only perform stripping and/or repeat the process with your consent. If you say ‘stop’ during the stripping, we will immediately stop moving our fingers and stop the stripping.
Of all pregnant women, 4% of the babies have not yet been born by 42 weeks of pregnancy.2 Scientific research has shown that membrane stripping starting at 41 weeks increases the chance of spontaneous labor before 42 weeks and reduces the likelihood of labor induction.2,3 It is difficult to say exactly how effective cervical stripping is—that is, how likely it is that labor will actually begin after the procedure. Research indicates that it takes cervical stripping in 6 women to prevent 1 induction. Membrane stripping is effective whether you are pregnant with your first child or have given birth before. However, scientific research suggests that membrane stripping may be slightly more effective if you have already
have given birth before (and are now, for example, expecting your second, third, or fourth child).3 It appears that routine cervical stripping between 38 and 40 weeks has no effect on inducing labor earlier.3 There is no clear information available regarding the effect of cervical stripping between 40 and 41 weeks.
We’ll discuss the procedure with you after 40 weeks. Our recommendation is to begin cervical stripping at 41+0 weeks of pregnancy, if that is what you prefer. In consultation with you, we may deviate from this recommendation, and it is possible to begin cervical stripping as early as 40 weeks. In general, we do not recommend cervical stripping before 40+0 weeks.
(1) M. Prins, J. van Roosmalen, S. Scherjon, Y. Smit. Practical Obstetrics (2009). Bohn Stafleu van Loghum Publishers.
(2) Finucane EM, Murphy DJ, Biesty LM, et al. Membrane sweeping for induction of labor. Cochrane Database Syst Rev. 2020;2(2):CD000451. Published Feb. 27, 2020. doi:10.1002/14651858.CD000451.pub
(3) Miranda, E. de, Bom, J. G. van der, Bonsel, G. J., Bleker, O. P., & Rosendaal, F. R. (2006). Membrane sweeping and prevention of post-term pregnancy in low-risk pregnancies: a randomized controlled trial. Bjog – An International Journal of Obstetrics and Gynecology, 113(4), 402–408. Retrieved from https://hdl.handle.net/1887/5014
