Membrane Sweeping In Pregnancy
לכבוד הרבנים ומרן הגאב׳ד שליט׳א
A pregnant women who is 40 weeks pregnant attends her appointment with the midwife. She is told that any woman who is over 42 weeks pregnant is more likely to have complications with childbirth due to problems associated with prolonged pregnancy (pregnancy which goes beyond 42 weeks) and the risk of stillbirth increases from 3/3,000 at 42 weeks to 6/3,000 at 43 weeks. She then undergoes an examination and is found to be 2 cm dilated. In order to help with initiating her labour, she is then offered a ‘membrane sweep’ whereby the doctor or midwife performs an internal examination and places a finger inside the opening of the cervix, and up just inside the lower part of the uterus (depending on how closed the cervix is and how easy it is for the midwife/doctor to reach). The cervix usually needs to be soft, and slightly open, enough for the finger to be inserted. The caregiver then uses a circular sweeping motion (often 360 degrees), to separate the membranes from the lower segment of the woman’s uterus. Care needs to be taken by the not to break the waters, however this may happen accidentally. Post procedure the women is then told that there is some blood on the glove of the doctor/midwife although the water did not break. According to the Rav shlita,
1. Is the women permitted halachically to undergo the procedure of ‘membrane sweeping’ which could induce her labour in the next 48 hours or should she wait as there is no imminent danger to her or the baby?
2. What is the niddah status of the woman post procedure? Do we deem this blood as dam makkah or is the act of stripping the membranes itself considered as petichat hamakor?
with many thanks
1. Membrane stripping does not include any prohibition for which danger is necessary to permit this procedure. Competent medical opinion would suffice to perform this procedure. Common practice seems to refrain until 41 – 42 weeks when she is clearly overdue and the risks increase. 40 weeks may be a little early as often the due date is not 100 percent accurate. In any event it should be clarified that any procedure to induce labor is being done for medical reasons and not convenience. In this regard one should wait for the divinely ordained time for the birth.
2. While this procedure may not constitute an issue of pesichat makor, as the woman may already be dilated sufficiently as to not necessitate further opening. Never the less the procedure does render her a nidah. Being that the blood is coming from the uterus, even though it was manually forced out it may be considered dam niddah [which is tameh even when forced out]. Alternatively it may be considered dam layda, from the beginning of the birthing process which also renders a woman a niddah. This is another reason not to prematurely strip the membranes, as if it does not induce labor she will be placed in a state of niddah until the birth, which may not occur for a number of weeks.