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Reducing a cervical lip

Last post 07-08-2009 12:19 PM by michelled4. 15 replies.
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  • 06-06-2009 5:26 PM

    Reducing a cervical lip

    I am just wanting some feedback on this.  As a doula, I am always encouraging my moms to listen to their bodies and trust themselves and their baby to give birth.  However, I have noticed that if a cervical lip is found, that most midwives in our area want to manually reduce them without giving the mom a chance to do it herself.  I feel this can be quite intrusive during one of the most vulnerable times in labor and actually seems to delay the onset of spontaneous pushing in some women.

    As a midwife, how do you feel about this intervention, and what do you do in your practice?

     

    thanks a bunch

  • 06-06-2009 6:24 PM In reply to

    Re: Reducing a cervical lip

    I wonder if in your meetings with your clients before labor, you can stress that if they reduce the amount of cervical checks/exams, they can rely on what their bodies tell them during labor rather than on what is "found".  You can give them examples of what they naturally do in other situations--sit in a semi-squat to have a bowel movement when they feel that pressure, lean over when they have gas, stretch when they have a cramp, rub their temples when they have a headache.

    Penny Simkin says: "Often the woman seems to know what to do, and in seeking comfort, also places herself in a position favorable for reducing the anterior lip.  If that does not succeed, time and positions that reduce the pressure on the cervix seem to be the best positions to use.  Gravity-neutral or anti-gravity positions, such as hands and knees, kneeling on a ball [sic. I think Penny means kneeling over the ball] or the open knee-chest positions ... may move the fetal head away from the cervix and take some of the pressure off.  Sidelying, semi-prone, or standing positions ... redistribute the pressure on the cervix and may reduce the lip."  She also suggests "Immersion in a bath of deep water".  This info comes from The Labor Progress Handbook by Penny Simkin and Ruth Ancheta.  This is a great little book to pick up and have in your birth bag.  It's a little pricey but maybe you can get it used on Amazon or off eBay.

    Now, what to do if someone is intervening?  Perhaps you can say, "Gee, Sally Sue. I was just reading about cervical lips in Penny Simkin's book [or on the Midwifery Today Forums!] and she says blah blah blah" and then w/o missing a beat say to your client, "Mary, would you like to try one of those positions?" or to her husband, "Fred, how about you try helping Mary onto her knees and she can lean over the birth ball?"  This way you're educating and empowering your clients, you're (hopefully) reducing interventions, and you're educating the birth attendant as well.  Perhaps that's the only way they know to reduce a lip!

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 06-06-2009 7:32 PM In reply to

    Re: Reducing a cervical lip

    Thank you very much for your suggestion Smile.  I actually do fully prepare my clients for this, among other issues during their birth.  I have been having so much trouble lately in the hospital with care providers needing "something to do".  I have to be very careful what I say in these situations, as I can be escorted out of the room.  My goal is for them to have a VE only if they want (or if it is an emergency), however the hostility from the care providers (midwives included) is overwhelming.  It takes a very strong couple to close the legs and say no!  Especially when scare tactics are used.  I just had a first time couple that was very prepared for this issue and stayed their ground.   After a very childish temper tantrum, the midwife and nurse left us alone for 45 minutes and then came in stating that the OB was being called in to perform a cesarean since she would not allow the lip to be reduced.  She had only been in active labor for 4 1/2 hours at this point!  Fortunately, that 45 minutes alone with her birth team gave her the power to spin her own baby and she gave birth within 20 minutes with no further interventive help.  Her midwife told her that she should just stay home the next time.  Nice!

    The couple was awesome, it is just a shame for the fight to happen in the first place!

    I also just had a mom's cervix tear during a lip reduction, fortunately it healed just fine.

    I would like to know in what circumstances is manually reducing a lip necessary.

     

  • 06-06-2009 9:14 PM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: Reducing a cervical lip

    Michelle,

    There are many different approaches to remedying a cervical lip.  The tincture of time usually works. Positional changes, definitely. Some herbal and homeopathic therapies can help.

    The only times when manually reducing the lip becomes important, to me, is when mama is pushing and cannot not push or baby is descending and you can see the lip on baby's head.  That's when I get my fingers on the lip and try to hold it back away from the head.  I always worry about cervical tearing while doing this so needless to say I don't like doing it nor doing it as the first remedy but it does have it's place.

    Blessings,
    April
    moderator

    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
  • 06-06-2009 10:18 PM In reply to

    Re: Reducing a cervical lip

    Cervical lips and waterbirth.....has any one else noticed that sometimtes, immersion in water seems to cause a cervical lip? Especially if mom reclines in the bath for more than a few min (unfortunately the pool in our active birth unit is a jacuzzi type thing, very tough on the knees despite extra pading in the form of towels under mum etc, often find a mum needing to lie back to rest her sore knees, know that this is an awful position for a mama in labour, but what do you do if shes unhappy to get out but has lost sensation in her feet and numb knees from the pool?) 

    Am i correct in assuming that the pressure of the head, now no longer evenly distributed on the cervix,predisposes towards a lip forming, and what can one do to prevent it??

    thanks guys

     

  • 06-07-2009 9:03 AM In reply to

    Re: Reducing a cervical lip

    I have mom's sit back on their heals in the jacuzzi between contractions.  This keeps the head coming down evenly and gives the knee caps a rest.  Usually during the contraction, mom gets on her hands and knees.  If she needs to rest, she gets on her side in the tub.  I actually feel the tub reduces lips by relaxing mom.

  • 06-09-2009 1:02 AM In reply to

    Re: Reducing a cervical lip

    Thanks for that, have definately found it can reduce a lip too....maybe its just a malposition that triggers the lip, and the water a coincidence.........

     

     

  • 06-12-2009 6:35 PM In reply to

    Re: Reducing a cervical lip

    If the lip is mushy it will just go away with more labor.

    If it is tight it will go away with more labor.

    Position changes as the mother feels

  • 07-02-2009 7:14 PM In reply to

    Re: Reducing a cervical lip

     I have had a cervical lip with all three of my homebirths. The first time I blamed it on a nuchal hand, the second time i was frustrated and the third time I was depressed. Now expecting my 4th I am hoping to avoid this. Evening primrose oil applied to the lip always helps, so this time I will be taking EPO vaginally for a few weeks in advance.

      In each case, after giving time and position changes, the midiwfe would hold back the lip. THis is soooo painful, and hard to push against. It was not until this last labor and a more experienced midiwfe that she identified my postierior cervix and drew the conclusion that the inteanse pain above my pubic bone at each birth is the cervix trying to pull forward. She "forbid" me from leaning forward,( previously the only position I could cope with the pain in) and made me recline so the cervix could pull forward. I would never get the urge to push when I tried to lean forward and ease the pain. (Actully, I don't really get a urge to push until the lip is resolved.)

      All this rambling to say- knowing the mother's cevical position prior to the birth (hard with a prima, if you don't do a VE) may be usefull in choosing the best positions. I would not usually recommend semi-sitting or laying down for a woman unless I knew she had a posterior cervix.

      The key to this is to remember that a pushing back a lip is not only very painful, but demoralizing to the woman. It shouts, "Your body is not working right, you are broken." I have really struggled with this feeling during and following each of my births. The more we can do to help women overcome this issue the better.

  • 07-06-2009 9:25 PM In reply to

    Re: Reducing a cervical lip

    I can't help but say.  If you don't check it you won't know what your cervix is doing!  I know that sounds simplistic,but nobody needs to be checking you unless there is something to be concerned about.  usually labor quiets down a little past transition.  Good time for mom to rest.  Moms will sometimes sleep durring contractions.  When they are ready,they will push.  Don't borrow problems or make them up as you go along 

    claudia

    Women and cats will do as they please and men and dogs should relax and get used to the idea. - Robert A Heinlein
  • 07-07-2009 6:01 AM In reply to

    Re: Reducing a cervical lip

    I totally agree!  However, most of the midwives that work in the hospitals in our area do not have the time or know-how to "read" the laboring woman without using vaginal exams.  I have actually had several of my moms scolded to refusing vaginal exams through transition and pushing.  Our local hospital just made a "mandatory vaginal exam" policy.... I believe this has come from my unmedicated mom's wanting to refuse or highly limit vaginal exams.  If that is true, the sad thing is that is came from our only local midwifery group.

     

     

  • 07-07-2009 6:59 AM In reply to

    Re: Reducing a cervical lip

    What happens if you refuse the mandatory vaginal exam?

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 07-07-2009 7:48 AM In reply to

    Re: Reducing a cervical lip

    I haven't experienced the "new policy" first hand yet, however one of my doula clients just had a prenatal appointment with the midwife who I last worked with and she stated the "new policy" as fact.  I'm sure that once in the hospital, my client can refuse the VE, however it just adds to the power struggle between the laboring mother and her care provider.... which is a shame, as they should be on the same page and be able to trust each other.

  • 07-07-2009 3:32 PM In reply to

    • ZoeysMom
    • Top 25 Contributor
    • Joined on 02-04-2009
    • Lincoln, NE
    • Posts 63

    Re: Reducing a cervical lip

    Ugh... what a system.   Those midwives must really feel stuck between wanting to practice as they see fit but needing to please the hospital so they still have a place to practice.  We have that issue here...  only a handful of midwives, homebirthing illegal, no birthing "centers", only 2 hospitals and all the policies that come along with them.  Bleh.

    Mandi
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