A woman can be almost fully dilated but still have a portion of cervix blocking the baby's head from coming down. This is often referred to as a "cervical lip". It's detected by the doctor, midwife, or nurse by doing a vaginal exam during labor. Because this happens near complete dilation, the laboring woman may feel a strong urge to push.
"If your cervix still has a thickened area (sometimes called a 'lip' or 'anterior lip'), you may need to avoid bearing down altogether until the cervix dilates completely. Otherwise, the cervix may swell and slow labor progress."*
I experienced this during my home birth. I was dilated to a 9, almost complete, with a little bit of cervix in the way. My midwife told me she would let me do a test push in a little bit and she left the room to talk with her attendant. Anxious to have my baby, I started to consciously bear down, only a few times. When my midwife returned to check my progress she found that my cervix had swelled and hardened, and I was now only dilated to a 7. It took a few hours for my body to dilate to complete again after that. I had no idea at the time that my little pushes could set my labor back so much.
When I was once again almost complete my midwife told me there was an anterior lip, and this time I listened to her and waited for the lip to clear when she told me to go ahead and start pushing.
"Your nurse or caregiver will guide you in what to do at this time. Although it is sometimes very difficult and uncomfortable to keep from pushing when you have a strong urge, it is not harmful to postpone pushing until the cervix has completely dilated."*
Some caregivers will help by holding the lip with their fingers during a contraction, to try and push it out of the way. They may also instruct you in how to breathe through the urge to push to help you be able to wait as the cervix dilates the rest of the way.
Cervical lips are not dangerous. They're simply a part of the birth process, and it happens to many women in labor. Knowing about this can help you experience labor and birth with more understanding and confidence in your body's ability to give birth.
***UPDATE: Some care givers don't consider a cervical lip to be of any concern whatsoever and will allow the laboring woman to simply follow her body's urges and push when she feels like pushing. The approach to a cervical lip can really depend on the care giver and his or her general approach to labor and birth***
***UPDATE: Some care givers don't consider a cervical lip to be of any concern whatsoever and will allow the laboring woman to simply follow her body's urges and push when she feels like pushing. The approach to a cervical lip can really depend on the care giver and his or her general approach to labor and birth***
*"Pregnancy, Childbirth, and the Newborn", by Simkin, Whalley, & Keppler, p. 199
Cherylyn - thanks so much for posting about my blog (above). Just noticed this post about cervical lips. I have written about this in 'leave pushing to the experts'. This is a common feature of labour for many women and is really not a problem. There is no evidence that pushing on a cervix will cause a problem. I have found if you just leave the body to do what it needs to do (push) - it will work it out : )
ReplyDeleteThank you for the input! I only recently discovered your blog, and I'm really enjoying your perspective and highly educational posts.
ReplyDeleteI wonder if knowing that there's a cervical lip could make a woman tense up and THAT could cause them to "go backwards" in labor. I know that when I was in labor with Stephen, when the nurse threatened me with going backwards because of the cervical lip, it made me scared, since holding back pushing was SO hard. Even though I didn't go backwards in dilation and was able to push for reals eventually, it was extremely difficult at the time (well, you know, you were there!)
ReplyDeleteJust a thought.
Oh yes Jamie, I remember. I think the nurse was having you pant through the urge to push more because the midwife hadn't arrived yet than because of the lip. But I agree that the way she approached it created some tension.
ReplyDeleteI should also mention that I really think my strange labor pattern had to do with the fact that my baby was breech. I remember the midwife commenting at one point when I was again at a 9 with a cervical lip (and we didn't realize he was breech yet) that maybe I was one of those women who just doesn't dilate all the way and that I should just go with the flow and push when I felt like it. I've been fully dilated with my other babies, so it was confusing to me at the time, but I really think it was because it was his bottom coming out first instead of his head! I'm so glad I was at home with midwives!