cervical lip/knowing when to push

[sanguine_speed]

In the past, I had a cervical lip while feeling the urge to push. I am concerned about this happening again.
At that time, I was having the midwife check my cervical progress because I had a very long and exhausting labour and needed the reassurance that progress was being made. But when I thought I was ready to push, she said I had a cervical lip and should not push. In the end, she ended up manually moving my cervix.

I had a subsequent birth, and also was not able to rely on my body's signals to know when to push. Now, this was a unique scenario--I had a breech preemie, and the bum dropped out before I was fully dilated causing an overwhelming urge to push. The pressure cuts of the umbilical cord flow, and my baby did in fact require resuscitation and entubation after being born with an Apgar of 0. I do not doubt the midwife for trying to have me not push at all here.

My point is, my last two births, my body told me to push when I shouldn't have. I had to rely on outside opinions--on other people, not on myself.

So this birth, I'd *like to* trust my body and let it birth the baby without someone checking my progress and giving me "permission" to push. I would like to let my body do what it's meant to do.

But what would have happened with the cervical lip issue? What if that happened again? What would the signs be? Would it just cause inflammation to the point of worse outcome? As it was, the baby was 9 pounds with a large head, I'd had a very long labour and ended up with internal tearing and a post-partum hemmorhage and intrauterine infection that req'd a D&C. This despite fighting so hard (and having) a natural, non-epi birth.

Is it common to have a 'cervical lip'? What are the possible negative outcomes if this is not noticed or addressed? Is it worthwhile to be "approved" by the midwife to begin pushing? What is this "inflammation" that can happen, and what is its effect?

I just want to be able to trust my own body, but have these reservations and fears, and I'm worried that the need for outside approval for birthing will really hamper the experience and outcome for me and the baby.

[vegasgrl]

I'm not a medical professional, but I'm 5 1/2 weeks pp and my cervical lip landed me a big ol' CS. I was a planned HB so I'm still pretty devastated. I give you serious kudos for letting them manually move your cervix; we tried once and that's when I said we're going to the hospital. It hurt way too bad to even consider another attempt.

My body told me to push around 6pm; we went to the hospital at 10pm, so I was pushing on that lip for 3 1/2 hours. In my case, the pushing had inflamed the lip so bad that once on the epidural, my cervix continued to come back instead of the lip retracting, i.e., I went in at 9-10cm with a partial lip on one side and after a few hours I was 8-9cm with a full ring of cervix. Eventually after 9 1/2 hours at 9cm I ASKED for the CS; it was obvious my body wasn't cooperating.

On top of that, my LO was born swimming in meconium. Who really knows why, or whose fault it was, but having that stuck lip trapping her in there certainly couldn't have helped the situation. (She's fine now - it was just super scary.) I was pushing for so long, but she couldn't go anywhere.

I had my 6 week checkup today and he said my cervix looks really good - I had been awfully worried about long-term damage - but I wanted to share my story. I wish to GOD someone had kept me from pushing, or maybe tried to hold the lip before there was so much inflammation. I'm all for trusting your body, but pushing on a lip just seems so risky to me.

Fwiw, I'm told that lots of women can push through the lip if it's super stretchy, which mine was - like the baby's head will push that last little bit out of the way. I think this is what they had hoped would happen with me. Unfortunately no dice.

[sanguine_speed]

I'm sorry for your experience mama, and thank you for sharing it. But now it still leaves me at having to ask someone else if I'm allowed to push . And thank you for recognizing that yes, it was quite painful and difficult to have it moved. Your story helps me appreciate that this painful help was important.

What I do glean from your experience however might be that if pushing becomes prolonged then it is worth a look? I wonder how long is "too long" before checking? I really dislike the idea that I need someone else to permit me to proceed, but is that what truly is necessary? Is this one intervention that is worth the benefit? It is primarily (for me at least) a psychological issue--I feel I need to psych myself up to trust my body in the whole birthing process--to believe that my body is capable of birthing without interference or intervention. So it might sound like a small thing to let someone tell me if I'm fully dilated before I birth, but it's a much bigger can of worms, I think. I think this one block prevents me from believing the whole bigger thing, ya know?

[smokeylo]

I had a cervical lip with my first birth. It was a water birth and although my midwife told me not to push, I could not help myself. I changed position between every contraction to try to vary the pressure and hopefully keep it from becoming a problem. This seemed to work because my daughter was born within an hour or two of that point.

[sanguine_speed]

Originally Posted by smokeylo

I had a cervical lip with my first birth. It was a water birth and although my midwife told me not to push, I could not help myself. I changed position between every contraction to try to vary the pressure and hopefully keep it from becoming a problem. This seemed to work because my daughter was born within an hour or two of that point.

How did you come to know? Did you just have regular vaginal exams?

[erin_brycesmom]

I think you could have relied on your body to push whenever it wanted to the first time around. If you hadn't had any cervical checks, that's what would have happened. I would just rely on your body to push when it pushes next time around as long as it's a full term birth. Good luck mama .

[sanguine_speed]

Originally Posted by erin_brycesmom

I think you could have relied on your body to push whenever it wanted to the first time around. If you hadn't had any cervical checks, that's what would have happened. I would just rely on your body to push when it pushes next time around as long as it's a full term birth. Good luck mama .

This doesn't really answer any of my questions. At what point would it have become apparent that I'd had a lip? Would it have already been "too late" and caused swelling that would risk the vaginal birth?
Despite my pushing the second (it wasn't my first birth) time around even when they said not to, I was not able to push through the lip without them moving it. How can you know that if I would have just pushed everything would have been fine?

[MegBoz]

Unfortunately, I can't answer your specific Qs, but they are interesting ones.

Originally Posted by sanguine_speed

So it might sound like a small thing to let someone tell me if I'm fully dilated before I birth, but it's a much bigger can of worms, I think. I think this one block prevents me from believing the whole bigger thing, ya know?

I totally get what you're saying. However, I'd heard of 2 horror stories of people pushing on a lip, so in advance of birth, I had it in my head that I wanted that reassurance from the MW. It was my 1st baby, and I didn't know what it would exactly feel like, so I wanted that reassurance. It didn't bother me in the least.

I understand that feeling the urge to push without being fully dilated is rare, but I still wanted the reassurance & I felt like this was one issue where I'd "rather be safe than sorry." I didn't view it as an intervention - it doesn't disturb the natural, physiological process of birth and alter the course of my birthing experience. It was just a normal part of the course, IMO.

You aren't UCing, so I assume you will have, and did have, a MW check things like fetal HR & your amount of bleeding to make sure you didn't have PPH? Did the MW also check the placenta to make sure it was intact? Did you want to do these things yourself, or are you emotionally content with leaving these to be the responsibility of the trained, experienced MW? Personally, I'm fine with leaving it to my MW. Perhaps you could just re-frame it in your mind this way & that may help?
(Because, personally, I'm thinking it might still be best, safest to have a MW check before pushing, although I don't know all the facts.)

ETA: because having a MW who does other things like checking fetal HR & checking for PPH does NOT mean I don't trust my body to know how to birth! I do! I just think it's wise to have SOME degree of "checking up" on things... not the extreme view they take in the American medical-model, but evidence-based "checking" & "safety nets." To me, the pre-pushing VE is another part of this evidence-based midwifery care.
It doesn't mean I don't trust my body & I don't believe my body can birth on it's own. It doesn't mean I don't trust my body any more than having fetal HR checks & evaluating for PPH means I don't trust my body.

[Astraia]

I don't know if this is helpful (since cervical lips seem to be a whole different ball game) but I found these 2 articles to be very interesting, at least....

http://www.midwiferytoday.com/articles/RuleOf10.asp

http://www.glorialemay.com/blog/?p=72

And on this page:
http://www.radmid.demon.co.uk/cervixlip.htm

this post really makes me think that maybe the first two articles have it right:

"I just can't believe that something that seems to happen to so many women must be pathological. In fact, I've always instinctively felt that letting women go with the urge to push *does* help - but do not have the evidence to back me up. The only support for my instinct I have is the fact that I do not recall *one single incidence* of an obstructive swollen anterior lip of cervix, in any of the 100s of births I supported whilst working in West Africa. That either means it didn't happen - or, if it did, was simply not a problem. I was usually only called late in the first stage of labour."

[sanguine_speed]

Originally Posted by MegBoz

Unfortunately, I can't answer your specific Qs, but they are interesting ones.



I totally get what you're saying. However, I'd heard of 2 horror stories of people pushing on a lip, so in advance of birth, I had it in my head that I wanted that reassurance from the MW. It was my 1st baby, and I didn't know what it would exactly feel like, so I wanted that reassurance. It didn't bother me in the least.

I understand that feeling the urge to push without being fully dilated is rare, but I still wanted the reassurance & I felt like this was one issue where I'd "rather be safe than sorry." I didn't view it as an intervention - it doesn't disturb the natural, physiological process of birth and alter the course of my birthing experience. It was just a normal part of the course, IMO.

You aren't UCing, so I assume you will have, and did have, a MW check things like fetal HR & your amount of bleeding to make sure you didn't have PPH? Did the MW also check the placenta to make sure it was intact? Did you want to do these things yourself, or are you emotionally content with leaving these to be the responsibility of the trained, experienced MW? Personally, I'm fine with leaving it to my MW. Perhaps you could just re-frame it in your mind this way & that may help?
(Because, personally, I'm thinking it might still be best, safest to have a MW check before pushing, although I don't know all the facts.)

ETA: because having a MW who does other things like checking fetal HR & checking for PPH does NOT mean I don't trust my body to know how to birth! I do! I just think it's wise to have SOME degree of "checking up" on things... not the extreme view they take in the American medical-model, but evidence-based "checking" & "safety nets." To me, the pre-pushing VE is another part of this evidence-based midwifery care.
It doesn't mean I don't trust my body & I don't believe my body can birth on it's own. It doesn't mean I don't trust my body any more than having fetal HR checks & evaluating for PPH means I don't trust my body.

Thanks Megboz, it does help me to think through some of the psychological stuff--maybe getting myself to a place of acceptance of this as useful...but I do veer toward wanting to do birth without hands in my vagina. I do think it's a bit more invasive than checking a placenta, kwim? But it's not all that ou there either. I suppose this whole mental thing is further complicated because I did actually have MWs check for hemmorhage and for placental completeness--and after they said everything was fine and left, I passed out from blood loss (hemoglobin 69) and ended up getting an intrauterine infection from retained placental pieces. So, perhaps there is also more to the trust issue--myself and the midwives. Now, I did have a subsequent birth with a different midwife whom I trust entirely...so this one I think is more on me.

But than you for offering some reframing--it is very helpful.

[sanguine_speed]

Originally Posted by Astraia

I don't know if this is helpful (since cervical lips seem to be a whole different ball game) but I found these 2 articles to be very interesting, at least....

http://www.midwiferytoday.com/articles/RuleOf10.asp

http://www.glorialemay.com/blog/?p=72

And on this page:
http://www.radmid.demon.co.uk/cervixlip.htm

this post really makes me think that maybe the first two articles have it right:

"I just can't believe that something that seems to happen to so many women must be pathological. In fact, I've always instinctively felt that letting women go with the urge to push *does* help - but do not have the evidence to back me up. The only support for my instinct I have is the fact that I do not recall *one single incidence* of an obstructive swollen anterior lip of cervix, in any of the 100s of births I supported whilst working in West Africa. That either means it didn't happen - or, if it did, was simply not a problem. I was usually only called late in the first stage of labour."

Thanks Astraia,
I think this points me to evidence-based care, which my midwife is very big on (even when the evidence goes against protocol, such as with my vaginal breech birth). I think talking to her about this issue in terms of incidence and outcomes would be enlightening and might allow me to regain some faith.

[sweetpea_119]

Originally Posted by Astraia

I don't know if this is helpful (since cervical lips seem to be a whole different ball game) but I found these 2 articles to be very interesting, at least....

http://www.midwiferytoday.com/articles/RuleOf10.asp

http://www.glorialemay.com/blog/?p=72

And on this page:
http://www.radmid.demon.co.uk/cervixlip.htm

Thank you! Thank you! Thank you! These links are exactly what I was trying to talk about with my midwife at my appointment yesterday, but I didn't have the links/hadn't read them in awhile, so I couldn't quite phrase what I wanted to say about avoiding cervical checks while in labor!

I am bookmarking these now so that I don't lose them again!

[fruitfulmomma]

The Rule of 10 is an awesome article. I am also one who wants to push before I am "complete" and have had that feeling with all five births. Next time round I am listening to my body!

[Friday13th]

The Rule of 10 article is great and I wish I'd read it before I had DS.
I had the urge to push at 10 with a lip, there was nothing I could do to stop it. So my midwife broke my water, thinking DS's head would drop and clear the lip. It did. Firmly into an crocked, posterior position with a nuchal hand. I then pushed for 2.5 hours before his heart rate dropped and I ended up having a csection.

I think in retrospect the pushing wasn't true "push the baby out" pushing but more of a helping him get into a better postion pushing and that if my bag of water hadn't been broken he would have had a better shot at turning. That's just my theory, though.

Good luck!

[erin_brycesmom]

Originally Posted by sanguine_speed

This doesn't really answer any of my questions. At what point would it have become apparent that I'd had a lip? Would it have already been "too late" and caused swelling that would risk the vaginal birth?
Despite my pushing the second (it wasn't my first birth) time around even when they said not to, I was not able to push through the lip without them moving it. How can you know that if I would have just pushed everything would have been fine?

You would have never known you had a lip. I think your body would have just pushed your baby out when it was ready, lip or no lip. I don't believe that swelling happens if you allow your body to push on it's own. Isn't that a myth? Doesn't swelling only happen when you mentally choose to push and your body is not ready?

You can never know that everything would have been fine but I really believe strongly in unhindered birth. With my second, I had a cervical lip that "had" to be held back by my provider. But with my third, I had zero cervical checks in my three day labor. No idea what was going on down there but eventually, my body did what it had to do to push out my 9.5lb baby with a 15 inch head and nuchal arm. It was a great experience. It's hard for me not to be effected by my own experiences and beliefs though. Good luck mama!

[sanguine_speed]

Well yes, that is exactly the point. I was asking for evidence about the incidence and outcomes of pushing through a cervical lip .

[erin_brycesmom]

I must have missed where you asked for that .
But anyway, my advice is to not have cervical checks. It's not possible to create evidence on cervical lips without doing cervical checks. However, I have researched cervical swelling in the past and have not found any evidence to support the idea that the cervix swells if not fully 10 all the way around when the body pushes at its own urging.

[erin_brycesmom]

A quote from this thread with tons of research for you - https://www.mothering.com/discussion...1061257&page=2

Do you have any research suggesting injuries (or any difficulty) when pushing on an anterior lip when there is an uncontrollable urge?

Here is the list of resources supporting the position that women pushing with an uncontrollable urge do not have increased rates of cervical injury, slow descent, maternal exhaustion, or fetal distress:

McKay S, Roberts J. Second stage labor: what is normal? Journal of Obstetric Gynecologic and Neonatal Nursing. 1985;14(2):101-6.

Roberts JE, Goldstein SA, Gruener JS, Maggio M, Mendez-Bauer C. A descriptive analysis of involuntary bearing down efforts during the expulsive phase of labor. Journal of Obstetric Gynecologic and Neonatal Nursing. 1987; 16(1): 48-55.

Aderhold KJ, Roberts JE. Phases of second stage labor: Four descriptive case studies. Journal of Nurse-Midwifery. 1991; 36(5): 267-275.

Cosner KR, deJong E. Physiologic second stage labor. American Journal of Maternal and Child Nursing. 1993; 18: 38-43.

Thomson AM. Maternal behaviour during spontaneous and directed pushing in the second stage of labour. Journal of Advanced Nursing. 1995; 22(6):1027-34.

Roberts J, Woolley D. A second look at the second stage of labor. Journal of Obstetric Gynecologic and Neonatal Nursing. 1996; 25(5): 415-23.

Roberts J, Hanson L. Best practices in second stage labor care: maternal bearing down and positioning. Journal of Midwifery & Womens Health. 2007; 52(3):238-45.

Roberts, JE. The “push” for evidence: management of the second stage. Journal of Midwifery and Women’s Heath. 2002; 47(1): 2-15.

Petersen L, Besuner P. Pushing techniques during labor: Issues and controversies. Journal of Obstetric Gynecologic and Neonatal Nursing. 1997; 26(6): 719:726.

[Astraia]

Originally Posted by Friday13th

I think in retrospect the pushing wasn't true "push the baby out" pushing but more of a helping him get into a better postion pushing and that if my bag of water hadn't been broken he would have had a better shot at turning. That's just my theory, though.

I think you REALLY need to be able to follow your urges on this. And I think that breaking your water and telling you to push stronger than your body's urges is.... well... IDK, wrong :P

I was 10 cm with a slight anterior lip and started bearing down slightly at the peak of every or every other contraction. My midwife asked "are you pushing?" and i siad "I don't know" (it didn't feel like PUSHING, it felt like putting downward pressure occasionally). So she checked me, told me I was 10 with a lip but could push past it.... and suddenly I'm purple pushing. For a LONG TIME. With virtually no progress for at least the first hour or so. (my water also broke as she was checking me. I've always wondered about that....)

She was acyclintic (however the heck you spell that stupid word- tilted head) and posterior. I really think that if I'd just done what my body needed me to do she would have been born at the same time, and more comfortably for both of us. I think she was working on positioning her head properly when I was directed to push and push hard for as long as I could with every contraction.

I had full plans of "breathing" my baby down, and was really disappointed with the entire pushing phase. THIS time I will listen to my body, thanks!

[SwanMom]

My sister had to resist the urge to push for about an hour due to a cervical lip. She said it was the worst part of the labor. The midwife used evening primrose oil to help melt the lip away--may be nice to have some on hand if you're worried. Baby ended up coming out eventually, but she was close to being transported.

I was never checked after 4 cm. I just knew when to start pushing. But that was before my sister's experience. I may want to be checked this time just to be sure everything's okay.