Hi Jackie,
First the posterior cervix question. If the labor is going along fine I don't worry about a posterior cervix. Of course, I tend not to be checking the cervix anyway, so there may be far more that are posterior than I know of. My birth assts. joke about yet another birth that occurred and I don't have a single cervical check on the chart, because none were done even in long labors.
However, if the labor is not going well (back labor, exhausted mom, baby in distress) then a posterior cervix seems much more common and usually indicates that there is a problem with baby's position.
So, the second part of your question. Back pain can be caused by several things. If the baby is in a good position with a well flexed head, it could be an arm that got caught in a bad position and is up against the sacrum. There is also the back pain that comes late in labor/early in pushing from the stretching of the sacroiliac joint and movement of the sacrum to allow the baby through the mid pelvis and outlet. However, that is really different from back labor and usually a few pushes to get the head past that point makes it feel much better.
If baby's not in a good position (asynclitic, deflexed head, posterior) then it feels like something is bumping or scraping on your sacrum with each contraction and sometimes in between. Everything is just sore and in spasm. It is pretty common for this to happen at 5-7 cm. Any of those baby position problems slow or prevent the usual rotation and movement of the baby's head through the mid pelvis. It is the movement of the baby's head down and through the pelvic curve that brings the cervix forward. It becomes a mechanical problem, not a soft tissue problem. Pulling the soft tissue of the cervix forward is only going to cause more trauma to the cervix, risking tearing and if hard enough, could cause separation from the lower uterine segment. (And yes, it hurts really, really bad) Same problem as when a lip of cervix is caught between the inside of the pubic bone and the baby's head. At a given point, it is caught between bones and pulling it won't move it, but with enough force could tear it.
Think of it this way, when you are tearing plastic wrap off the roll, if there is no pressure from your opposite hand holding the roll while the other hand pulls on the wrap then the wrap just keeps rolling. But, with the counter pressure of your hand (this would be the baby's head and your pelvis) holding back the roll (uterus) , it is easier to apply enough pull to separate the piece you want (cervix) from the rest of the roll (uterus). Sorry if that's TMI.
So pulling the cervix forward is not solving the problem of a malpositioned baby, it is only temporarily seeming to fix a symptom of a larger problem. Perhaps it has worked in the past with a woman who had a normal posterior cervix and helped to speed things up a bit. But, with a baby that is malpositioned, it has the potential to cause some serious injury to the mom without resolving the baby's problem. If a midwife or physician does not understand that this is a mechanical problem, then they won't understand how to fix it.
In all of my readings in how to resolve back labor, malpositioned babies, long labors, etc. I have never seen a midwife recommend such a thing as pulling the cervix. IMHO suggesting this for the situations I have talked about here shows a basic lack of understanding regarding the mechanics of normal birth and its variations.
I hope other midwives or doctor jen will pop in to discuss this further.
Yea, labor was long, it sucked, I was in pain....I needed encouragement, love & patience. Not cervix pulling.
