"lip" of cervix

[johnsmom]

I hope some of you can give me some thoughts/advice about the wisdom of pushing against a lip of cervix.
During my first birth my midwife had me push on and off for 90 minutes against a not quite fully dialated cervix. She tried to push the lip back with no success several times. This was the most agonizing 90 minutes of my labour and when I finally reached full dilation I still had another 2.5 hours of pushing until baby came. I feel like in addition to being horribly painful, the first 90 minutes of pushing served no purpose other than to completely exhaust me.
I am planning an April homebirth with the same midwife and I want to bring up this topic at our next appointment. I would rather labour for as long as it takes than try to speed things up by pushing back the lip. I'm sure she'll be respectful of my wishes, but I'd like to be armed with some info just in case.
Any thoughts would be appreciated.

[Nan'sMom]

Honestly, someone telling me to push when I didn't feel ready to do it would make me never want to use them again. Did she ask YOU whether you wanted to push? It sounds like you might think about looking for a less interventive midwife and/or discuss with your current midwife why she thought pushing was a good idea in that situation.

[blissful_maia]

I don't see any point in making a mama push against an anterior lip, unless she was having uncontrollable pushing urges and pain and I could easily slip it over the baby's head. I have seen an anterior lip get quite swollen and end up in lack of progress/intervention, but most mamas just have to labor a little while longer and baby comes just fine.

Pushing that little bit of cervix is so, so painful and I can't believe your midwife did it for 90 minutes! You poor mama.

[teachinmaof3]

So what do you do when there is a lip that is swelling when Mama pushes?

[mwherbs]

I think that it would work best to just talk about your experience and what you want this time-- there are a few studies not many here are a couple abstracts--

J Nurse Midwifery. 1999 Jan-Feb;44(1):36-9.

Spontaneous pushing during birth. Relationship to perineal outcomes.

Sampselle CM, Hines S.

University of Michigan, School of Nursing, Div. II, Ann Arbor 48109-0482, USA.

Vaginal birth is a recognized factor in perineal tissue damage and postpartum
perineal pain. This study examined outcomes of 39 primiparous women who had spontaneous vaginal births. In a retrospective survey, women were asked to describe the type of pushing used to give birth and what the level of pain had been in the perineal (or vaginal) area during the first week postpartum. Labor and delivery chart data documented extent of episiotomy and/or laceration sustained. Eleven (28%) women reported using spontaneous bearing down efforts,and the remaining 28 (72%) were directed. Women who used spontaneous pushing were more likely to have intact perineums postpartum and less likely to have episiotomies, and second or third degree lacerations (chi 2 [3, N = 39] = 8.1, P = .043). Other variables, such as maternal age, infant birth weight, length of second stage, provider type, and use of epidural, did not demonstrate a significant difference in perineal outcome. Further analysis showed a significant relationship between the extent of perineal disruption and pain (F [3,30] = 5.08, P = .005).

PMID: 10063223 [PubMed - indexed for MEDLINE]
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Nurs Res. 2005 May-Jun;54(3):149-57.

Effects of immediate versus delayed pushing during second-stage labor on fetal well-being: a randomized clinical trial.

Simpson KR, James DC.

St. John's Mercy Medical Center, 7140 Pershing Avenue, St. Louis, MO 63130, USA.
[e-mail]

BACKGROUND: Although there are two methods of caring for women with epidural anesthesia during second-stage labor (coached closed-glottis pushing immediately at 10-cm cervical dilation or delayed pushing until the woman feels the urge to push, passive fetal descent, and encouragement of open-glottis pushing when the woman has the urge to push), there are limited data concerning which method is most optimal for fetal well-being. OBJECTIVE: To evaluate effects on fetal well-being, as measured by fetal oxygen saturation, of two different methods of second-stage labor nursing care for women with epidural anesthesia. METHODS: Forty-five nulliparous women who had progressed to the second stage were randomized to 1 of 2 groups (immediate or delayed pushing). Fetal oxygen saturation was continuously monitored and values at 10 cm, initiation of pushing
and immediately prior to birth, as well as the amount of time that fetal oxygen saturation values were abnormal (< or =30%) were compared between groups. Also evaluated were additional measures of fetal well-being such as fetal heart rate patterns, Apgar scores, and umbilical cord blood gases and maternal outcomes including length of labor, method of birth, and perineal status. RESULTS: There was a significant difference between groups in fetal oxygen desaturation during the second stage (immediate: M = 12.5; delayed: M = 4.6) F(1, 43) = 12.24, p = .001, and in the number of > or =2-min epochs of fetal oxygen saturation <30% (immediate: M = 7.9; delayed: M = 2.7), F(1, 43) = 6.23, p = .02. There were more
variable decelerations of the fetal heart rate in the immediate pushing group
(immediate: M = 22.4; delayed: M = 15.6) F(1, 43) = 5.92, p = .02. There were no differences in length of labor, method of birth, Apgar scores, or umbilical cord blood gases. Women who pushed immediately had more perineal lacerations (immediate: n = 13; delayed: n = 5) chi(1, N = 45) = 6.54, p = .01. DISCUSSION: Delayed pushing results in less fetal oxygen desaturation and less > or =2-min epochs of fetal oxygen saturation <30% during second-stage labor than the immediate pushing method; thus, delayed pushing is more favorable for fetal well-being as measured by fetal oxygen saturation.

PMID: 15897790 [PubMed - indexed for MEDLINE]

[VaDoula]

I pushed against a lip with my last birth but I was having to fight my body not to push. It was taking everything I had not to push on it so my midwife tried to move it without success and told me to go for it if I wanted to. The decision was left up to me. She told me to listen to my body and push or not depending on what I felt like I needed to do.

[UmmSamiyah]

i agree with the above mama's why did she make you push in the first place? If that is the case next time and you do feel pushy try not to lean into your contractions so much. ya know? like try to let your body work without aiding it. I have heard of some midwives stretching the cervix gently with their hands, but I don't know how safe that is. work on kegels though. so that if you need to stop you have the strength to do so.

[lorijds]

I think it's fine to hold up a lip if mom is feeling like pushing, but the pain of the lip being pinched between the head and the pelvis is prohibitive and a simple change of position has not helpted to melt the lip away.

I think it is done too often; hands just shouldn't be in there that much in general. But I've also seen situations where it was really helpful, enough so I would never say never.

[Malga]

I don't see any point in making a mama push against an anterior lip, unless she was having uncontrollable pushing urges and pain and I could easily slip it over the baby's head. I have seen an anterior lip get quite swollen and end up in lack of progress/intervention, but most mamas just have to labor a little while longer and baby comes just fine.

Pushing that little bit of cervix is so, so painful and I can't believe your midwife did it for 90 minutes! You poor mama.

:

Its seems if the woman can just wait a little while the lip usually goes away on its own, especially if there are some position changes, etc.

[rnchrista]

Originally Posted by teachinmaof3

So what do you do when there is a lip that is swelling when Mama pushes?

I will try to answer this question. The problem is my new preceptor reads these boards so she will see very quickly how much I don't know

There are probably a lot of times that lips happen that we never know about because we aren't checking. But if a lip is occuring that is causing problems with descent, I would first try to figure out why the lip is occuring. I think most likely it is because the head isn't applied evenly on the cervix. Maybe the head is tilted a little. Position changes might help to resolve that (althernate sides, hands and knees, etc). Knee chest might also help to take some of the pressure off the cervix and allow the baby to back out a little and get his head in a better position. Once the baby is in a better position, I would *think the lip would go away.
Other things that might help with a swollen lip include EPO, Arncia, and ice. I wonder if a bath would help too?

Of course, someone please correct me if I'm wrong.

[Malga]

On a side note, it seems that the midwifery practice I used to work with we always had issues with persistant anterior lips. Why was this? I remember being at countless births while the midwife held back a lip.

Now I am a nurse in the hospital (working towards a CNM) and we hardly ever have issues with anterior lips. I'm not sure why this would be. Most of the people I work with in the hospital have epidurals and if there is a lip when we check a mom we just wait. And I always let them labor down until they feel like pushing and at that point there is never cervix left.

[lorijds]

Originally Posted by Malga

On a side note, it seems that the midwifery practice I used to work with we always had issues with persistant anterior lips. Why was this? I remember being at countless births while the midwife held back a lip.

Now I am a nurse in the hospital (working towards a CNM) and we hardly ever have issues with anterior lips. I'm not sure why this would be. Most of the people I work with in the hospital have epidurals and if there is a lip when we check a mom we just wait. And I always let them labor down until they feel like pushing and at that point there is never cervix left.

I think you've answered your own question there--letting them labor down. They can't feel the pinching or the overwhelming urge, so it's not a big deal. KWIM?

ETA--maybe it is positional, too. Most of my experience with lips comes with unmedicated, mobile moms. Maybe being up and around contributes to cervical lips, while being in a reclined or sidelying position for a significant portion of the labor helps prevent them?

[johnsmom]

Thanks for all the great responses. I'm going to have this chat with my midwife next week and I'll ask her if maybe there was some reason she had me push against a lip for so long. I'm giving her the benefit of the doubt, because she has otherwise been great throughout both pregnancies.

[lorijds]

Can I also submit that perhaps your mw misread your signs. Maybe she had you push against the lip because she thought you were ready to push, that you wanted to push.

Even great midwives make mistakes, misread client cues, and experience miscommunication. She may have thought you wanted to push, that you were nearing your end and needed to push, or that you were having an overwhelming urge to push. It might also be that when she did the initial exam, that lip felt so soft and stretchy that she thought with one or two pushes it would go away, and then one or two pushes ended up being many. She might have physically misassesed you and felt that, once the lip was gone, the baby would descend easily and quickly. There might have been a very good rationale for it at the time that with hindsight doesn't seem so good.

Without asking her, who knows? I think it would be great for you to discuss it with her. FIrst of all, you won't have to speculate any more, you'll just know why she had you push for so long. Secondly, you can give her good input as to why, from your point of view, this was not a good thing. It will help her learn and grow as a practitioner, something that any good midwife will appreciate, no matter how experienced they are.