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childbirth with no cervix?  

post #1 of 30
3/27/08 at 12:16am
Thread Starter 
A friend of mine had her entire cervix removed due to cancer years ago. She got pregnant and had a cerclage, which was removed a few weeks ago because she is due any day now. She will be having the baby at a hospital, and she will probably opt for an epidural fairly early.

My question is: How will the doctors tell when it's "time to push"?

I know that if she were going the natural route, it wouldn't be as much of a concern because her body would just push when it was time. But since she'll be in the hospital with (probably) an epidural, and she has no cervix to "dialate to 10," how will she or her doc know when it's time???

I'm just curious - I'll be there as her doula, and I want to be prepared if at all possible. Are there any midwives or obs on the board who have any idea how the second stage of this labor might progress?
post #2 of 30
3/27/08 at 8:26pm
I'm having a hard time picturing exactly what her insides might look like or behave like if she really had her entire cervix removed. How did they close the bottom of her uterus after the surgery? What is holding the baby in now that the cerclage is out? I'd love to hear input from anyone who's got a clue.
post #3 of 30
3/27/08 at 8:34pm
Seems like the perfect reason to not check for dilation at all!

However, I'm guessing that dilation will happen normally and she'll just seem fully effaced right away.
post #4 of 30
3/27/08 at 10:23pm
I'm curious too
post #5 of 30
3/27/08 at 10:31pm
post #6 of 30
3/27/08 at 11:00pm
I have never seen a pregnancy after complete removal of the cervix.

I have seen a few pregnancies with a uterine cerclage. These were done because of cervical dysplasia treatments that removed most, but not all, of the cervix. The cerclage was placed in the lower uterine segment because there was not enough cervical tissue to hold a stitch. But these were permanent cerclages and were never removed. Both moms delivered by c/s.

I would assume that in the absence of a cervix, the uterus would just open immediately once any kind of stitch was removed. So like everyone I am also baffled by this story.
post #7 of 30
3/27/08 at 11:29pm
Thread Starter 
Yeah, it's pretty puzzling to me too! I must have misunderstood her, or maybe she has gotten misleading info from her docs. She was due today, and the cerclage was removed 2 or 3 weeks ago, so I don't know how the baby is staying in - there must be a tiny bit of cervix remaining.

So I guess, then, that the little bit of cervix she "does" have will dialate...

And I'm assuming that she will have a normal first stage, as well. Right? I mean, the baby has to rotate and all that other good stuff. It's not like its just gonna drop out once she has a few contractions. Right?!?

Thanks for your help ladies!
post #8 of 30
3/27/08 at 11:46pm
don't go spreading the word that the baby will just drop out after a couple of ctx - we might see a bunch of women having their cervix removed for easier birth! JK

Sounds like incomplete / incorrect info. I'd be asking the mother to talk more about it with the doc so she (and you) has a clearer picture of what's going on/ what's going to happen.
IMO, everywoman should fully understand how her body works.
post #9 of 30
3/27/08 at 11:56pm
It is impossible IMO to predict what her birth will be like based on such incomplete information. Perhaps it will be more or less normal... perhaps it won't! It could be extraordinarily fast. Depending on the size and shape of her pelvis and the baby's head, there may or may not be a lot of rotating necessary. I'm actually wondering if she really has little to no cervix if something is keeping the baby from descending, because I would have expected her to have given birth by now otherwise. I would think pressure would cause her water to break as soon as the cerclage was removed or shortly thereafter, regardless of where the baby was at the time. There's a lot of things that don't make sense to me here.
post #10 of 30
3/28/08 at 12:09am
Thread Starter 
Quote:
Originally Posted by momileigh View Post
I would think pressure would cause her water to break as soon as the cerclage was removed or shortly thereafter, regardless of where the baby was at the time...
That's interesting...I didn't even think about that. Seriously though, I asked her several times "so you really don't have a cervix *at all*???" and she said no every time. Well, I guess I'll be calling her tomorrow to see if she can give me some more info!
post #11 of 30
3/28/08 at 12:15am
if it's okay, can you let us know? I'm curious to learn about this.
post #12 of 30
3/28/08 at 1:01am
Thread Starter 
Quote:
Originally Posted by majikfaerie View Post
if it's okay, can you let us know? I'm curious to learn about this.
Certainly!
post #13 of 30
3/28/08 at 1:04am
it's possible there could be a lot of scar tissue sealing everything in. if so, it's possible labor could "fail to progress" without breaking up the scar tissue if it doesn't open up on it's own.
post #14 of 30
3/28/08 at 1:14am
Quote:
Originally Posted by bri276 View Post
it's possible there could be a lot of scar tissue sealing everything in. if so, it's possible labor could "fail to progress" without breaking up the scar tissue if it doesn't open up on it's own.
Oh, yeah, I hadn't thought about scar tissue... that could be an issue.
post #15 of 30
3/28/08 at 4:27pm
Quote:
Originally Posted by bananababies View Post
A friend of mine had her entire cervix removed due to cancer years ago. She got pregnant and had a cerclage, which was removed a few weeks ago because she is due any day now. She will be having the baby at a hospital, and she will probably opt for an epidural fairly early.

My question is: How will the doctors tell when it's "time to push"?

I know that if she were going the natural route, it wouldn't be as much of a concern because her body would just push when it was time. But since she'll be in the hospital with (probably) an epidural, and she has no cervix to "dialate to 10," how will she or her doc know when it's time???

I'm just curious - I'll be there as her doula, and I want to be prepared if at all possible. Are there any midwives or obs on the board who have any idea how the second stage of this labor might progress?
It's hard to tell in this specific case without more details what her labor is going to be like. But as far as when to push with an epidural, I do not have my moms with epidurals start pushing the second they reach the magic number 10. We wait - labor down - until the uterine contractions push the head of the baby far enough down that the mom feels pressure on the pelvic floor. Usually they say they are feeling lots of pressure or say they feel that they need to have a bowel movement. This has saved us many, many hours of fruitless pushing. I can't guess how this particular labor willl go, but this is my general experience with epidurals.

So my answer would be you'll know it's time when she tells you it is.
post #16 of 30
3/28/08 at 5:27pm
Can you go with her to her next appointment?
post #17 of 30
3/28/08 at 5:52pm
Not to be gross, but I'd really like to see what it looks like.
post #18 of 30
3/28/08 at 10:54pm
I wonder if she had a cone biopsy, where they remove a portion of the cervix to check for cancer.

The cervix is just the lower opening of the uterus. Still, it sounds weird. I wonder if there is a miscommunication?
post #19 of 30
3/28/08 at 11:34pm
Thread Starter 
Quote:
Originally Posted by bri276 View Post
it's possible there could be a lot of scar tissue sealing everything in.
Bingo!
I asked her today "So if you don't have a cervix, what is keeping the baby in?" and she said that there is a tiny bit of cervix left and lots of scar tissue. Which now makes me nervous - I hope that she can open up enough to have a vaginal birth. Does anyone have any insight?

The story behind her cervix being removed is that she had cancer on one half, and she had the surgery to remove it but they removed the wrong side! So she had to have surgery again to remove the correct side, leaving her with little to no cervix.
post #20 of 30
3/29/08 at 12:18am
Okay for those of you who know about scar tissue from past cervical surgeries,... In my experience it can be broken up rather eaisily with your hand while doing an exam especially if they have been using epo. But on occasion(sp) no matter what you do it just won't budge. I have seen both. You ladies?
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