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Old 06-21-2002, 03:11 AM - Thread Starter
 
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What would you do in this situation:

birthing woman dialates to 10 except of a lip of her cervix. She is stuck in transition for hours.

At what point do you push the lip of the cervix past the baby's head? Or do you do something else?

Under what circumstances would you leave a laboring mother?
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Old 06-21-2002, 03:11 PM
 
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I am just apprenice-level and a doula, but here is my opinion for what it is worth: I would try changing positions, having the mom position herself so the baby's head is on the lip, and if that doesn't work trying the opposite, if the mom feels pushy and the cervix is stretchy, she could try to gently push and see if it moves out of the way. But you want to be careful because this could make the cervix swell and make matters worse. If nothing is working I have seen midwives hold a lip back for a few contractions until the head moves down.

At what point in labor are you talking about? It is not unusual to leave for a break if the mama is in early labor and taking her time, handling things well, and doesn't need you there. But in transition or far along or wants the midwife there, regardless of how much progress, you stay. Was this a particular birth that this happened?
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Old 06-22-2002, 12:50 AM
 
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not a professional opinion, but the situation you describe is exactly what happened to me.
I was at 10 + a lip for about 5 hours when my medwife and the (s)OB on call decided that this was all a sign that my baby was too big to come out and it was time for a c-sec.
of course, the cervical lip got very swollen bc she pushed me to push before I felt an urge -- and she did WANT to hold it back but I told her something to the extent of, "if you touch me there I will kick you SO HARD in the face".

I'm curious to see what others would do.
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Old 06-25-2002, 08:12 PM
 
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indiegirl what happened? Can you share?
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Old 06-26-2002, 09:42 PM
 
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At our practice we (the midwives--not me, I'm the nurse!) have held up the lip, if mom has the urge to push, and if the lip is stretchy. Or we have guided mom's fingers to the lip and had her hold it up, if she can reach it.

It is not uncommon to have this problem, especially if there has been some sort of cervical trauma--surgery/biopsy, etc--and there are adhesions/scar tissue holding the cervix back. I don't think that someone is a medwife or is meddlling, to hold a cervical lip out of the way if there is an indication for it. Just mho, though.

Position change, GETTING IN THE WATER, relaxation and massage (of mom, not of the cervix or the perineum), food and drink, getting to the bathroom to void, encouragement, visualization, talking to the baby, mom feeling safe surrounded by supportive people, pushing how and when mom feels like it, all of these things are indicated for a persistent cervical lip that won't budge.

Any other ideas out there?

Oh, I don't think a mom should ever be left, extenuating circumstances aside. If you need to take a break, someone else needs to be there for mom, even if they are just sitting in the corner out of the way. Most doulas I know work in pairs, so that if it becomes too intense, or too long, they can trade off and someone can get a break. Unless, of course, mom tells everyone to get the hell out; then it is okay to leave!
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Old 06-27-2002, 12:15 AM
 
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My midwife held up my bit of lip for a couple contractions while I pushed the head through enough that his head was holding it and then he slipped out pretty easily. She didn't wait very long-probably only 10-12 contractions be fore she held it back. It hurt like he-- but then it was over.
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Old 06-27-2002, 11:54 PM
 
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My midwife held back a lip for me so i could push and it was enough to get it out of the way. It still took a long time to push him out, but at least the lip was gone. I think most people do that, or at least attempt it, I could be wrong on that, but it seems somewhat common.
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Old 07-02-2002, 07:38 PM
 
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Old 07-03-2002, 12:43 AM
 
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My midwife held a lip out of the way when I pushed. Like the others it really hurt, but I'd been fighting an urge to push for four hours, so I was glad to have it out of the way so I could push like heck and get my baby born. I've also held many a lip back myself, if the mom is okay with it. It all depends on how it feels. If it's really tight, I don't keep it up and try some position changes like knees to chest, so she's laying with her bum up in the air like a baby sleeping. If it slips past easily and she's willing to put up with the pain, I go ahead, usually they are agreeable so the baby will come, and most of 'em have epidurals so they really don't care.

I don't understand the part about leaving the mom. I can't imagine a good care provider leaving a woman at that point. There must have been extenuating circumstances, but even then. . .

SMC to Sophia, age 15, and Eleanor, age 9, and mother hen to too many nursing students to count!

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Old 07-05-2002, 10:59 PM
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I'm a midwife and I find that persistent cervical lips are usually because of malpositioning of the head. It just isn't coming down straight, or it's occiput posterior. If you can correct the malposition, the lip will go away. I have pushed back cervixes alot of times. If someone wants to push with a cervical lip, I let them go ahead. If after a while, it's getting swollen, then I will ask them to wait. I have also on a very rare occasion asked a lady (5th or 6th baby) to go ahead and push with a cervical lip which was very soft and stretchy but stayed for a long time. The baby delivered right through the (visible)cervix. Technically, she never was completely dilated! I just went with my intuition that said this cervix was stretchy enough to push through. But if the cervix is very tight or very swollen, its best to leave it alone.
Does a persistent anterior lip indicate the baby is too big for the pelvis? Maybe, if the head is very high and doesn't descend. But if the head is low, it's already halfway through the pelvis. More likely it's a malposition, which is also a problem, but usually correctable.
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