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-   -   what do you do for a cervical lip? (http://www.mothering.com/forum/228-birth-professionals-archive/556461-what-do-you-do-cervical-lip.html)

woodstar 11-10-2006 10:04 AM

hi..i am curious about cervical lips. is it effective to 'push through it', or do you use positioning methods to get past this last lip to completion?

in both of my labors, i was 9 cm dilated with a stubborn lip that eventually got 'pushed out of the way' by my care provider. my first birth eventually ended in a c-section after hours of pushing in the hospital. my second ended in a vaginal birth at home after hours of pushing. it seems that both babies were ascynclitic (sp?), as they had a little knot on the side of their heads. is this what caused the lip, or are cervical lips pretty common? will i most likely have this with another birth?

homemademomma 11-10-2006 10:29 AM

nak- did you feel an urge to push when you had a lip? if so listening to that urge would allow you to push past it. if no urge to push, then i would just wait it out, except in rare cases where mom is exhausted and really wants to be done. really though i probably wouldnt even know if you had a lip because i wouldnt have checked. oh yea position is important, i would try to encourage baby into a better position if he/she was op or async.- knee chest, walking stairs, etc etc etc

Marilyn82 11-10-2006 01:55 PM

In my understanding, uneven application of the baby's head on the cervix can cause cervical lips and the first thing I would suggest (as a doula, not a mw here) is to put one foot up on a chair (on the side of the lip if you know it) and lean into that leg during a cx. Not comfortable, but effective. That being said, listen to your body on things like this and practice good positioning techniques before the birth. I think women tend to wait for their care provider to tell them what to do, instead of listening to herself. I don't think that you will necessarily have the same probem this time, but it's good to be prepared!

sapphire_chan 11-10-2006 02:01 PM

If the pattern of labor was disrupted, I think most midwives and doulas would suggest moving around and laboring in different positions. That would help position the baby better and would resolve the cervical lip.

If pushing is done according to the body's signals, I don't think it's even necessary to check for a cervical lip, is it?

pamamidwife 11-10-2006 02:59 PM

I would say the asynclitism caused the lip. True cervical lips are rare, aside from malpresentations - they usually only occur when someone is constantly "checking" to see if mom is complete.

riomidwife 11-10-2006 04:37 PM

[QUOTE=woodstar;6498725]
in both of my labors, i was 9 cm dilated with a stubborn lip that eventually got 'pushed out of the way' by my care provider.QUOTE]

woodstar, I empathize with the lip! I agree you are more likely to encounter lips the more checking you do, but sometimes they are there regardless. And sometimes you have to decide to either wait it out or try to push on through it. I have seen some pretty stubborn lips, two clients in particular stand out, one was 5 hours, one 7 hours. I've heard arnica applied cervically can help with the lip itself and associated swelling though it hasn't worked for me.

babycatcher01 11-10-2006 09:16 PM

We have very few lips but if we get a swollen one that just isnt going to go, with mom moving around, as odd as this sounds we have mom relax, take a steril glove in one of the fingers we put an ice cube and apply it to the lip and leave it there for a few mins, an poof no more lip, works every time.

Charmie981 11-10-2006 10:20 PM

Lobellia tincture given orally has worked for me.

Another midwife I know swears by clary sage oil directly on the cervix. She said it melted under her hands when she applied it.

nurnur 11-11-2006 01:31 AM

All I can say is that the worst part of my entire labor and what almost drove me over the edge was the mw manually trying to push the lip back and having me lay on the side that the lip was on. It was very traumatic and I wanted to get the hell up. After the birth when I was doing processing I aksed her over and over "If you would have just left it alone would it have eventually dilated itself?" and she had to admit that yes it would have and she should have left me alone. This is so the trail of one intervention leading to another, first you check her, then you find the "LIP", then the ???? seems to be so what do we DO about it. Slippery slope. Just my 2 cents!

doctorjen 11-11-2006 02:31 AM

I don't see many lips, because I don't do many exams. I do agree that unusual positioning often causes them, though. Doing what you can to encourage optimal fetal positioning is the best way to avoid a cervical lip - but really the problem isn't the cervical lip, it's the poor positioning. I don't believe cervical lips hold up babies that could other wise be born, but that babies that aren't well positioned don't dilate the cervix all the way sometimes. Therefore, I don't think techniques that "get rid of the lip" are what helps, but things that adjust the baby's position are what helps. Usually, these moms are not having a good, consistent urge to push, although they may be feeling sort of pushy off and on, but more like they could take or leave it. So when an exam is done in late labor, usually because we are wondering where is the baby already, and a cervical lip is found, I usually try to see if we can get mom moving around, getting herself hydrated or refueled, and see what will make her more comfortable. I've had good luck with sticking mamas in the tub for a while - perhaps the buoyancy floats the baby into a different position. I've had 2 women who had long-term cervical lips eventually go to cesarean, though. One with an OP star-gazing baby, and one with a deep transverse arrest that was also assynclitic. Those uneven heads just couldn't dilate the cervix fully, and then just couldn't fit out.
If the mom is having a good urge to push, though, we just push, and I've usually seen the baby just come out - generally, I would not even find the cervical lip then, because a woman obviously pushing spontaneously to me doesn't need a cervical exam. I know these lips exist, though, because sometimes my nurses will have checked the client, and I used to always do an exam prior to pushing and found lots of these lips that seemed to need some "treatment."

Mama K 11-11-2006 12:07 PM

Not a birth professional, but I found the thread interesting, anyway. With my second, I was stuck at a 9 for nearly 2 hours. Dr. said I had a cervical lip and had me lay on my side, and pretty soon after that I was complete.

It was MISERABLE being in transition for sooooo long. I did birth DD naturally, but was really wanting an epidural after sitting at a 9 for so very long.

Mama K 11-11-2006 12:08 PM

Oh -- forgot to add my dr. said that DD's head was off to the side, and that's what caused the cervical lip. And that's why she had me lay on my side, to get DD's head moved over.

kenyarena 11-11-2006 01:05 PM

My MW also "pushed" the lip out of the way. I was not totally coherent as to what was going on. She was telling me something to the effect that if she could move the lip I would have an easier time pushing the baby out. I can't remember the reaction from my doula. All I know is that was BY FAR the most painful part of my birth experience.

I will definitely want to know my options in case it occurs again. My MW wasn't examining often though (I couldn't stay still long enough!), so I'm not sure when she saw it. Is it possible when I was pushing? I don't know. I just never want to feel that pain again. It really sticks out like a sore thumb memory. Besides that, it was a beautiful experience...and I had wonderful support from MW, doula and loving DH

riomidwife 11-11-2006 02:22 PM

Quote:
Originally Posted by doctorjen View Post
I don't believe cervical lips hold up babies that could other wise be born, but that babies that aren't well positioned don't dilate the cervix all the way sometimes. Therefore, I don't think techniques that "get rid of the lip" are what helps, but things that adjust the baby's position are what helps.
I think sometimes the lip itself can keep baby from coming down. If a lip is discovered I discuss with mom all the possible options from waiting, moving, manually reducing, etc. Sometimes a multip mom will want to just go ahead and have us try to reduce it so that she can push the baby out already, and in these cases often when you can push the lip back baby just plops on down.

doctorjen 11-11-2006 04:36 PM

Yes, but often in those multip moms if they just go ahead and push the baby comes right down, no lip pushing needed. Try it.

WendyC 11-11-2006 04:49 PM

So, my 'lip' was a regression in dilation from nearly complete to 4 with a long swollen protruding cervical thing that the midwife almost mistook for an arm. She described it as a long arm of cervix. When we transfered 2-3 hours later, the L&D nurse thought it was the head at first.

There was misalignment - and heavy, heavy, heavy involuntary full on pushing.

So, I guess I didn't have a textbook case of a lip - but a weird variation that no one knew what to do with. They were all nervous that I would shear off my cervix.

I did everything I could last time to get her in a good position, but I think this time if my intuition tells me that the baby is in there funky, I will just knee-chest it and get in some water. This thread is a good resource for me though.

jengacnm 11-12-2006 06:56 AM

I'm so grateful to share my timely experience. Earlier today I helped a woman have her baby boy who had a persistent lip.

After laboring in every position possible and remaining 7 cms for four hours at home, she said in no uncertain terms that she'd had enough and wanted pain medicine. Attempt #1 to push the lip back-I thought it may have worked if she'd been willing to let me work it back, but it was going to require more manipulation than I thought was fair when she'd clearly said she wanted to go to the hospital for pain medicine.

So we did, first iv medication and then an epidural. My consulting doc recommended starting pitocin, which we did, but it ended up staying at the lowest dose. The last three hours was spent "laboring the baby down"-she could have pushed, but I wanted to wait for her to feel something first. At the end, she pushed for less than 30 minutes. And I could "see" how the baby was malpositioned when I saw the caput pattern on his little head.

Incidentally, this was her second baby, so I would NEVER have anticipated this.

Time from 7 cms to birth-14 hours. She's my she-ro. :-)

I'll definitely remember her labor and birth as an example of sensible use of medical technology. Not to mention how FAB she was.

Jennifer

pamamidwife 11-12-2006 07:48 PM

Being 7cm isn't, in my opinion, the same as having an anterior lip.

I still stand by my belief that anterior lips are normal and go away - it's the constant expectation by providers and always checking that make them "persistent".

Aside from malpresentations, I don't believe they're an issue at all.

Jane 11-12-2006 11:17 PM

Well, I usually only find a lip when a mom is insistant on having her baby "now" and thinks there is something holding it up and requests a vaginal exam. With that in mind, I will offer to reduce the lip if I think it might go. I will hold a lip while the mom pushes really hard. If she's not feeling like pushing yet, then I won't reduce the lip (unless the baby needs to be born quickly).
My first choice is to keep her moving. Sometimes a position change so the lip is down and gravity brings the baby's head onto the lip makes it go away, sometimes it's flipping off the lip that helps. But you don't need vaginal exames to tell you to try a new position if the mom is pushing and the baby isn't coming down, no?

KestrelDream 11-14-2006 12:27 PM

I had issues with my cervix last time. About 12 hours into my labor, my back would KILL during a contraction. My MW checked me & found that I was a 4 but still posterior. She wanted to pull my cervix forward. It was hell. After another 12 hours, I had enough & transported to the hospital. The OB on call said baby was posterior, MW didn't agree. I got some pain meds, still really hoping for a VBAC. I got to 9 cm (without someone pulling on my cervix) but there was still a lip. I ended up being cut again. My OR report said baby was LOT, but maybe there was some asynclitism...who knows.

So, is malpositions the only cause for a stubborn posterior cervix??

I'm currently in the 2WW, & I want things to be different next time.

jlpetitte 11-14-2006 04:06 PM

Quote:
they usually only occur when someone is constantly "checking" to see if mom is complete.
pamamidwife~

mwherbs 11-14-2006 04:53 PM

Quote:
Originally Posted by pamamidwife View Post
Being 7cm isn't, in my opinion, the same as having an anterior lip.

I still stand by my belief that anterior lips are normal and go away - it's the constant expectation by providers and always checking that make them "persistent".

Aside from malpresentations, I don't believe they're an issue at all.
I agree with this completely agree-- something that we do to measure a cervix at about 6-7 cm or so you measure what is left of the cervix instead of on the inside to see how wide it is stretched. and the last bit you feel is how much cervix is in front - if it has vanished then a woman is complete- if it is there she is 9 or 9.5 --

malpresentations feel like a sleeve to me way sooner than near complete- you feel that the head is not well applied if you aren't able to feel the sutures well the sleeve should give you a clue and moms often want to push and she should give it a try- painful then not something she should do. sometimes we have mom lay in different positions or walk briskly - lunges or stair climbing .


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