childbirth with no cervix? - Mothering Forums

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Old 03-27-2008, 01:16 AM - Thread Starter
 
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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?

Kristen - doula and birth educator, wife to Ben and mama to Sydney Mu (8/06) and Cal Edward (7/09) :
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Old 03-27-2008, 09:26 PM
 
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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.

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Old 03-27-2008, 09:34 PM
 
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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.
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Old 03-27-2008, 11:23 PM
 
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I'm curious too

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Old 03-27-2008, 11:31 PM
 
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Old 03-28-2008, 12:00 AM
 
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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.
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Old 03-28-2008, 12:29 AM - Thread Starter
 
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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!

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Old 03-28-2008, 12:46 AM
 
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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.

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Old 03-28-2008, 12:56 AM
 
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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.

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Old 03-28-2008, 01:09 AM - Thread Starter
 
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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!

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Old 03-28-2008, 01:15 AM
 
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if it's okay, can you let us know? I'm curious to learn about this.

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Old 03-28-2008, 02:01 AM - Thread Starter
 
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if it's okay, can you let us know? I'm curious to learn about this.
Certainly!

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Old 03-28-2008, 02:04 AM
 
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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.

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Old 03-28-2008, 02:14 AM
 
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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.

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Old 03-28-2008, 05:27 PM
 
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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.
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Old 03-28-2008, 06:27 PM
 
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Can you go with her to her next appointment?

Jenny: 40 Something AP mom to 2 adult kids, 2 teen step kids, and one amazing 7YO. Doula and Brio Birth educator, too!
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Old 03-28-2008, 06:52 PM
 
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Not to be gross, but I'd really like to see what it looks like.
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Old 03-28-2008, 11:54 PM
 
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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?
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Old 03-29-2008, 12:34 AM - Thread Starter
 
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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.

Kristen - doula and birth educator, wife to Ben and mama to Sydney Mu (8/06) and Cal Edward (7/09) :
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Old 03-29-2008, 01:18 AM
 
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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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Old 03-29-2008, 04:54 AM
 
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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.

they removed the wrong side of her cervix!?!?!?!!?!??
is she getting compensated? I'm speechless.

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Old 03-30-2008, 10:16 PM
 
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Wow, I can't believe they removed the wrong side!! But how in the world did they eventually realize the error?
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Old 03-30-2008, 11:07 PM - Thread Starter
 
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I hope she's being compensated too, but I'm not really comfortable asking her!

I really don't know how they discovered it was the wrong side - either during the surgery or at a follow-up appointment, I assume.

She still hasn't started labor yet, but she has been having a lot of pre-labor/bh contx.

I've noticed that EPO is used to soften the cervix...anyone have any idea on how it might work for scar tissue?

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Old 03-31-2008, 01:10 AM
 
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They removed the wrong side!?

The last birth I was at...she had some scar tissue that was keeping her from progressing for a bit during labor. We had her taking Evening Primrose orally and also applying it on her cervix each night (I believe it was started at about 35 or 37 weeks).
At one point during her labor we discussed massaging it to encourage the scar tissue to break up...but at that point her body and EPO had a great deal of breaking it up, we just waited it out and within 50 mins she progressed from a 5 cm to having a baby in her arms.

Sooo....I would def. suggest EPO to her...if it doesn't help...it at least wouldn't do any harm.
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Old 03-31-2008, 10:03 PM
 
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Here's my guess (and of course no one can really know without looking at medical record!) of what really happened. I think this mom is confused about the procedures she had. In a woman who wishes to keep her fertility and has localized cervical cancer, a cone biopsy (kind of a of misnomer since a large chunk of cervix removed, not really a biopsy) can be performed. If you think of the cervix as the neck of the uterus, basically they remove the outer portion of the cervix in a cone shape, so a deeper, but narrower piece of the internal cervix is removed and a wider, shallower piece of the outer cervix. I've never heard of a procedure that removes "half" of the cervix, nor would removing half preserve cervical function. I'm guessing perhaps her margins still showed cancer or dysplasia and a second cone was then done, deeper than the first. The non-pregnant cervix is 4-5 cms long, and a cone specimen is usually like 2-3 cms long from the narrowest part to the outside, leaving some cervix behind. Frequently women who have had a previous cone biopsy have a cerclage in pregnancy (a stitch to hold the cervix shut) as they are at higher risk of earlier cervical incompetence. This is removed at 36-37 weeks, and many women labor fairly soon after - but many don't and go into labor on their own weeks later. I have seen women with previous cervical procedures have issues with scar tissue, though. Often, these women efface fully but don't dilate well, and sometimes you can manually break up the scar and that helps. The most amazing case of that I saw was a woman who was obviously in hard labor, but not dilating, and the doc used his finger to break some small adhesions he could feel stretching across her 1 cm dilated cervix that was 100% effaced. Immediately, she was 9 cms! She birthed her baby not long after.
Anyway, it is unlikely this woman has *no* cervix as there likely would be no way to retain a pregnancy and removing the whole cervix basically would mean taking off the whole bottom part of the uterus. Most likely she had a cone and has a shortened cervix and had the stitch to help her make it to term.
Here is a fairly good picture of a cone biopsy (note I did not read the accompanying text so I don't know if it's any good - I was just looking for a picture!)
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Old 03-31-2008, 10:20 PM
 
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thanks so much doctorjen!!!

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Old 03-31-2008, 11:35 PM
 
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great picture link drjen, thanks!
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Old 04-01-2008, 08:51 AM - Thread Starter
 
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Thank you drjen! That was a great explanation. That's why I came here - I knew someone would clear things up for me!

I don't wanna go around spreading misinformation, but I could only explain based on what my friend told me! Maybe she's just used to "dumbing" it down for people and didn't bother explaining the whole thing to me.

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Old 04-01-2008, 08:58 AM
 
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she could have had lesions on the outside of her cervix removed and they removed the wrong part on the outside (err..well as outside as a cervix can get. you kwim, the part in the vagina) then redid it and left her with a very thin one...
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Old 04-01-2008, 10:58 AM
 
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don't shoot me, but I now have this image of Elaine, from Seinfeld, in one episode where she steals a sliver off a slice of cake. only then it's uneven, so she has to keep cutting more and more of the cake so it doesn't look like it's been nibbled at.
in the end she ate the whole thing.

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