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Discussion Starter · #1 ·
Had an interesting birth Thurs. First time mom, 41 wks 6 days, induced by cervidil (which is probably a debate in and of itself.) Mom did beautifully coping with her labor, and developed a strong urge to push. To my surprise, she was only 5 cms dilated on exam, and the cervix was very posterior. Very experienced nurse was taking care of her, and encouraged her to try all sorts of positions, and do little grunty pushes if she couldn't hold back. Mom does this for a couple hours, with urge to push getting stronger and stronger. She eventually got very "transitiony", threw up a few times, etc. She sat on the toilet for most of this part of labor, and pushed off and on.
Finally, she crawled back into bed and asked to be checked again. She is 9 cms, and the anterior part of the cervix is what I would call "fluffy," perhaps someone else would say swollen. For a little while, her contractions spaced out a little, and she slept between them, but would wake up pushing. Contractions picked up again, and she started to push hard with them (we weren't coaching her at all, and she was pushing for 3-5 seconds at a time, mostly with the peak of contractions.) The baby started descending around that time. That fluffy cervical lip was still there, but mom could not hold back any longer. After an hour of pushing, it was still there. Mom squatted and pushed for a little while, then flipped to hands and knees until her legs were too tired. She hated side lying with a passion, and at this point was tired enough that she just wanted to be semi-sitting with support for her legs. Head was low, now (+2 station or more) but that lip was still over it. With her permission, after an hour and a half or more of pushing, I pushed the lip back over the baby's head while she pushed through one contraction. Baby then surged down to the perineum, and he was finally born about 3 contractions later. Baby emerged ROA, if that makes any difference.
Why would someone have such a strong urge to push so long before the baby was born? When the urge started, it was about 4 hours before she was even 9 cms. And if someone has such a strong urge, do you just have them go for it? I almost never see someone have a cervical lip, and certainly not one that persists for so long when the mom has such a strong urge to push and pushes so naturally (mostly because I don't usually do exams - this mama requested to know where the baby was a lot, plus felt she pushed better with some downward pressure, so that's why I know the lip stayed until the very end) I don't generally believe trying to reduce a cervical lip helps anything either, but pushing that lip back definitely made a huge difference this time.
Anyone have such a situation?
 

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Was her pelvis broad and shallow (like a dinner soup bowl?) I've seen a couple of these and they all seem to have this broad shallow pelvis that allows the baby to come down far enough to trigger the urge to push way too early, and also allows for some wierd/nasty malpresentations (thus the posterior cervix) If she hated side lying, that's probably the position she needed to be in to make it go away and to get the baby to be in a good position...sigh.
 

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I just had a client with almost this exact same scenario, minus the induction. She was about 7 when she started feeling pushy and was nine with the "lip" when the pushing urge became overwhelming. She ended up getting an epidural and they used the vaccuum to help birth the baby. I can't help but think that if the doctor had just tried to push back that lip things would have went differently. This was a VBAC, so there were a lot of emotional things going on as well, but she definitely needed to push and the baby was still really high...-1.

With my apprenticeship, the midwife I work with often pushes back "lips" and it is usually also described to me as being a very posterior cervix. This is usually in circumstances when mom is feeling so tired and/or defeated. I don't know how I feel about it though...is it good, neccessary? But then with this client at the hospital, I just kept thinking..."push back that lip...push back that lip."
 

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It happened to me!! HB 12 hours of pushing contractoins at 6 cm...we tried pushing the lip back bny hour 12 I had swollen back to 4 cm. They (my MWs) were worried about me and decided I had to transfer. All the interventions at the hospital proceeded as usual and I ended up with an "emergency" C section for supposed decells with IFM.

Can ya tell I'm bitter???
 

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I usually don't think "push back the lip" but rather "how can we help the baby be in a better position so the lip goes away"

I'll hold a lip in a pinch, but I'd sure rather have a baby in a good position instead. Often putting a little pressure on the bones of the head with a mom in a knee/chest position will make it happen. A couple of clients babies that I helped this way had caputs on places on their heads after they came out that showed why they were 'stuck' because they were so acynclitic that the caput was behind the ear. Both of these babies birthed within 20minutes of repositioning (after the moms being 'stuck' at 7-9cm for hours and hours hurting in that non-productive way before deciding something needing 'doing')
 

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midwifetx said:
I usually don't think "push back the lip" but rather "how can we help the baby be in a better position so the lip goes away"

QUOTE]

Ok...how big of a deal is a lip, anyway? I've heard of all the stories about if you push with a lip you'll cause all this swelling.
well, what if you're trying not to do VE's? How do you even know there is a lip? I wonder how many women have had a lip, never been checked, and just pushed past it?

And, can someone give me some instances when VE's are really warrented? It seems like they're mostly done to satisfy our curiosity on how fast the woman is progressing. Do you use them just to confirm presentation and position? To help determine if they're asynclitic? If you're typically hands off, in what cases do you feel its necessary to do a VE?

Thanks for the info!
 

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With my second child I had an issue like this. I was 9 cm for a couple of hours with no urge to push. My midwife said I just had a little lip left and had me try to push through it but pushing didn't feel right. I ended up waiting and finally pushing with no real urge. Babe was born 10 minutes after starting to push but was originally anterior and rotated to posterior. I definitely think there was some sort of bad positioning at work given my lack or the urge to push which was overwhelming with my first baby. His head was actually perfectly round so there was no indicator there.
 

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Discussion Starter · #10 ·
Funny that this got resurrected so long after!
Anyway, I'll still not sure what the deal was with this mama, but I suspect it had to do with the position of the baby's head - also, she kept wanting to be checked for progress, so I had lots of opportunity to wonder about that lip. I do wonder if the baby wouldn't have been born shortly anyway, no matter what I did. I do think there must have been some slight positional thing with the babe that gave her such a strong urge to push when the baby was still relatively high and the cervix not very dilated.
These days I do even fewer cervical exams, so I haven't really seen a cervical lip since.
My criteria for doing an exam are if a mama requests one (which happens now and again when a mom has been pushing for a while and just wants to know "where the baby is") or if mom has been pushing for a while and there are no signs of descent (heart tones getting lower, perineum bulging, stool being pushed out, mom feeling the head descend, etc.) to see if there is something positional going on, or if we need to consider operative delivery. The other reason for an exam would be serious fetal distress and the need for quick birth if possible, to see if it's possible the babe will be out soon, or if an operative vaginal birth or a cesarean birth will be needed (this is fortunately very rare, but I did have a mom abrupt on me while pushing last year. She had risk factors, having pre-existing hypertension with superimposed pre-eclampsia and having been induced. While she was pushing in a full squat there was suddenly tons of fresh blood all over the place and the baby's heart rate fell into the 60s and did not recover. A quick exam showed the baby to be very low and a she had a quick vacuum assist to bring baby to crowning, then her dh caught the baby as he had planned. The placenta and a lot of clots and more fresh blood actually slid right out with the baby - very scary - but I'm guessing I'm not likely to see something like that ever again, so it can't be a very common reason for needing to do an exam!)
Otherwise, I don't do any exams during second stage, so if a lip is there, I wouldn't know about it. I suspect a lot of women naturally push with a lip, and that this is normal and babe is just pushed past it. I also suspect a lot of women spend some time at the end of labor without an urge to push with a lip or rim of cervix present, and when it finally goes on it's own, then they push. I think if you do a lot of exams you end up either coaxing the group that doesn't want to push into pushing prematurely, or trying to discourage the group who have an urge to push to wait unnecessarily. I don't think in general lips are any kind of issue, and I'm happier not looking for them.
 

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I wish I had not asked for so many exams during 2nd stage. I was in prodromal labor for approx. 48 hours (reg. contrax which would get closer together and then space out again for a few hours), then in active labor for around 5 hours before I got to 7 cm. It was all back labor. When I got to 7 cm I started having this extreme urge to push. I felt that I should resist it because I was only 7 cm...I asked for another exam to make sure. My doula also thought I should not push. I spent the next few hours trying as hard as I could not to push and getting checked as frequently as I could (the doctor was kind of hard to find and I think she was reluctant to keep telling me that I was *still* at 7 cm because I was getting discouraged). 7 cm, 7 cm, 7 cm. Not a bit of dilation for the next few (increasingly agonizing) hours. Finally I got the epidural because I had been at 7 cm for 8 hours and the mention of Pitocin came up...and I myself was starting to believe that I would *never* dilate unless something took away this urge to push. I was using ALL of my energy to resist it and somehow that was interfering with the dilation, was my thought.

So I got the epidural and I did start slowly dilating...about 4 hours later I was at 10 and quickly pushed out dd.

I really wonder if I had not had any checks and had just gone with what I felt my body doing, if I would have actually had her much sooner and avoided the epi. But I was so afraid of swelling my cervix! I am inclined to agree with midwifetx that it was a positioning issue...dd came out normally positioned but it was clear from my back labor that something was not quite right about the position she was in for most of labor. I tried everything my doula and I could think of but maybe I could have rotated her somehow...I also wish that someone had been willing to "push back the lip" so that I would not have had to get an epidural.
 

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Okay...so what I'm getting from this is that:

I went through 12 hours of forcing myself not to push unnecessarily.

I was transfered to the hospital unnecessarily when she should have already been born.

I was tortured and sexually assaulted by the hospital staff unnecessarily.

They surgically removed my child from me unnecessarily.

My child was in NICU and not allowed to breast feed for a week unnecessarily.

We spent months struggling to try to breastfeed because of the NICU experience unnecessarily.

At 2.25 years out I am still really angry unnecessarily.

and I still don't feel bonded to my child unnecessarily.

Do I have this right?

I should have just pushed when I felt like it and would have given birth to my daughter at home on my own 12 hours before they ripped her out of me and pretty much screwed up my life???

Sorry...Just venting really...I just read through this thread again and found myself in a fetal position under the table bawling my eyes out with the discovery that everything I felt was right, because everything that happened to me was wrong.
 
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