Here is a scenario I keep hearing over and over: A woman is labouring away and all is good. She begins to push with contractions, and her midwife encourages her to follow her body. After a little while the midwife checks to ‘see what is happening’ and finds an anterior cervical lip. The woman is told to stop pushing because she is not fully dilated and will damage herself. Her body is lying to her – she is not ready to push. The woman becomes confused and frightened. She is unable to stop pushing and fights her body creating more pain. Because she is unable to stop pushing she may be told to have an epidural. An epidural is inserted along with all the accompanying machines and monitoring. Later, another vaginal examination finds that the cervix has fully dilated and directed pushing begins. The end of the story is usually an instrumental birth (ventouse or forceps) for an epidural related problem – directed pushing = fetal distress; ‘failure to progress’; baby mal-positioned due to supine position and reduced pelvic tone. The message the woman takes from her birth is that her body failed her, when in fact it was the midwife/system that failed her. Before anyone gets defensive – I am not pointing fingers or blaming individuals, because I have been that midwife. Like most midwives I was taught that women must not push until the cervix has fully dilated. This post is an attempt to prompt some re-thinking about this issue, or rather this non-issue.
Anatomy and Physiology
Birth is an extremely complex physiological process but very simplistically 3 main things occur:
- Dilatation of the cervix
- Rotation of the baby through the pelvis
- Descent of the baby through the pelvis
But this is not a step-by-step process – it’s all happening at the same time, and at different rates. So whilst the cervix is dilating the baby is also rotating and descending.
1. Dilatation of the cervix
The cervix does not open as depicted in obstetric dilatation models ie. in a nice neat circle (Sutton 2001). It opens from the back to the front like an ellipse. The os (opening) is found tucked at the back of the vagina in early labour and opens forward. At some point in labour almost every woman will have an anterior lip because this is the last part of the cervix to be pulled up over the baby’s head. Whether this lip is detected depends on whether/when a vaginal examination is performed. A posterior lip is almost unheard of because this part of the cervix disappears first. Or rather it becomes difficult to reach with fingers first.
The cervix dilates because the muscle fibres in the fundus (top of the uterus) retract and shorten with contractions = pull it open (Coad 2005). This does not require the pressure of a presenting part ie. baby’s head or bottom (lets stick to heads for now). However, the head can influence the shape of the cervix as it dilates up around it. For example, a well flexed OA baby (see pic A) will create a neater, more circular cervix. An OP and/or deflexed baby (see pic B) will create a less even shape. For more about OA and OP positions see this post. Most baby’s will be somewhere between these two extremes whilst the cervix is opening and will be changing their position as they rotate.
2. Rotation
Babies enter the pelvis through the brim. As you can see from the pictures above this is easier with their head in a transverse position. As the baby descends into the cavity their head will be asynclitic – with the parietal bone/side of the head leading. This is because the angle of the pelvis requires the baby to enter at an angle – see picture on the right. Once in the cavity the baby has room to rotate into a good position for the outlet which is usually OA. Rotation is aided by the pelvic floor and often by pushing.
3. Descent - the urge to push
The urge to push… and I’m talking spontaneous, gutteral, unstoppable pushing… is triggered when the presenting part descends into the vagina and applies pressure to the rectum and pelvic floor. This is called the ‘Ferguson reflex’ – probably after some man. This reflex is not dependent on what the cervix is doing, but where and what the baby’s head is doing. So, if the baby’s head hits the right spot before the cervix has finished dilating the woman will spontaneously start pushing. An alternative but common scenario is when the cervix is fully open but the baby has not descended far enough to trigger pushing. Unfortunately some practitioners will tell the woman to push and create problems instead of waiting for descent and spontaneous pushing.
Pushing before full dilatation
Because we are not telling women when to push (are we?!) they will push when their body needs to. If we are directing pushing we risk working against the physiology of birth and creating problems (see previous post). Spontaneous pushing before full dilatation is a normal and physiologically helpful when:
- Baby’s head descends into the vagina before the cervix has dilated. In this case the additional downward pushing pressure assists the baby to move beyond the cervix whilst pulling the cervix out of the way.
- Baby is in an OP position and the hard prominent occiput (back of head) presses on the rectum. In an OA position this part of the head is against the symphysis pubis and the baby has to descend deeper before pressure on the rectum occurs from the front of the head. In the case of an OP position, pushing can assist rotation into an OA position.
I am yet to find any evidence that pushing on an unopened cervix will cause damage. I have been told many times that it will but have never actually seen it happen. I have encountered swollen oedematous cervixes – mostly in women with epidurals who are unable to move about. But, this occurs without any pushing. I can understand how directed, strong pushing could bruise a cervix. But I don’t see how a woman could damage herself by following her urges. In many ways the argument regarding pushing, or not is pointless because once the Ferguson reflex takes over it is beyond anyones control. You either let it happen or start commanding the women to do something she is unable to do ie. stop pushing.
Telling women to push or not to push is cultural not based on physiology or research. For example, in some parts of the world eg. Central Africa, women are told to push throughout their entire labour (on an unopened cervix!). This is often accompanied by their midwife manually stretching the cervix too – ouch. Alternatively in other parts of the world eg. the US women are told not to push until a prescribed point in labour. It seems midwives are bossy worldwide.
When left to get on with their birth, occasionally women will complain of pain associated with a cervical lip being ‘nipped’ between the baby’s head and their symphysis pubis during a pushing contraction. In this case the woman can be assisted to get into a position that will take the pressure off the cervical lip (eg. backward leaning). When undisturbed women will usually do this instinctively. At a recent waterbirth a mother (first baby) who had been spontaneously pushing for a while on all fours floated onto her back. A little while later she asked me to feel where the baby was (for her not me) – baby was not far away with a fat squishy anterior lip in front of the head. The mother also had a feel, then carried on pushing as before. Her daughter was born around 30 mins later.
Suggestions
Avoid vaginal examinations (VEs) in labour. What you don’t know (that there is a cervical lip) can’t hurt you or anyone else. VE’s are an unreliable method of assessing progress, and the timelines prescribed for labour are not evidence based (see this post).
Ignore pushing and don’t say the words ‘push’ or ‘pushing’ during a birth. Asking questions or giving directions interferes with the woman’s instincts. For example, asking ‘are you pushing’ can result in the women thinking… am I? Should I be? Shouldn’t I be? Thinking and worrying is counterproductive to oxytocin release and therefore birth. If she is pushing let her get on with it and shush. For more about pushing in general and a link to a great audio by Gloria Lemay see this post.
Do not tell the woman to stop pushing. If she is spontaneously pushing (and you have not coached her) she will be unable to stop. Pushing will help not hinder the birth. Telling her not to push is disempowering and implies her body is ‘wrong’. In addition, after fighting against her urge to push she may then find it difficult to follow her body and push when permitted to do so (Bergstrom 1997).
If a woman has been spontaneously pushing for a while with excessive pain (usually above the pubic bone) she may have a cervical lip which is being nipped against the symphysis pubis. There is no need to do a vaginal examination to confirm this unless she wants you to. If you suspect or know there may be a cervical lip:
- Reassure her that she has made fantastic progress and only has little way to go.
- Ask her to allow her body to do what it needs to, but not to force her pushing.
- Help her to get into a position that takes the pressure off the lip and feels most comfortable – usually a reclining position.
- If the situation continues and is causing distress – during a contraction apply upward pressure (sustained and firm) just above the pubic bone in an attempt to ‘lift’ the cervix up.
- If the woman is requesting further assistance the cervical lip can be manually pushed over the baby’s head internally. This is extremely uncomfortable!
Note: This nipping situation is rare and usually a cervical lip will simply move out of the way without causing any problems.
Summary
An anterior cervical lip is a normal part of the birth process. It does not require management and is best left undetected. The complications associated with an cervical lip are caused by identifying it, and managing the situation as though it is a problem.
This post is also available in French
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I just love this post. I would love some opinions on a recent birth I attended where we had an unusual cervix, to say the least. Primip had a long, slow labor, 3 days in all, remarkable endurance, and a fantastic baby. When spontaneous grunting commenced, she found herself on the toilet. I offered warm perineal compresses, and she sunk into them as she worked with her urges. After 30-45 minutes or so, I touched her perineum with a bare (gloved) hand, to find bulging membranes, and an incredible, protruding cervical lip. Further exploration (with mom’s consent) revealed this 3 cm wide, 6-ish cm long, finger-like protrusion of the cervix, outside of her introitus. Mom found great relief with manipulating this cervix behind baby’s head, much to my surprise. We’d talked about options (doing nothing, positioning, AROM – but she SROM’ed a few minutes later, reduction. Leaned heavy on nothing; mom requested help.) The lip would slide back, but would not stay. She birthed a 9 lb 3 oz baby beautifully UNDER that protruding cervical lip! Any thoughts on different “management” choices? Am open to any opinions
I have heard about a similar protruding lip from a homebirth midwife friend. She described a finger like protrusion with a swollen satsuma sized bobble on the end. She massaged essential oils into and it eventually moved up out of the way. Women’s bodies are amazing and unique aren’t they! I have no idea how I’d deal with this situation until I was in it. What you did worked x
I have 6 kids, 1st hospital, then 5 home waterbirths! Had anterior cervical lip with all of my babies. The midwives held it back for me while I pushed baby past it, since pushing against it was causing it to swell… having it held, that was agony. Stopping pushing to wait for it to resolve was agony…Having a midwife loose the grip on it and let it slip during a contraction… AGONY!
With my 5th birth I discovered I could find it and hold it back myself!
I could feel/control what was going on and so it was much less painful.
That was awesome.
So.. you could instruct the mother how to hold it back herself.
Much more pleasant that way!
Hi :O)
I’m pregnant with my 3rd baby I have recently had many lightbulb moments when hearing info like this.
I was in labour 45 hours with my 2nd baby during an attempted, failed vbac.
Reading & going to hypnobirthing classes during this pregnancy, revising the stages of labour and in particular ‘transition’ bought back flash backs from my previous labour.
I was ‘stuck’ at 7 cm’s & toward the end I suddenly felt like I couldnt cope anymore, my contractions were on top of each other, I started bearing down, I felt my body ‘pushing’, I went from silence to making low groaning sounds. I was checked and still “only 7cm’s” I was over it and felt like I couldnt cope anymore, an epidural was suggested & I accepted (after planning very adamantly to have a drug free birth)
I was then told it was time for a cesarean as bubs head was deflexed.
So I’m curious! what do you think would have happened if i had followed my body and allowed myself to bear down?
Hindsight is a wonderful thing and not very helpful. I have no idea what would have happened if you had followed your body but it is sad that you were told to have a c-section and not told how wonderful you were instead. Let me know what happens with your 3rd
Hi Sarah, Don’t despair – you have a really good shot at third time lucky – I did! VBACs are so interesting because they challenge on emotional as well as physical levels. Sounds as though you were in transition and if you had been at home with me there would have been no VE to take away your self confidence. A deflexed head can be a royal pain but it can also be shifted by having Mum go “upside down” for a few contractions. I’d say your main problem was “caregiver fatigue” or perhaps hospital policy. Try to forget the “how-to’s” of Hypnobirthing etc. As long as you and baby are hanging in there, your labour can take as long as it needs to. I find VBAC labours often go really slowly over a period of time – both to ease the body into labour and to deal with the head stuff that inevitably comes up. If you can allow yourself to trust your body’s inate ability to birth, you’ll surely get the birth of your dreams. Do let us know! Love and best wishes for you next birth!
Thanks so much.
I’m feeling very positive about this birth thanks to hypnobirthing & the principals behind it :O)
That sounds a lot like my vbac – baby boy born December 22, 2010. This post is a very big lightbulb for me. I was “stuck” at 7-8cms as well and the midwife told me not to push or I was going to swell my cervix, even though I felt I needed to push a little bit. I also felt like I wasn’t coping anymore and got a little louder than I had been. We tranfered to the hospital (I was trying for a homebirth) and put on an epidural. The doctor told me 3x that she wanted to do a csection right away and get it over with. I milked every last option I had, up to getting pitocin in the end. I couldn’t give up after three days labor! Interesting enough both midwife and doctor told me I had 2 cm to go but the nurse who checked me, much older than both of them, said I had a “frill” which I’m taking as a small “lip”. I wish I knew all this before. I didn’t want the epidural and sure if my body was let to do what it was going to do, everything was going to be fine. It was also the same nurse that discovered he was posterior as well and told me “babies are born how babies are born”. She was definitely sent to me by God that day. My 9lb 2oz son was a vbac. I’m so proud of that!!!
I remember very clearly getting pissed off at my contractions, actually angry at my body for having contractions so painful, then getting up on my knees in the tub, saying to my husband, “I’m going to start pushing now,” 30 minutes later, that was that. Of course, he went and told the midwife who came in and goes, “Let me check your cervix to make sure this is the right thing to be doing.” She declared that it was 9 and stretchy and to go ahead, but even if she hadn’t done so, I would have kept doing it without her “permission”. Spent my life doubting my body, wasn’t about to do it at a critical moment in labor.
On the flip side, someone I took a birth class with told the story of her labor. After hours of pushing, the midwife found an inflammed cervical lip and had to transfer her to the hospital for an epidural to get relief. Although she said she felt the baby in her butt (pushing on the rectum), evidently there was no progression and she had to be sectioned. I’m not sure what to make of a situation like that.
I left a comment below about my birth, and then read your comment. I, too, had gotten as far in natural labor as feeling his head in my rectum (I feel like I’m going to poop a bowling ball). I kept saying, “One more push. I can feel that just one more and he’ll be out!” but he didn’t. I was transported to a hospital – after 6 hours – and sectioned. He had gone all the way back up by the time I got there.
I also had a lip, followed my body’s urges to push, was sure I was giving birth any second, but DS kept sliding back up after every push. Midwife tried pushing it up over his head, applied a lot of counter-pressure, and even reached in to try and help him rotate. After 4.5 hours of hard pushing, my labia were so swollen I could barely walk, and I was transferred for my surgery. Post-op I was told I had a swollen cervix and was even swollen on my internal organs. As a result, I am not sure how to process this article or my experience in light of one another.
Monica – is there any way you can talk to your midwife about what happened? There may have been something else going on that led to this outcome. Having said that – there will always be individual situations that are exceptions to the norm. The norm is that anterior lips are not a problem (as most of the comments here support). However, I am sure that on occasions they do cause a problem. But, they should be treated as normal until there are signs they are not… as in your case.
I had an anterior lip and uncontrollable pushing without any breaks, and I know for a fact I had a lot of swelling which prevented progress, I checked myself and midwife confirmed. We got past the lip (she held it back for me) but I still had swelling in the way, so I had my midwife apply arnica inside then I laid down flat to take the pressure off and as best I could I panted rather than pushed. 15 minutes later I couldn’t stop pushing again, I jumped up to kneeling, and DS2 flew out in moments. Swelling is occasionally a real concern, but it can be overcome.
WOW!! This is such a wonderful post. So full of great info and sound advice. It also crazy to me when providers get frustrated when a woman who is completely dilated has no urge to push and she is told “you are not pushing right” I am always like “LOOK!!! you do NOT have to tell an unmedicated pregnant/laboring mamma when/how to push. When her body is ready TRUST me she will push” Its crazy!!! The things we do/say in the name of birth!
Thank you again for your excellent post. This explains to me exactly why I had the urge to push that then went away 2.5 hours before I gave birth. Bubs was OP at my 41 week ante-natal check, but was born OA. And a big hooray for my middy who didnt both to check bubs position when I was in labour and never did any VE’s (not that I would have let anyway
I’m curious: what would you tell a woman (me) who does not ever feel the urge to push? My first was a homebirth transfer ending in c-section, but then I had two wonderful homebirths, both of which had 2 hour transition, cervical lip, and NO urge to push. With my middle child the baby was crowning and they had to tell me to push with the contractions because there was no urge!
At this point I am totally happy with the way my births went, but want to have at least one more child, preferably as easily as possible!
Thoughts?
I am so blessed by your story of having home births after your first ended in a transfer to a c-section! Brave and great testimony to others!
)
Hi Sara
Thoughts… Some women don’t experience an urge to push. Babies can be born without any pushing at all and women in comas have given birth. I have found a baby under the sheets when a mother had a dense epidural and was busy watching TV (not pushing). The uterus will continue to contract until the baby is expelled. It gets smaller and smaller and the baby gets pushed out. It takes longer than if the mother is assisting with pushing – but it still happens. You will probably find you have no urge with your next and last child too.
That’s amazing.
I learn something new everyday. That is amazing.
Oh – I find the idea of a mum too busy watching TV to notice she’s had her baby so sad. It’s amazing what the body can do on it’s own – but that is just heartbreaking to me.
I had no “URGE” to push with my last baby, my body did all of the pushing. My first birth was a c/s for breech, my second was breech twins who were born vbac in the hospital, where I had no urge, but was told after reaching 10cm that I had to push like mad and finally 4 hours later the first baby was born (my Ctrx were 7-10 mins apart I think from all the stress and people). Last baby was born at home with a midwife, who almost didn’t make it to the birth because I was laying on the bed dealing well with labour, stood up to get in the bath and the baby was just coming. NOW. We called the midwife who raced over while I was trying not to push, holding the baby in with my hand (we really didn’t want an unnassisted birth). She kept saying on the phone not to push but “I” was not pushing, my body was just doing it all on it’s own. I was doing nothing but every contraction she just moved down and no matter what I tried to do to stop it, I couldn’t. Although it was a little scary at the time, in hind-site I find it amazing that left completely alone to wander my house and labour the baby moved down and down, and then all of a sudden was ready to come out. After red in the face pushing with all my might with my twins, it is amazing to know that if we had been just left alone, they would have come out on their own and that my body would have done it all on its own. I think all of the micro-managing of birth just causes problems and if everyone was left alone, most babies would eventually come out with out the mother ever having to push push push.
“I think all of the micro-managing of birth just causes problems and if everyone was left alone, most babies would eventually come out with out the mother ever having to push push push.”
Absolutely!
My 2nd baby was 12 pounds at birth. I never forget pushing him out.It was a water home birth. Do you think being that big he would have been able to come out by himself, like described above?
Sara I had a very similar experience and was wondering the same after reading this.
First baby – labored at home most the time, arrived at hospital at 6-7cm and 80% effaced. Was in a tub quickly and asked to be checked about 2 hours later. 9cm with a lip. Threw up, then the midwife remarked “i’ll bet that lip is gone!” NEVER felt the urge to push. Water didn’t break until I was pushing and I had to ask on multiple occasions what to do because I felt SO LOST. It was the one part of my labor that totally threw me. I had always expected that urge and it never came.
When severe burning pain started in my upper thighs the pain was becoming unbearable and i begged to start pushing because i just wanted to be done. It was explained to me that the pain was because he was so low and just sitting there.
So I pushed. And had to be coached through the pushing because NOTHING felt natural or reflexive. There was NO INSTINCT (and i am bothered when i read over and over again that a woman will have this to guide her through – unassisted). I had maybe 3 pushing contractions and he was out. The first my water broke.
Amazing experience. But I would say that I really needed permission from my midwife to start pushing without my body’s prompt to do so.
There are always exceptions because we are all unique. Don’t worry that your body works differently and doesn’t tell you to push. As I have previously said – you don’t need to push to birth. Maybe next time you could own your experience by feeling when you baby’s head is crowning (with your fingers) and if you want to actually ‘push’ do so. Or cough, or laugh – it will have the same action. You don’t need anyone’s permission to do anything but if you are uncomfortable with the previous suggestion ask your midwife to guide you – that is what we are there for. To assist you in any way you choose – including giving directions if you want them. Some women do want guidance and that’s fine.
Thank you, thank you, thank you! I’ve had this in my last three labors and holding back or having it pushed behind the baby’s head is agonizing. Pushing past it was painless, though!
Very interesting and educational… it has been 16 years since my last child… even though he was my 6th child (home birth). I remember it so well, it was the most painful, but I never understood what “exactly” happened.
Thank you for your passion and mission for serving others!
Amy
Oh my goodness, this is so enlightening. I was a homebirth transport at 10cm due to some decels that our midwives felt were due to a cord prolapse.
I laid on the hospital table for over an hour while nurses yelled at me to not push and every test imaginable was conducted on me and my baby. That’s the only time when I was scared through the whole labor. I felt like my body was failing me. They were telling me not to push and yet that’s the only thing you can do. I started giving up, believing that I couldn’t birth this baby.
For the longest time I believed it was my fault, because I couldn’t labor “correctly”. I realize now that’s not the case. Thank you!
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What a wonderful post!
I am a birth doula, and have a question. A couple of years ago I had a 1st time mom. Laboured for 2 days at home, we went to early assessment twice during that time, and both times her labour completely stalled and we were sent home. Finally admitted. Laboured in every position we could think of. Baby was OP, we moved around a lot, trying to facilitate his turning. Mom chose AROM at 6-7cm because she was becoming exhausted and very fearful that she’d be unable to keep going much longer and still have any energy left (She’d had ctx 5mins apart or less for 36 hours, no sleep for 2 nights). Things got intense after AROM. She got to 8cm without pain meds, and then her body started pushing, involuntarily, it was the most intense, body-shaking pushing I have ever seen. She was scared, she couldn’t stop it, but she couldn’t contribute to it because she said it was ripping her apart. Her body was spasming all over the place. Doctor suggested epidural. She wanted a med-free birth, and declined. I suggested Nitronox in hopes that she it might help her to calm and not fight this urge. She used the gas for about an hour, with a LOT of support from her husband and I. She was then checked again and found to have a “grossly swollen” cervix, at 5cm dilation. OB suggested surgery. Mom said no way in hell, she wasn’t giving up yet. We chose an epidural in hopes that it might allow for rest and perhaps the cervix would calm down and dilate again later (and if not, well, c-sect was being pushed on her, so it was worth a shot). An hour later, she was found to be back at 8cm. We laboured as actively as possible- supported squats, supported lunges, anything to get baby to turn, he was still OP. Few hours later she was at 9 with an anterior lip. Over the next 12 hours, we tried everything we could in terms of position and movement. A doc tried pushing back/massaging against the lip, both with and without mom pushing. OBs got in there and tried to manually turn baby- he turned really easily, but would slip right back to OP as soon as they let go. Eventually, she got to 10. Was “allowed” to try pushing, but didn’t have an urge, couldn’t feel what was going on because of the epi. No progress, apparently baby was still quite high (?). She decided to get an epidural top-up and try to get a nap because she was so exhausted, and try pushing in an hour or two. After napping, she was checked again, and was found to be back at 8cm, and baby’s HR was up at 165-170. The OBs said they’d give her another hour if she wanted, but that they were recommending surgery, as baby was starting to show signs of distress (he’s been happy up until then). She decided that an hour wasn’t going to cut it- she’d been 8 cm or more now for something like 15 hours- she decided on surgery.
What do you think about this? I have since read about how the LEEP procedure can cause cervical scar tissue that can do strange things (she had this done several years before the birth). Although hindsight can be 20/20, I am not sure what we could have done differently- maybe AROM was not a good choice, considering his OP presentation. This mom is planning to become pregnant again and is hoping for a VBAC, but is fearful and I think she distrusts her body and her cervix (“what if mine just doesn’t open?”). Midwifery and homebirth are unavailable here, so she will be in hospital with OB care for her next birth. Aside from reviewing everything on ICAN, do you have any advise for this mother, or for me as her doula? We can try to minimize vaginal exams but we will be limited in this because she will be considered high risk, and this hospital is a tertiary care facility, and not very hands-off when it comes to birthing…
Thanks for any insight you have on this!
What a journey for you all! It sounds like you all worked extremely hard for this birth. Cervical scar tissue probably was the cause of the stop start, long ‘early labour’ phase. This is a common pattern for women with cervical scarring from previous procedures. It takes a while for the scar tissue to soften and release. For some reason 5cm seems to be a sticking point. However, once released the cervix usually dilates steadily. I think this poor mother had a combination of things going on (exhaustion, OP, cervical scarring, epidural, stress, etc) and once the baby showed signs of having enough (high heart rate) surgery was probably the best option.
The good new is that the scar tissue has been released and her cervix has opened so next time this shouldn’t cause a problem. Her main problem will be having the ‘high risk’ label and the emotional issues associated with her first birth. I’m sure you can support her through this. Let me know how she (and you) goes
Thanks so much for your reply. It is encouraging to hear that the scar tissue will likely no longer be an issue. I have suggested that when the time comes, both her and her partner might benefit from “Birthing from Within” classes, as I have heard that they really address fears and include more spiritual growth and transition into their mentorship. Thanks for such a womderful blog, I love to read it and often share with my doula mothers!
Thank you for this post! I’ve been carrying trauma from a birth I attended where mom had an anterior lip. Her Med-wife kept her from listening to her body for a little over an hour, then threatened hospital transfer for compromised oxygen. Sigh. I’m grateful for the way you articulated this, and will be using it in CBE and prenatals. Again, thank you.
I have pushed two babies out, one OP, at 9cm (or at least that’s where I was at my last examination), in less than half an hour. When my body is ready to get a baby out, there is nothing a doctor or nurse can say to stop that from happening. The MOST obnoxious thing I have been told with each of my four babies was “slow down,” or “stop pushing.” As if I had any real control over that at the time!
Great post, with interesting points. Could you address the situation when an anterior lip becomes swollen due to mom’s pushing, and instead of the cervix being thin and stretchy, it becomes thick and firm again, also reducing in size? (all this, supposedly because of pushing?). The few cases I’m thinking of were both epidural and non-epidural births. (And if memory serves me correctly, OP babies). One of the midwives I work with swear by using ice on a glove to reduced the swollen anterior lip – but waiting for that anterior lip to disappear before mom gets to push again.
Thoughts?
Anterior lips (and cervixes) become swollen with or without pushing. They rarely become thick and firm without other interventions going on ie. induction, syntocinon, epidural. If pushing created this the cultures that push all the way through labour would have died.
I have heard of the ice solution and every intervention has it’s place in an individual situation. I just haven’t encountered a cervical lip (even a fat, swollen one) that didn’t move itself… yet. I have pushed lips out of the way on request of the mother.
I’m interested in the idea that you can get a woman to wait until the lip goes before ‘mom gets to push again’. If the baby is triggering the Ferguson reflex mom has no choice in the matter and cannot stop pushing. Therefore telling her to stop is like telling someone to stop blinking – impossible and distressing.
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I think this is great information and makes me think about what I ahev said in the past that might be unproductive. The only thing that is missing that could/should be talked about is cervical scar tissue. This changes many things. In my experience in recent years regarding this very common but not discussed issue, mom’s wind up pushing against a cervix that won’t open. This post I think is misleading in that it seems absolute. I would love to know your position on cervical scar tissue and how you think it could affect what your saying here.
I’m sorry that you find the post misleading. I can’t cover every possibility within one post or you’d all get very bored and stop reading half way through. The post is aimed at the majority of healthy women without previous cervical procedures and focuses on the ‘anterior lip’ rather than pushing on a cx that has dilated only a little. That is a whole other post and a much rarer situation.
See my reply to ‘Doula’ above re. cervical scar tissue. This is something that needs to be identified and discussed with mother’s antenatally so they are aware their labour pattern may be different until the scar ‘gives’.
I haven’t noticed a difference in pushing for women with scar tissue. Usually they get stuck around 5cm and then once released there is no difference. So, really since I am talking about an anterior lip – it wouldn’t affect what I am saying here. Maybe I will do a post on scarred cervixes in the future
thank you for a very wonderful and informative post! i will be sharing in numerous places in hopes that women will understand to trust their bodies!
Baby # 5 I was told to stop pushing “the baby is to high” . Ya right!!!! I was not “pushing” my body was doing its job of birthing a baby. The reason why….the DR was not in the room yet. I was on my side and out comes baby all by himself…mmm how did that happen???? We are women, trust your body to do its job !!! Love all the great info.
Was told not to push with baby #3 ’cause nurse was setting up and had already been insulted by a doc who said I was 6cm when she thought I was 8. Baby boy was born 4 min. after I announced I was pushing the he pulled himself out (45min after arrival at hospital).
Oh and I never had “noticeable” contractions just a slighly pissy disposition every 5-7 min when my mother would start talking. I also remember checking myself a few times in the bathroom that day and wishing I could just birth sitting alone. Intuitively took lots of walks and meditated. My CNM didn’t have privledges anywhere and the OB who covered my last month of prenatals had a horrific bedside manner. Glad he didn’t have to catch my precious precip… he was down the hall eating after insulting the nurse for having small fingers and not measuring me correctly.
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Thank you, thank you, thank you! Labor with my second child went very quickly. . .I went from 4 cm to 9 cm in an hour and a half. Then I had the urge to push. . .but I still had the “lip” . . .my midwife let me push briefly, then she tried to push the lip back (very painful), and finally told me I had to stop pushing because I was causing swelling. I spent 4 agonizing hours fighting the urge to push. . .but by the end of most contractions I’d end up with losing the battle and doing a small push. . .so the midwife suggested an epidural. I was crushed. We transferred to the hospital across from my birth center. My wonderful doula kept saying to me “Don’t worry, before they give the epidural, they will check you and you will be at 10cm.” Luckily, I was and we canceled the epidural. I was then “allowed” to push. My son was born an hour later.
My doula told me in a different situation (such as a homebirth) they would not have checked my dilation and would have followed my body’s messages. I always believed that if I had been allowed to push when my body wanted to, my son would have gotten past that lip. Instead, I was fighting my own body, even doubting whether my urge to push was really an “urge” or just me being weak and trying to shortcut to the relief of pushing (it was obviously uncontrollable but I began to doubt my own body and mind!).
Thank you for this article. I’ve been reading about this since my VBAC (3 years ago in May) and I’ve always wondered if this could have been what happened to me, only in MUCH earlier labor? My labor started like a freight train – lost plug, immediately close contractions, within an hour I was screaming – that kind of thing. I had only been at the hospital for a short while when I found myself totally unable to keep myself from bearing down through the contractions. It was like my breath caught in my throat on the only thing I could do was follow the energy down and push. My doula was so convinced that I had to be in transition that she ran to the hall and got the nurse. When they checked me, I wasn’t more than 3 or 4, which of course meant that I was nowhere near being “allowed” to start pushing. It was a HUGE let down, and that was when I told them I couldn’t stop myself from pushing so I HAD to get the epidural. To make a long story short, my labor lasted another 30-something hours, stalled many times, and I finally FINALLY got my vaginal birth the next night.
I have always wondered if it’s possible to have the urge that soon? Could my body just have been transitioning that fast? I personally attended a birth as a doula this summer where the primip mom had a VERY precipitous labor and dilated from 5-10 in just two contractions (scared the nurses half to death, but thankfully the midwife showed up just in time and calmed them down.) So given what I’ve seen, maybe my labor was just going really fast before I stopped it with the epidural? What do you make of the situation? And how would you handle it if you had a mom who was bearing down at 3-4 cm?
Congratulations on your VBAC (against all odds)! It is really hard to comment on a birth without having been there. So much of ‘what I would do’ depends on the individual situation and my intuition at the time. I also don’t like to criticise other individual practitioners because I know that only those there at the time can judge. Having said that…
I don’t generally do VEs during a labour so I have no idea what is going on with the cervix and don’t really care as it doesn’t tell me anything about how the labour will progress. So, I guess I wouldn’t have known you were 3-4cm and you would have pushed away and possibly given birth. An epidural does interfere with labour progress and the stress of being told your body is failing would also interfere. It is possible to get the urge to push that soon and some women, like you do.
My situation was similar and dissimilar to yours when I was having my daughter. I was at 6 cm and not progressing but feeling the urge to push and being told very strictly by the nurse that I SHOULD NOT push or else my cervix would swell and things would go very badly… I should not have listened to her and listened to my body, after 2 hours in the shower of the most unbearable pain from not being able to push, I said eff it and pushed! Voila, in one push I felt and heard a pop, she moved down and I went from a 6cm to a 10cm and pushed her out in two pushes (only after the nurse was yelling at me and my husband that I HAD to get in the bed because I couldn’t have the baby on the shower floor…). Believe in your body!
I can’t say anything about what would have happened with your birth, but I had a similar situation to Krista. I was in roaring labor when my midwife arrived and checked me. 20 minutes later I was pushing, and 20 minutes after that I met my third baby. Some babies just seem to be in a hurry to get out.
I just experienced a birth where the woman had an uncontrollable, intense pushing urge throughout the whole labour. This also happened in her previous labour, in which she was actively pushing throughout the whole 6 hour labour and had a normal vaginal birth at the end. During the latest labour she also pushed throughout the whole labour, which ended up being only 1 hour long and also ending in a normal vaginal birth- no damage done!!! This actually got me thinking at the time, whether this whole ‘not pushing before the cervix is fully’ thing is really true or relevent?? Thanks Rach for the post!!!
The body is pretty remarkeble. I had my third baby at home in 2009. I was laboring very differently to the first two times, but was at the point where I clearly thought “I need to get this baby out, or call the midwives and ask for gas “. I had very long previous labours, so up to that point had been labouring just with my doula in attendance.
So, even though I had no urge to push, and baby still felt a little high, I decided to push. I can vividly recall the burning as my baby’s head pushed through what I am sure was my not yet fully dialated cervix. That took about 4 pushes, and after that it was just another two until he was born.
Thanks you so much for this blog. i read this post yesterday then went to work on labour ward last night. At one point i was covering for a midwife during her allocated midwives break and we had a woman in who had been pushing uncontrollably at 5-6 cm (1st baby). she went in the pool and at this point usually i would have been encouraging her to breathe; not push; pant etc. but this time i said nothing, she was pushing deeply and constantly. after an hour or so in the pool i did a quick vaginal examination (to cover my back) and she had an anterior lip about 2cm thick in places. Again i thought of what i had read and did nothing but wait patiently. she adopted a reclined position in the pool and continued to push. Her midwife returned and i explained what was happening and then went off on my break. when i returned, lo and behold she had given birth. Thank you
In rare cases (N=1 for me), getting a woman to hands & knees or side-lying actually makes the lip larger, to the point where it acts as a sling to prevent descent. For my one woman, eventually I instinctively got her into the dread lithotomy position, after trying others, and presto!!! out popped the baby. For her next delivery, when she had the urge to push, she just put herself into full lithotomy and second stage was a breeze. Odd anatomy, no doubt, but something to consider.
That would make sense as hands-knees and side lying would put pressure on the lip. I also find women instinctively get themselves into supine positions to take the pressure off the cervix.
If you see my long comment below about my labor, I’m wondering if all the positions I had tried (a lot of side-lying and hands and knees) didn’t contribute to the long labor. It would also explain why lying on my back produced the best results, and we were all stunned that that was the case! Very interesting… I’ll have to look into this more. Thanks for sharing this!
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thanks so much for your incredible blog. i’ve just read through every single post in the last couple of days and it’s just amazing the info you present, so clear and easy to understand. i’m 7 mos pregnant, first time mom-to-be, and living in bolivia. i’m planning a home water birth and am trying to find a midwife or even ob to attend the birth (that does happen here i’ve heard) that will be as hands-off as possible. i’ve been interested in midwifery for a long time but now of course the interest is kicked up a notch.
anyhow, reading your posts have reassured me so much – i believe in my body and its ability to give birth, but having research to back it up only helps that belief. thanks again ~ ~
Thank you thank you for your sanity. I agree wholeheartedly. I have heard so many stories of homebirth midwives stressing moms about cervical lips during spontaneous pushing. Bless you for educating the world.
Janelle
beautiful. thank you.
supporting what you are saying, i was thinking of two other great articles:
http://www.midwiferytoday.com/articles/ruleof10.asp
and claire hall’s blog on the male mindset (march 31, 2010′s entry):
http://charisbirthsupport.blogspot.com/
keep on telling the truth!
blessings
Thanks for the links. Claire Hall is a wonderful and wise midwife. I didn’t link to Lydi’s article despite the great content. The reason is because she is now advocating PowerBirth – a technique that tells women they should be pushing from 5-6cm. This involves lots of VEs and directions rather than acknowledging the individuality and power of each woman. Having said that, the article on it’s own is good.
Rachel ~ as you said, the article on its own is good. i don’t understand how one could come to a power birth practice from this insight, and i’m very disappointed. thank you for letting me know regarding this, as i will consider that when referring to the article.
or i will plain not refer to it. yikes!
“Power Birth”
*snort*
There is no power in being told that you need to be coached through having a baby. At least, there is no power for the mom, although the “care” provider probably gets to feel pretty good about him/herself.
I had a cervical lip with both births. At the hospital, they told me to just go ahead and push past it and baby was born in 15 minutes of pushing. At home with my second, my MW said we could wait or she could push it to the side. She was already in there, having to push on one side of his head because his head was tilted so that he’d come out straight. So she did and it was excruciating. I pushed for about 30-45 minutes to birth him (took longer because of the cord around his neck and shoulder dystocia)
I remember I found one position – leaning over a birth ball with my shoulders even with my hips) that lessened the pain (nothing else helped) and then the MW said I had to find another because (I found out later) my dilation had gone backwards. That was frustrating. I’m wondering if that position was helping to lift his head off my cervix a bit and maybe he would have turned his head straight, and maybe not had a lip, if I’d stayed in that position for longer.
This was a really great post. I’m so curious if this happened to me and I was misdirected by my midwives. I planned a homebirth. Immediate 4 min apart contractions. She did three or so VEs before saying I could push whenever I wanted (pre-labor, I knew I would feel the urge to push on my own; during labor, I felt a nag, a small disappointment, like “shouldn’t I know that I can push now?”) and I started pushing.
I pushed for six hours. Before pushing, she said I had a cervical lip. She kept using her fingers when I would push (inside me). It was painful. My most successful pushing took place with me on my back and my legs being held by my head. But still, after a million other positions and no rest, my baby wasn’t there. She could see his head, his hair (the waters hadn’t broken, but hind waters were present). She could touch him, and when she showed me how far she had to put her finger in to touch him, it was less than an inch. For whatever reason, I didn’t reach for him to see how I was doing. Because his heart rate was dropping more frequently (though reacting positively to oxygen) and the hind waters were mostly meconium, and I had been pushing for six hours, we transported. By then, I could not push with the same energy though I continued to feel the urge, so I would as much as I could to ease the pain. By the time i got to the hospital, my baby was all the way back up in my uterus and I was measuring at 9cm. Two hours later, I had my son by c-section and all the normal hospital nightmares typically expected that urged my husband and I to choose homebirth.
Regarding damage, sex is definitely more painful. Even using my diva cup feels uncomfortable. I wonder, after reading some woman forums if the process of ALMOST giving birth naturally and then not affected how my body recovered after the physical trauma.
After all of this, I am left with a few thoughts for my next baby: was my first birth really a birth that necessitated a section? Was I truly one of the 10-15% of women who really needed it? Or, should I be sure to have a different midwife? Should I not let go, so readily, my focus and reason when I’m next in labor? Should I just study midwifery or what?
If you have any insight or theories, I’m really interested in hearing. I admit that ever since, 28 months ago, I can’t help but think of it. Plus, my scar is constantly itching, reminding me…. (apologies for any typos. bed time.)
Again, excellent post. Thank you!
I’m sorry your birth was not as you’d hoped. I can’t really comment about your midwife’s practice without having been there and seeing in the context of what was going on. It does sound a bit like the PowerBirth technique though. Is this what she was following? Perhaps insist on no vaginal examinations in your next labour and follow your body. Find a midwife who is happy with this approach and trusts you to birth instinctively. I don’t think you need to study midwifery – just trust yourself because you are already an expert in your own body/baby and birth
Great post. In short this is my story, my second baby was a successful drug-free VBAC in a hospital with a 98% epi rate, and over 30% c/sect rate. My total labor was 34 hours. I stalled at an 8 having been up for about 48 hours already and I was exhausted. I was sleeping between cntx and my nurse gently suggest AROM to see if it would “melt away” the remaining 2cms. I said what the heck ( I could not afford a doula, my mom and hubby were helping me through) and it made the cntx so much harder and I had the urge to push almost immediately. They turned me on me side ( I was in bed at that time, had been in a jacuzzi, on a ball etc) it was excruciating, but i went to a 9 pretty fast, i was blowing since thats the only thing you can do to even attempt not to push. I was pushing anyway, but not letting myself bear down. It was awful all in all i fought the urge for about 2 hours. Of the whole 34 hour labor, (BACK LABOR) that was the hardest. I was hyperventillating and taking oxygen between contractions. I do remember a nurse trying to push the last bit away, i dont know how much, but it wouldnt move. When I was finally complete the nurse had to leave to get the doc and told me not to push (yeah right) I pushed for close to an hour and a half before my baby was here. It felt so good to get to push that my body was even pushing without the contractions. I couldnt stop it. I was laying down tho, in the typical hospital birth position. I am sure had i used the squatting bar the pushing would’ve gone much faster. At that point i didnt care, i just wanted to PUSH. Now i think had I not fought my body my cervix may have done its thing while I was pushing. I also know, I won’t ever opt for AROM again. Slow and steady worked until that point, and thats when things got hard. I got my drug free VBAC in the end. Hind sight 20/20!! If there is another baby in my future I will be in an area where even at the hospital natural birthing is encouraged and there are 4 birthing centers in a city less than half the size of where I am now. Thanks for this!!!
I am totally overwhelmed by the response to this post and I just wanted to thank everyone for sharing their comments and experiences. Thanks!
I love your illustrations, and the detailed A&P of this post! Posts like this really help me refine my practice as a birth educator. Thank you for sharing!
Kristine Burneko LCCE
LAMAZING
Great post!
I had cervical lips during both of my homebirths, and it was truly agonizing to try not to push.
However, I’m wondering if you’ve seen instances where there are other reasons for the lip besides that it’s just the last part to dialate? For example, I had terminated a pregnancy in my early 20′s and had a subsequent DNC which I think damaged part of my cervix. I wonder if that might have been what was responsible for both of my labors being plagued with a cervical lip? In that occasion, would one risk tearing her cervix by pushing before being fully dialated?
Just wondering if there are any other reasons you see for cervical lips outside of the fact that the anterior part is just the last to dialate? And if so, what you do about special circumstances such as mine?
Thanks!
See my response to the comment by ‘Doula’ further up re. scar tissue in the cervix. Pushing should not be an issue because if women are left to get on with it, they will only push when they are unable not too. Therefore the argument about ‘not pushing’ is pointless because they can’t stop pushing. To tell them to stop is like telling them to stop their contractions – impossible. You might have some scar tissue that needs more time to soften, stretch and move. Like most situations patience and trust are usually the solution.
I wish I had read this before I had my daughter! I was doing fine with labor until I felt that strong urge to push and my body started pushing on its own. I told the nurse, and she went to get the doc, who said I wasn’t quite fully dilated yet so stop pushing. Then he ran off somewhere. I spent the next hour or so fighting against my body before they finally gave me the “green light” to go ahead and push. My daughter was born about 10 minutes later. I wish I had had more faith in my own body, and listened to it instead of to the doctor and nurses. I think it would have been a lot more relaxed and bearable labor if I had not been fighting against my body’s natural urges. At least now I know for next time!
I so appreciate the bit about asking a woman if she is pushing. As a student I worked with a number of midwives who believed themselves to be minimally interventive, but when “pushing” came there would always be lots of chatter, and questions, and checking and skepticism. I hadn’t had a baby yet, but it all seemed so counterproductive. If the woman was pushing, would she be pushing, instead of talking to us, and wouldn’t it be obvious? Engaging the mother in that way always made me queasy and you’ve summed up quite nicely just why!
I’m curious on your view of my birth with my daughter. Short story: I went into pre-labour midnight on the 13th. Laboured well all day. Upon arrival to the Birth Centre at 11pm that night once in active labour I was 3-4 cm dilated. I wasn’t managing my pain well and had an injection to give some relief and get myself together a bit. It helped heaps.
At about 8am the next day (14th) I was checked and hadn’t dilated any further at all and we were told bubs didn’t have her head chin to chest, but tilted up like you would to look at the sky. My cervix was apparently swelling rather than opening.
They gave me a couple more hours, no change. Then encouraged me to have an epidural to see if it would relax bubs and I for her to move her head. They did a drip for 3 hours in this time too to increase contractions too. But the swellling only worsened and baby moved her to the left so it wasnt even straight any more. So it was decided C-Section was the way to go while bubs and my body was still coping. So after 38 hours of labour (from 1st contraction which were regular right from the beginning) to delivery.
I’ve never had friends experience this with their babies so would love your opinion having been a midwife. Part of me wonders was I given a bit of rubbish info and directed in C-Section direction falsely?
I can’t really comment on a birth if I wasn’t there and don’t know the mother or the context. Hindsight is a wonderful thing!
You don’t mention that you were pushing – demonstrating the point that cervixes can swell regardless of pushing. Your baby’s head was deflexed which might cause the cervix to open unevenly. This is fairly common and as the baby moves into the pelvis they usually tuck their head in because of the force of contractions and the shape of the pelvic floor. In your individual situation I really don’t know why your cervix didn’t dilate or whether your c-section could have been avoided.
Before you have another baby I suggest you debrief with someone who can work through your experience with you. There is no reason that this would happen again. Every birth is different.
THANK YOU for this!
I had an anterior lip and when my MW tried to hold it back it was excruciating, truly the only part of my 40 hr birthing that I still vividly remember as being terrible. Turns out my little one was born with a strong and stubborn nuchal hand. No biggee coming out but trying to hold back that lip before pushing (we eventually did give up because the intensity of the pain was just too much!) was literally a fight of force between MW and baby! (: Yes, in the end, the baby won and came out looking like Super Woman taking off in flight.. After the incident I thought back…”hmmm, wonder if her hand had anything to do with that little lip incident?” turns out they were probably directly related.
As a doula, I’ve seen simple, uneventful, pain-free moments of holding a cervical lip back but when a battle ensues, as did with my own birth, one has to consider the idea that indeed mom and baby’s body will work things out on their own.
All said, I chalk it up to a tiny morsel of info my otherwise wonderful midwife had not fallen privy to. It happens.
This is a great post and something I will share with my future clients and fellows! Thank you!
I was told to stop pushing while in active labor on my third birth because the nurse could not break down the bed (she was born 1 min. later) as if no baby in HISTORY has been born with out a hospital bed broken down! Sheesh!
I have just got to say that whenever I hear about a cervical lip, I just want to scream! This happened to me. When I had my daughter I progressed quickly and I was handling this pretty well. All of a sudden my contractions were overlapping and I had the overwhelming urge to push. When the OB checked me she said that I still had a lip that she was unable to push out of the way with a contraction and told me to stop pushing. Stupidly I did what she said and for the next 30 minutes I fought my own body to keep from pushing. Finally she convinced me to AROM and the lip did go away. But just as you said, after fighting my own body for so long, I couldn’t get back into listening to my body. Even though I did not have an epidural or any other medications, I might as well have because I could no longer recognize my contractions let alone the urge to push. And because of the overlapping contractions and fighting my body, my daughter’s heart rate dropped and I was forced to just push straight for 5 minutes to get her out and avoid the forceps/vacuum that the OB threatened me with. She ended up being perfectly healthy, but I ended up with a nasty internal tear. All because of that stupid cervical lip! After the birth, I did my research and I learned that I really should have listened to my body and pushed past the lip. If I am ever lucky enough to have another child, I will certainly find a midwife that would encourage me do that and not get hung up on a stupid lip!
Hi Rachel, have been following your blog with great interest. As a student midwife its’s very informative and quite different to practice seen on placement. Oh well…..
Basically during labour as a midwife it is best for the woman to follow her instincts in terms of pushing/positioning etc rather than have it dictated to them and told what to do…(though of course this makes the most sense)
As never having had a baby, I’ve never quite understood the need to give ‘permission’ to push. Do you know of any reasons as to why a woman would be told to push (push now stop, push now again?)
The only one I can think of is if a woman has an epidural and can’t feel her contractions to push with? But as you said above the uterus will naturally ‘expel’ the baby, just takes longer without pushing?
Kate ~ I found this interesting: “But as you said above the uterus will naturally ‘expel’ the baby, just takes longer without pushing?”
How do we know? There is no way of knowing what would have happened “if she hadn’t been told to push” or “if she had been told to push”. Personally, I trust birth, and I feel that mothers and babies know what’s BEST for them. I trust their bodies entirely. If a mother has supported this pregnancy the whole way, who am I to start telling her how to birth?
I would suggest this great audio on physiological pushing ~ very inspiring:
http://aamishop.com/index.php?main_page=product_info&cPath=8&products_id=128
or this one:
http://aamishop.com/index.php?main_page=product_info&cPath=17&products_id=294
blessings
paule
Loved this post! I have only experienced my own birth up to this point, Bulgaria I feel like it was good for me since I would like to pursue midwifery. My own birth taught me to trust my body to know what to do. I had read many both stories but of course mine was like non of them. Since labor started very slowly but progressed faster than I imagined possible I benefited from being alone and listening to my body’s cues. I started pushing instinctively and never did get a single vaginal exam because by the time we arrived at the hospital my daughter was crowning. I see routine vaginal exams in a similar light to routine ultrasound late in pregnancy – if you look for problems you will probably find some, but everything is usually okay without checking…
Hi midwifethinking
Really loving your blog and really appreciating the time and effort you are putting into these blog posts. They are growing into great resources for women and more important to me personally, great resources for midwifery students. The number of comments you are getting just goes to prove there is a real need for this sort of information, which I had thought was already “out there”.
I am also really interested to see the number of stories that are being told…and I am left with the question…are we as midwives facilitating this story telling adequately and effectively? What do you guys think?
Thanks Sarah
I am also amazed by the response I am getting for what I also consider to be information already ‘out there’. Clearly this information is not being applied to practice! It does take effort and time but I also use it as a resource for students eg. pre-readings for a session. It saves me repeating myself. It is also a great place to practice procrastination while I am supposed to writing my thesis
Women’s birth stories are so important and need to be heard. If you are interested in narrative I’m happy to share some of my methodology chapter which is about story-telling for mothers and midwives. We use stories as an integral part of the curriculum in the MMid course in a number of ways:
- Case based learning ie. using a story as a framework for students to investigate issues etc.
- Using stories to accompany content eg. a link to a blog site story for pre-reading
- Inviting mothers to come and share their stories with the students eg. VBAC
- Photo stories from personal practice and from the internet
- We have a session a week that is based around the students sharing their experiences and stories and learning from each other
We can learn so much from sharing stories!
I would be interested to hear if mother’s think midwives facilitate story telling adequately and effectively too… I suspect not.
Just saw this answer to my comment…after I wrote my blog post. I know there is heaps of research into birth story telling but not so sure what work is being done in relation to social media….I expect there’s a PhD student somewhere looking at it.
But I do suspect midwives do not do as good a job as they could to support women to tell their stories…especially in maternity systems where women do not have individual midwives.
Sarah in answer to this – my experience was that midwives were the worst people to debrief with! After my first birth in the public system I was sent home without having a single conversation with anyone about my birth and how it happened. No-one asked about it until my booking in for my second child and then I had the disconcerting experience of a mw I didn’t know saying ‘no that can’t be right’ and ‘correcting’ the hospital records while completely ignoring my protests! After my second rather traumatic birth I found mw’s either felt the need to defend their colleague’s actions (even when they didn’t know the people concerned) or tried to guilt trip about home birth. An ex-midwife turned counsellor was a god-send. Perhaps midwives need more counselling skill training? Just finding one who could shut up and listen was marvellous and took me 5 years!
Midwives definitely need more education in debriefing and ‘listening’ to women. Unfortunately their curriculum is so full of clinical skill tick boxes that this far more important aspect of midwifery is undervalued. I’m pleased you found someone to listen in the end.
I also think that DEMs may story-tell differently from CNMs. When I finally asked for my hospital records following my primary c/s and needed some clarification, I spoke with the CNM who cared for me that entire pregnancy and tried to help me birth my child. I was told that my pelvis prevented my baby’s descent. However, I looked through my pregnancy journal, and my CNM had commented in a prenatal exam that I had a great birthing pelvis. IMO, this midwife was more interested in covering her a$$ and towing the party line than giving me information that would help me in future births.
I’m still struggling to believe that my body won’t fail me and that I can trust a care provider to help me along my journey.
No one can accurately estimate how your pelvis will work in labour. It is extremely rare for a woman’s pelvis to not be able to fit her baby through unless she has a deformed pelvis due to disease (ricketts) or accident (fractured pelvis). I’m not sure what kind of prenatal exam your midwife did that allowed her to assess your pelvis. All women have great birthing pelvis. I really hope you learn to trust your body. Gloria Lemay has a good audio about pelvises: http://www.blogtalkradio.com/waterbirthinwoman/2010/06/04/pelvises-i-have-known-and-loved that may help.
You’ve inspired a blog post…not about how we birth but how we tell our birth stories: http://sarah-stewart.blogspot.com/2011/01/is-facebook-replacing-midwives.html
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I just posted this already on someone’s previous post, but had to share with you:
That sounds a lot like my vbac – baby boy born December 22, 2010. This post is a very big lightbulb for me. I was “stuck” at 7-8cms as well and the midwife told me not to push or I was going to swell my cervix, even though I felt I needed to push a little bit. I also felt like I wasn’t coping anymore and got a little louder than I had been. We tranfered to the hospital (I was trying for a homebirth) and put on an epidural. The doctor told me 3x that she wanted to do a csection right away and get it over with. I milked every last option I had, up to getting pitocin in the end. I couldn’t give up after three days labor! Interesting enough both midwife and doctor told me I had 2 cm to go but the nurse who checked me, much older than both of them, said I had a “frill” which I’m taking as a small “lip”. I wish I knew all this before. I didn’t want the epidural and sure if my body was let to do what it was going to do, everything was going to be fine. It was also the same nurse that discovered he was posterior as well and told me “babies are born how babies are born”. She was definitely sent to me by God that day. My 9lb 2oz son was a vbac. I’m so proud of that!!!
You should be proud!
I had lips with 2 of my births, doc just had me push through them, no problems, a bit more burning.
My favourite bit – “This is called the ‘Ferguson reflex’ – probably after some man.” ROFL!!!
The only thing I would like to add to this post is that there are INDIVIDUAL cases were pushing with an anterior lip has caused major trauma. One case that I know of specifically is when a patient on my unit had a strong urge to push but however had a rather small ant. lip ( approx 11 to 1 o’clock position-I’ve seen and assisted with pushing in patients with much larger ant. lips with no negative outcomes). None-the-less this patient had the strong “ferguson reflex” to push and was allowed to do so. In this particular case she had a severe outcome: during pushing with the ant. lip she infact did rip her cervix quite severaly. She pushed for several minutes and just as she “pushed past the ant. lip” started to have profuse bleeding. She was immediately taken for a STAT c-section and the rip in the cervix extended all the way through the lower uterine segment into to main corpus (body) of the uterus. She had a blood loss of almost 2000mL, required a blood transfusion, uterine artery repair (possibly embolization, can’t remember that far as I was not her OR nurse) and almost had a hysterectomy. The baby too had some complications with an inital Apgar score of only 3 and required several mins of resusitation due to the massive bleeding and decreased bloodflow to the placenta.
Now I know that this is a unique and individual situation but it is also quite severe. So, although I completely agree with allowing a woman’s natural powers to progress them through labor and delivery, I also know that in the past there were a greater number of woman that had extreme complications and possibly even death (maternal or fetal) from childbirth. And we have learned a lot over the years about labor and delivery to help stem those negative outcomes. Therefore, there may be individual times/circumstances where although the body is telling a woman to do one thing, maybe a practitioner should/needs to step in a direct a patient differently to help avoid such cases.
Thank you for listening and wishes for good births to all !
Hi Sarah
Thanks for commenting and sharing your thoughts.
There will always be individual cases of unusual outcomes. I worked for years in a large regional referral hospital as a midwife (lead practitioners in the UK). I could write about many of the unusual/dangerous birth situations I encountered. Most of them caused by intervention. I have seen a uterine rupture (like the one you describe) with pitocin but no one suggests we don’t use induce labour. I agree that modern medicine saves women and babies but by treating every woman as someone who needs to be saved we create danger by using interventions unnecessarily and disempowering women.
I think it is the job of the midwife to reinforce women’s ability to birth and their expertise within their own bodies. However, it is also our job to recognise the occasional complications and manage them. The problem is how do you identify a complication if you never see a physiological birth?
In the case you share, what else was happening? I assume the woman was in hospital and most likely had the associated interventions – medication, IVs, CTG, etc. Instinctive birth is difficult when you are in unfamiliar surroundings. In addition for this woman if she was truely spontaneously pushing ie. no one gave her ‘permission’ or used the word ‘push’ or encouraged her to do it… the she would have been unable to stop pushing. Telling her to stop would have been like telling her to stop contracting – impossible. Therefore, there was nothing you could have done to prevent this rare complication. The answer is not to tell all women not to push in case they are the 1 in how ever many rare cases like this. I think if you read the comments to this post you will see the damage done by telling women that we are the experts and they should stop pushing when they can’t.
You said: “I also know that in the past there were a greater number of woman that had extreme complications and possibly even death (maternal or fetal) from childbirth. And we have learned a lot over the years about labor and delivery to help stem those negative outcomes.”
Less than half of all women birth without pitocin or surgery. You cannot tell me that all these women and babies would have died. Many of the routine interventions we have put in place cause morbidity eg. premature clamping. I think we have learned very little about the physiological birth and safety. Check out the infant mortality rate in the US compared to European countries with midwifery led care and homebirth: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
Having given birth to a 7lb 10oz baby boy on 7th January, I went in search of answers following what I can only describe as a ‘traumatic’ delivery.
I was induced due to SPD and back problems (I had a lumbar spinal fusion with metalwork 4 years ago) at 38+4 weeks. Syntocin and Oxytocin (sorry about spelling). I couldn’t have an epidural due to my back so gas and air it was!
I wasn’t told I had a ‘lip’ but I didn’t seem to be progressing well at all. In fact I had the ‘urge’ to push and when examined I was only 5cm dilated! The end result was Doctors and Midwifes in the room all argueing about what to do. I was very frightened and by this point pushing even when told not to – trust me I really couldn’t help it. The pressure in my bottom was unbearable and there really was no way I could stop the pushing – almost as if my body was doing it without me (sounds silly I know).
The upshot was a more experienced Midwife manually manipulated the ‘lip’ whilst I pushed through (I think I was about 7cm tops) and eventually out he came. The most painful thing I’ve ever been through and my little boy was sunnyside up as well (hence the pelvic pain).
I just wonder if the obsession with ‘is she 10cm’ were not there and were I allowed to do what my body was telling me, would the whole experience have been better? No Docs and Midwifes argueing in front of me, no awful pain of the manual intervention etc.?
At least this article has helped me understand a little better what was going on during my labour which I really did need. Thanks
You spontaneous need to push was not silly. It was your body working the way it is meant to. There was no way for you to not push. I am so sorry that your birth experience was unnecessarily traumatic. Perhaps a letter to the hospital would at least make them consider what they are doing to women. Thanks for sharing your story x
I just came across this website on Motherings facebook page. I am currently a medical student looking into practicing as an OB. I LOVE this page, and I am very excited to be able to suck up this knowledge. Please don’t stop writing anytime soon.
Thanks Lauren
Good luck with your studies! Keep listening to women’s experiences and think about practices openly and critically = you will make a fantastic OB… and we really need good woman-centred OBs.
I love your blog!
Thank you for this post! The hardest part of my home birth was the couple of contractions I tried to not push through. I spent several hours at 4-5 cm and then my midwife accidentally broke my waters when she checked me. I went from 5-10 in 1 1/2 hours – so they were a little nervous when I said I felt pushy and asked me to hold off until I couldn’t anymore. After a couple of contractions not pushing I had a small break and then rolled over onto my side ( I labour the whole time on my hands and knees) and simply said – baby’s coming! She was born in 13 min – and I was trying to go slowly! I know she had been posterior for quite a while and I had been working at getting her anterior near the end of my pregnancy. I also found out a week later that I tore my cervix but not badly enough to do any harm.
Thank you so much for this article. I really appreciate it. I gave birth to my second child in January–also my second home birth. I feel as though I was raped by my midwife. I know that sounds dramatic, but it’s truly how I feel. During labor, my midwife asked me if I felt like pushing. I said that I felt no urge whatsoever and, in fact, felt that it would be hours before I was at that stage. She told me I was wrong and that, based on my vocalizations, she could tell that I did have the urge to push and just couldn’t recognize it. At this point, I thought that maybe my body wasn’t working and I should tell it to push. Because of what my midwife described as my uncontrollable urge to push, she felt it necessary to physically manipulate my “persistent anterior cervical lip”–something that would not have been discovered but for a vaginal exam. In my unread birth plan, I’d asked for no vaginal exams unless absolutely necessary. The midwife’s manipulation of my cervix was excruciating–far worse than back labor or anything else I was experiencing. I begged and pleaded for her to stop, but she merely paused and began again. Apparently laboring women say no when they really mean yes. I felt so helpless and powerless to change the situation. I didn’t know why she was doing what she was doing and I certainly did not consent. I share this only because I want to impress that this type of manipulation is or can be a very painful intervention–both physically and emotionally. I also mention my experience because I want to point out that the problem does not arise only in situations where a midwife is telling a woman not to push when she can’t control her urge to do so. In my case, I believe the problem was manufactured by telling me that I couldn’t control my urge to push over my insistence that I did not feel any urge whatsoever. If my body had been given the chance to continue normal contractions, I believe my cervix would have opened on its own BEFORE I had an urge to push.
Thank you again for explaining this issue.
Brenda
I so sorry you had such a traumatic experience. Feeling raped is not dramatic – it is real. I hope you were able to report her for misconduct and assault. There is absolutely no excuse for what she did to you. Are you getting support to deal with this?
I couldn’t get this post out of my head whilst at a birth the other day as a student midwife. Mum was coping well, things were intense but she was doing it. She was in/ approaching transition when I arived on shift, lots of pressure, VE by midwife on duty, 8cm. I think this is where things went downhill for her. Very anxious primip, diagnosed with anxiety disorder, this made her really doubt herself. “I should be ten by now!” An hour later, involuntarily pushing with most contractions, another VE by midwife who took over care, anterior lip. struggling with being told not to push, “I’m not! my body is just doing it!” stressing about being told her cervix could swell. Anyway, 5 hrs later, despite many position changes, an epidural and some synto for about 1 1/2 hrs, lip still there. off to theatre. babe deflexed op, cord twice round the neck. devastated mama. so strong through it all; ineffective epidural, hard time placing spinal, her begging to make it stop, so scared she will feel it or she will die. mad me cry. she’d only come into hosp that morning and had progressed so well. made me cry for her. perhaps things could have been different.
p.s 3 times they tried to manipulate the lip but to no avail.
Poor woman
I have been meaning to ask you this- as a future midwifery student, I would like to know when you think vaginal exams are warranted in a normally progressing labor.
Hi Sara
In short I don’t. In a physiological undisturbed birth the cervix will open in it’s own unique way. Sometimes taking 1 hour to get from 3cm to baby, sometimes taking 6 hours to get from 9cm to baby. So, knowing what the cervix is doing only tells you what it is doing while your fingers are on it. It does not provide a good indication of what will happen in the future. If we accept that the partogram should not be used in a ‘normal, low risk’ labour (according to Cochrane review) then why do a VE to see if the woman is following it? I’ve just written an article for AIM journal on this – will post it once it’s published.
The only time I would do a VE at a physiological birth with a well mother and well baby is if the mother asked me to. Even then I suggest they have a feel themselves rather than me do it. I don’t need to know what the cervix is doing. VEs are a useful tool to keep in the box but are rarely needed in a ‘normal’ labour.
Thanks! I think what I meant to ask is ” is a VE ever needed in a normal labor” and I think you answered that. Is there a reason other than maternal request that you would do one? To fond baby’s position, maybe?
In a normal labour it doesn’t matter what position the baby is in. You may have some idea from abdominal palpation but the baby will move through the pelvis as it needs to and change position during labour. See my post on OP babies: http://midwifethinking.com/2010/08/13/in-celebration-of-the-op-baby/
I can’t say how grateful I am to have discovered your blog. I find it incredibly inspiring and thought-provoking, and it has been such a confidence-boost to refer to as a newly-qualified midwife. I was wanting to clarify something which I read in the post on anterior lips – at the beginning of the post it’s stated that “The cervix dilates because the muscle fibres in the fundus (top of the uterus) retract and shorten with contractions = pull it open (Coad 2005). This does not require the pressure of a presenting part ie. baby’s head or bottom (lets stick to heads for now). However, the head can influence the shape of the cervix as it dilates up around it”
I understand that cervical dilatation will perhaps occur eventually in the absence of a well-applied presenting part solely due to uterine contractions, but so many midwifery texts state that the role of a well-applied presenting part (which stimulates the release of prostaglandin PGE2, which also stimulates uterine contractions) is essential to achieving frequent and effective contractions to assist cervical dilatation (Simkin and Ancheta: The Labour Progress Handbook 2005:95) As your article only suggests that the head is influential in affecting the shape of the cervix as it dilates, I was curious to hear more of your thoughts on the above! Thanks once again for such a fantastic blog.
Thanks for the question – I’ll try to give you an answer…
Cervical dilation does not require pressure from the presenting part. Women can dilate quickly with a transverse baby or a baby who has not engaged in the pelvis. Cord prolapse is a risk in these cases. Also, I am sure that many midwives are familiar with the common OP pattern of rapid dilatation then slowing at 9cm or anterior lip. These babies are not well applied yet the cx opens quick.
PGE2 is released in response to tissue ‘trauma’ ie. the cx stretching and opening which happens with contractions, not just pressure. The pressure from a ‘well applied presenting part’ can help to release PGE2 but with or without it, the cx will open. In a well flexed OA baby the forewaters bulge through the cervix with contractions and help to stretch and dilate the cx – the head is unable to do this. I explain this in this post: http://midwifethinking.com/2010/08/20/in-defence-of-the-amniotic-sac/
I also wonder what is meant by ‘frequent and effective’ contractions? I see some great births with infrequent but very effective contractions. What is effective anyhow? Meeting timelines imposed without evidence? Is a uterus that takes 24 hours to birth a baby is effective?
The anatomy and physiology of birth still requires a lot of research to iron out what exactly is going on. A lot of assumptions have become text book and are having to be re-examined. There is a lot more to the cx opening than the mechanics of a ‘battering ram’ baby. Despite this we do ARMs to assist create ‘pressure’ without evidence that it speeds up labour and with evidence of the harm it can do.
Does that answer your question?
ps. Keep asking questions – it’s so important for developing your knowledge and practice.
Thanks for your very informative response which I have read and re-read several times, including the post on ARM.
It’s difficult to depart from the ingrained (obstetrically-driven) idea that strong, frequent contractions, accompanied by a well-applied presenting part, are essential to achieving cervical dilatation. Inevitably this is all connected to the weighty issue of time-limitations in labour which in my view is the biggest hurdle to challenge as a hospital midwife in any country. As they say, knowledge is power and this blog is certainly empowering for women and midwives.
I believed what I was taught for years. I only really learned about birth by witnessing women do things they ‘weren’t supposed to be able to do’ at homebirths. Without rules and constraints amazing things happen and you begin to see how birth actually works. Then when you look for the evidence to support the assumptions we have about birth, it is rarely there. I think it was Marsen Wagner who said ‘fish can’t see the water they’re swimming in’. Midwives have to keep finding ways to see the water – it’s hard!
Very true. It’s especially hard to “see the water” when you work within an institution as opposed to independently. I wish there was a manual on how to assertively challenge the obstetric-model of care/decisions of our obstetric and midwife colleagues when we feel that these are not in a woman’s (and her baby’s) best interests. Your blog is an incredibly useful spanner in the rather large tool-box that’s required to attempt it though!
Thank you for another wonderful post!
I have a question about my personal experiences. I’ve given birth twice – once in the hospital with an OB and once at home with a midwife. Both times I’ve felt impatient toward the end and wanted to push despite feeling no urge. I actually asked for an exam from my midwife. After the fact I wish I would have waited until the urge. I know I am capable of having a pushing urge because earlier in my first labor (sometime before 9 cm) I had an urge to push that led me to go to the hospital. (I was staying home “as long as possible” – should have just stayed home the entire time!)
I realize that you can’t necessarily tell anything since you weren’t there, but I was wondering what your thoughts were.
Whatever you did worked. It is usually best to wait until the body starts pushing but some women don’t want to and if it works, it works. There are no rules for birth
Thanks, Midwifethinking.
If I ever have another child, I’m going to try to wait. But you’re right, of course!
I really enjoy reading your posts. So glad there are midwives like you out there!
Hej,
I enjoy reading all of your posts! Luckily enough I found a midwife here in Germany for my home birth who says she never got why most people have to have their hands on birthing women all the time
I will see how it goes in just four to six weeks…
During my first birth, a drug-free birth center birth, I had the midwife check me often because I somehow thought someone had to tell me how far I was and what to do now.
Later after hours stuck with 6cms, I just did what I felt like all the time – not pushing but breathing down, with a light pressure when holding my breath really short after the inhalation. Probably some people would say this is pushing but it was just what I felt like doing for so long – 7cms to full dilation in like one and a half hour.
For my next now upcoming birth I know that my body just knows what to do and that I can flow along, no matter what cms – and I already told my midwife that I don’t want internals unless really necessary because I got so stuck on them in my head.
Thanks for your thoughts – I will be a birth professional some day although I don’t know how yet (I’m nearly a doctor by now but doctor’s don’t have the right to attend births alone here without a midwife) and your thoughts definitely inspire me!
With our 1st, we were told over and over again in our Bradley class not to push unless fully dilated because our cervix will swell and the baby will get stuck. Well. Of course I had the pushing urge and wasn’t fully dilated, plus I had no idea how utterly defeated transition would make me feel. I just knew I wouldn’t be able to have this baby. So we loaded up and headed to the hospital, with me fighting the pushing urge all the way AND mentally preparing to have a c-section. (Yes, I was a bit dramatic, a LOT scared, and foolishly naive for not believing in my body.) Of course the baby was born just fine a few minutes after we got there. The OB did stretch my lip over the baby’s head, it was horrendously painful (though not as bad as being tied down on my back), and I am left feeling idiotic for freaking out and believing all the negative garbage people had been telling me.
The next two births were awesome though. You learn better, you do better.
This is a wonderful site and discussion here.
My midwife for both of my two homebirths was wonderful in that she assisted, more like stood by and waited for any indication from _me_ the birthing mother and baby. She hardly ever interfered and never made me feel like I could not birth when the baby was ready to be born. We all have our way of coming into this world and babies are so wise. It is the classes, over-preparation and intense medical interventions that gets in our way of birthing beautiful babies the way they are meant to be birthed. Of course there are times when we really do need outside help and that is perfect in itself. Getting “stuck” at 7-8 cm seems a natural break to let us rest for the hardest work yet to be done. It’s not a stuck but a necessary grace at times, to pause before that glorious moment coming. It is hard to know it when we are in the throes of labour, but on my second birthing, I knew more what to expect and the “stages” of labour felt more natural to me than with the first. We learn so much as human beings going through life on this earth. We need to be able to learn on our own, especially while birthing! What better way to trust our selves, our babies, our very carrying on of a species? It is spectacular. My midwife matched this high standard and thensome. I cannot be more grateful to her and my sons for the lessons they gave me room to learn from. I continue to learn from my boys as they grow and teach me how brilliant their young minds are. Homebirth really is a way to let them come into this world respectfully and mindful of their wisdom. This is the strength of a woman and her babes. We need to make it so.
As a first-time mom I am soo thankful for this blog. There is an immense amount of wisdom here. I really want to go the natural, pain management-free route, and trying to get my hands on as much info since I’m in my 2nd trimester now.
I hear from everywhere- don’t be hero, there’s no medals for bravery so just get the epidural.
Thank you for this page and I will revisit often!
If there are any links or “Need to know” info that you could direct me to I’d really appreciate it!
I recommend Sarah Buckely’s site/books/articles to parents. You can download a free ebook from her site: http://www.sarahbuckley.com/
There are no medals for bravery but the oxytocin and endorphin cocktail you experience without an epidural is better than a medal and more empowering.
I don’t know if this happened to me but I did go from 5cm to what I assumed was 10 very quickly with my second baby. I had a burning sensation when I pushed so perhaps this was the last of my cervix? The pain seemed to me to be a warning not to push, so I tried not to. I felt the contractions but was able to stop myself from pushing. But the midwives encouraged me (gently) and once I got past that burning sensation it was fine. Your article and some of the comments have got me thinking about the possibility I may not have been fully dilated when I first got the urge to push.
In any case, I have to agree that an internal examination is not the best idea. I wanted to get an idea of my progress but when I heard 5cm I thought “halfway”. Actually I was getting to the home stretch.
Whatever was happening you listened to your body and did an amazing job of birthing your baby
Thank you so much for this!!!!!!! I believe this is what happened with my second baby (first VBAC). My body started pushing uncontrollably, I likened it to vomitting, when my midwife suggested an epi as my cervix was “undilating” WTF? Of course, I believed her (did someone say something about hindsight being 20/20?) and opted for the epi. I have always believed that it was an anterior lip but had no idea what that was then. I am proud to say that I got my VBAC without any instrumental involvement but if I had of been left to my own devices, I may have achieved the drug-free VBAC that I had craved.
I had that with my first. I always describe it as similar to a “gag reflex”!
Oh, wonderfully written! I had an anterior lip twice … then didn’t bother checking for one on the 3rd birth after telling my midwife (different from the 2nd birth) that my only recollection of pain had been pushing against the lip while my midwife moved it out if the way. That birth was also a shoulder dystocia. Birth #3 had me very impatient but my midwife was so hands-off and trusting of my body. Thank you for this comprehensive reminder of how amazing our bodies are, even when we feel like they’re complicating the process!
Hej Rachel,
I birthed my second baby girl the day before yesterday at home in my birth pool with a totally hands-off midwive. She just checked me at the end because I was asking something about my membranes that didn’t release and told me “Open – hmmm, 9 centimetres”. I thought about this post immediately and just went on with my pushing and breathing and 15 minutes later baby came out perfectly fine
She trusted me and my body as I did and was amazed by how well it all worked.
Thanks for this post!
Congratulations Laura!
Enjoy your little one x
Thank you so much for this post. After all these years I was sure there was something wrong with me because of this anterior lip. My first birth was amazing, despite the midwife trying to “fix” my “lip problem.” I experienced the primal pushing urge and it was an amazing thing. My second birth, not so much. Same midwife showed up (I hadn’t hired her this time, my new midwife lost her nerve and called for back up) and she insisted I had a “stubborn lip” again. She held it while I pushed for what seemed like forever. I never got the primal pushing urge, in fact, she decided I wasn’t going to have it and yelled at me to start pushing. And these were homebirths!
After this I had lost all confidence in my body and in lay midwives. After much contemplation, I decided to have #3 unassisted. Not the best choice because I hadn’t ever really regained the trust in my body to birth without someone sticking their hand inside me. I ended up deciding to transfer during transition. Luckily the hospital birth was fine. The doctor said nothing about a lip, just told me to push. I was so far from an urge that I couldn’t even figure out the mechanics, but it all worked out in the end.
Now that you’ve alleviated my concerns about the anterior lip (thank you from the bottom of my heart!) I am wondering now about that pushing urge. It was so obvious and sudden with my first. With my second and third I didn’t experience anything like that at all. I figured it was just yet another way my body was failing me in birth, but maybe there is another reason? Maybe I was just rushed to pushing too early? Maybe if I have another baby I will feel this urge again? Maybe I’m not broken after all…
You may not have had an urge to push because the baby’s head was not low enough to press on the relevant nerves. Or, you may be one of those rare women who never feel an urge to push. Either was the baby will be born. The uterus continues to contract until the baby is out whether you push or not. Unconscious women can (and have) given birth. Trust yourself
Maybe it was just the mechanics of those particular births. My first and third had uncontrollable urges to push. I really like the phrase “throwing down” (as opposed to throwing up) to describe it. My second birth – nothing. No discernible urge at all. My uterus was doing some pushing on it’s own, I guess, since my midwife said I was grunty, but I didn’t feel a thing. This post has reminded me again how complex the mechanics of birth is. It should be no surprise that each one is unique, even to the same mother.
Wow, what a great site! I was unfortunate enough to push when I did not really feel like it with my 5th birth and pushed my uterus out with my baby! We were at home and it was almost tragic. It was very traumatic for all concerned, but we all made it, and lived to tell the tale! I hemorrhaged and was demanded to “come back here, do not leave me” by my wonderful Midwife when I just let it all go after everything was out! It worked! Only due to her competency I was able to save my uterus, something that I do not think would not have happened if I had been in hospital! After putting the uterus back in she firmly said ” if you want to keep your uterus don’t get out of this bed for a month”! I did what she said with a very dedicated support system and I did not get up for a month! It has been almost 15 years and my uterus is just perfect along with my beautiful daughter!
Wow! How scary for all involved. I’m pleased you survived
I just w3ant to say that this comment is completely true and that it happened to me with my first child and that I never listened again to anyone else and never had any trouble pushing out babies before I was supposed to according to the carers and I think its because women get into vibrations together and the babies come in a rush that is too uncontrollable for the hospitals . I gave birth in the wrong ward because the nurses thought I was not ready and then had to be lifted on to a wheel chair and moved with the head crowning because it looked bad that I was put in the wrong place.
This is a great article and it has given me hope that I can have a successful VBAC if I listen to my body. I was induced with Pitocin and went without pain meds/epi for a while until the lack of progress and the urge to push at roughly 4-5 cm, -1 stations and bulging bag of waters defeated me. I wish I would have followed my urges and pushed. I have a long laundry list of “should haves” including declining VE’s and not consenting to Pitocin induction and avoiding the epidural; all of which were the original Bradley Method plan. At the time I felt like the induction was medically necessary, but feel a bit differently now that I’m not an emotional time-bomb with the world of my unborn child on my shoulders (speaking solely for myself and not generalizing for all pregnant women). I came across your post while I was trying to find anything linking Pit with premature urge to push and it possibly being a sign of uterine rupture. I’m trying to figure out what went “wrong” with my Bradley birth turned induction, turned C-section before I try for a VBAC. Building my arsenal of info on everything and anything that was/could be a pitfall for me. After reading your article I am wondering what your thoughts are on pushing with the urge while on Pitocin? Since it creates artificial contractions that come with risks (tectonic contractions and uterine rupture) should I have still listened to the urges to push? I hope to not be in that situation next time but with possible gestational diabetes it is likely to be an option before repeat C-section.
The urge to push is related to where the baby is in the pelvis rather than the strength of the contraction. If you have an overwhelming urge then you can’t ‘not push’ so it is not really an issue about whether or not to do it. It is the tectonic contractions rather than pushing that ruptures the uterus.
I wish was informed about this before I went into labour, I just recently had my first child on April 8th. I was given cytotec 5 hours after my water broke because I was told my cervix was not dilating fast enough then pitosin another 4-5 hours after that. At that point I accepted to have an epidural because I was told my contractions would be more vicious with the pitosin. I was able to get 10 cm dilated but was told that I had a lip on my cervix, the nurse pushed the lip aside while I pushed. I pushed as hard as I could because the doctor was talking c-section. My vagina became very swollen and I did not want the nurse to push the lip aside any longer because I did not feel it was helping. The doctor said the baby was not going to be born vaginally and that I had to have a c-section because I became feverish and developed an infection too. My experience was very traumatizing but my husband and I want another child later on so I am going to find a midwife next time and hopefully I can have a VBAC
I am sorry that you had this birth experience. Knowledge is power but women often don’t have the information before the event. I hope you have a healing VBAC with your next baby.
Just read your story, Sunshine, and wanted to commiserate with your experience. In Australia Cytotec is not used (as far as I know) but from what I have read it is a nasty way to augment or start labour, so an epidural is almost mandatory! Also, Pitocin (“Oxytocin” over here in Oz) is a powerful drug which causes very strong and painful contractions which are nothing like the gradual build-up which a woman’s body can produce. You are amazing because you actually got to “fully” so, when you next give birth, your body will remember that and dilatation should be much quicker and easier. Of course, you will be much more likely to relax and dilate if you are not being bullied or frightened into accepting unnecessary interventions. It is also possible you might have been misled about about the fever and infection. The epidural itself is well known to cause a rise in temperature, which can lead to baby’s heart rate rising when Mum’s does. Were you given antibiotics (probably by injection)? The membranes can be ruptured for many hours without infection if vaginal exams are avoided. If I were the midwife looking after you I would be reassuring you that you have an excellent chance of gving birth naturally next time!
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I had two births, one was a natural and the last one was an emergency c section. Both times I had my midwife manipulate my lip as I was trying to push but they just wouldn’t come out. With my first I was so close to giving birth but the erge to push just dissapeared but eventually came back about 1 hr later. With my second I had a sudden emence pain that was nothing like anything I had experenced before and a whole team of people were called in. Bubs had shifted and was coming out as brow presentation and I was told to stop pushing. Do you feel she shifted position as she couldn’t get out? Should I have been monitored more closely and had the lip moved again? I am now 6 months pregnancy and thinking about a c-section again just to avoid this situation again but I am really wanting to have a vbac.
It is impossible to say what would have happened if you had been not had intervention and instead trusted yourself and were surrounded by people who trusted your ability to birth. Sometimes babies need time to get themselves into a good position before moving through the pelvis and if the mother is unable to move instinctively and wait they can end up coming through in an unhelpful position. It is unlikely that your baby moved into a brow position due to lack of space in your pelvis and a brow presentation = a much bigger diameter than a tucked in head. You can have a vbac – just trust your body and avoid being ‘monitored’ or being directed by others.
That described my 1st birth to a T!!!
Tho second birth still had anterior lip and instrumental birth altho short labour and no epidural…
With my 1st birth, I was in labour for 36 hours all up. At around 28 hours in, I was told to follow my body and push, resulting in an hours worth of pushing with no progress. After a VE a hospital midwife told me my cervix was swollen and only 9cm dilated, with an anterior lip. I was exhausted and they gave me an epidural and told me to wait a few hours. I was again told to push as the epidural wore off, I pushed for another two hours before I was given an episiotomy and a forceps delivery which left baby with cuts on face. 9lb 12oz daughter. (6 days later I was back in hospital on a drip with burst stitches and infection).
Second labour was 6 hours all up, my waters were broken at 3cm after labouring 4 hours and with in an hour I was 10cm. Pushed for 2 hours with another anterior lip (doctor was pulling the anterior lip back with each contraction, AGONY) baby not making progress.. The doctor was nearly about to start pushing baby back in and get me ready for C section but then decided to give an episiotomy and metal ventouse delivery because babys heart rate dropped dramatically. Ventouse ripped an area of skin of my sons head that didn’t heal completely for months.). 9lb 4 son.
I am worried about having a 3rd baby as I don’t want bad things to happen again!! Is it possible for me to actually have a normal birth? Or should I get an induction and epidural a few weeks early so baby is smaller and wont cause so much damage?
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I have never worried about cervical lips with multips…a cervix that has opened before moves out of the way easily once the spontaneous urge to push sets in.
When a primip starts to push, I simply ask if there is any “pinchy” feeling up front. If so, I suggest hands and knees so that the descending head can move the cervix completely out of the way. Works like a charm.
No swollen lip, no vag exam. Mom gets to keep following her instincts to push or hold back or breathe or grunt or whatever feels right.
However, if she is still feeling the pinch I may suggest breathing through. It is possible for a person to feel both urge to push and also the pain of an anterior lip with that urge… so as midwife it is my role to lend a hand and make suggestions that ease the way of birth.
I have found the The Anterior Cervical Lip post by ‘midwife thinkin’ fascinating. I had my first child 5 years ago and my body started to push at 5 cm. I was told to stop pushing but I couldn’t, my body took over and after a while was examined and told that my cervix had swelled (the words ‘Anterior cervical lip’ were not used ). As I could not stop pushing, they convinced me to have pethedin, which did nothing, and then ended up having an epidural, whereby many hours went by whilst waiting for the cervix to calm down. The baby was also in the wrong position, and I was asked to different positions to try and readjust the baby. The birth ended in a van-teuse delivery, after pushing for 1.5 hours unsuccessfully. I was very dis-sapointed to have drugs and it begs a question were they necessary ? I am now pregnant with my 2nd (at 40 years of age) and am concerned that this will happen again, so want to know as much information as possible to prevent it (if I can !) Your thoughts would be greatly appreciated. Donna
Donna – all you really need to know is that you are the expert and know how to birth your baby. If no one knows what the cervix is doing it is not an issue – so perhaps decline vaginal examinations
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“I believed what I was taught for years. I only really learned about birth by witnessing women do things they ‘weren’t supposed to be able to do’ at homebirths. Without rules and constraints amazing things happen and you begin to see how birth actually works. Then when you look for the evidence to support the assumptions we have about birth, it is rarely there. I think it was Marsen Wagner who said ‘fish can’t see the water they’re swimming in’. Midwives have to keep finding ways to see the water – it’s hard!”
This is great. I agree.
I’m an evolving midwife, too. I’ve “reduced” many lips in my time. I don’t, any more. I’m finally doing what I love…attending home/birthing center births. I don’t do exams if I can possibly help it. I leave the cervix alone. I’d never tell a woman not to push. It’s so much better working without rules and constraints, and supporting women in their power. The less I do, the better it gets.
I attended a birth of a first time mother a couple of months ago. She requested an exam when she arrived at our birth center. She was pushy, and sounded complete. I checked, she was only 4cm. I asked her to listen to her body and to do what felt good. She hung from a swing and moved about the room, got in hands and knees position as we prepared the bath. She spontaneously pushed for a few hours (long before she was complete, I’m sure), and had a lovely waterbirth a little while later. No more exams.
One of the problems I see is that women “try” to push the baby out when they begin to feel rectal pressure or the urge to push….the valsalva, bug out your eyes, hold your breath kind of pushing. I ask them not to do that…and to wait until their body is pushing spontaneously. Unfortunately, women have been culturally conditioned to hold the breath and push. They don’t trust that the body knows how to do it.
When I read this post I felt very sad as it sounded exactly to the letter how the birth of my baby had turned out. I am a midwife and was keen for a drug free water birth. After 2 days of labour and no drugs I finally felt the urge to push and push I did. After some time (I was pushing in the birth pool) my midwife decided to check where I was at. You guessed it 9cm with a lip. To cut a long story short I was told to stop pushing which was extremely distressing and might I say impossible. In the end I was told I needed an epidural and after many more hours, a syntocinon drip and an abnormal ctg my daughter was born via forceps. I ended up with an episiotomy and tearing, incontinence for a few days, wound breakdown which required reconstructive surgery at ten weeks postpartum, six months of pain and a lot of emotional scarring. I am scared for next time now. It makes me sad to think that if they had just left me alone I would have birthed my girl in the water without drugs and without fear.
Culla – it is very unlikey that this will happen again. Get informed and supported and work through your fears.
Dear Culla,
I’m so sorry for you!
You cannot know what would have been if…
Probably this post helps you for the next time and you don’t need to be scared now – you’re able to do this! Probably Hypnobabies might be good for you, to recognize your fears and let them go.
Thinking of you!
This is interesting…I have had an anterior lip with both my births (different midwives). First midwife manually held back the lip during contractions and pushing, after breaking my water…AGONY! Second birth, midwife did not break my water, or intervene in any other way. She had me do some contractions on my hands and knees, after she discovered that I was 9 cm with an anterior lip, and I remember them being more painful in that position for about 3 contractions. Then each subsequent contraction got less and less painful until I felt I had made whatever progress was to be made in that position, and then she checked again and the lip was gone. She also administed Arnica orally (under the tongue) every 10 minutes during the last hour of labor and my water broke naturally as the baby descended with no pushing on my part whatsoever. It really amazed me as I had to push against that lip of cervix for 45 minutes with my first birth!
Just saw the previous post by Kristin Kali, about hands and knees positioning to take care of an anterior lip, after I posted mine…I guess it is a known trick! Worked for me!
One note on this.
When my x was in labor ( natural w/h mw in hospital) we were not told ahead of time that her body would push on it’s own. She thought she would be directed as to when to push. I do not remember this being discussed during any visit. It scared her that her body was doing this as she was unprepared. Please be sure that even as you are not telling moms when to push – which is good- you ARE telling them that there body will push for them when the time comes, rather than the more vague just listen to your body. Great article.
Such a great post – I’m due to give birth in two weeks (or so!) and this article has come at great timing
They can keep their hands away from my bits
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I like your article. I’ll have to check out more. I’m done with my baby-making career now. I have 3 boys. My first birth was a ‘failure’ on so many levels. I had a midwife who had lots of experience except with a woman like me. She told me to push when I was ready. Well here’s the first mistake. I was having mild contractions, lost my plug. We called her and she showed at about an hour later. She had to come from another town. I started to push not realizing that I ‘really’ didn’t have the urge. (I didn’t come to this conclusion until after the birth of my 2nd child.) I wished I had not pushed so soon. I think what happened with all that pushing was I got so swelled up in the vaginal area that that prevented things from being smoother. After about 10-12 hours of pushing, in and out of a tub of water, my son’s head came past the cervix and he then was brow -presentated and sunny side up. He got stuck. I was going into shock. They called for an ambulance and the techs told me not to push (ha ha, if I could have punched them I would) for the 45min ride to 2 towns over to the hospital. The hospital performed a c-section and pushed my son back through the cervix and out the belly. I had quite an infection from that procedure. My belief is that if I had waited maybe 4-5 hours before pushing that maybe my son would have presented better. I hope this helps out you all for better future births.
Aspen, what do you think should have been done to help you not get a c-section? your birth experience is the same as mine (I do have a post above about 2 months ago) and I am due in 7 weeks but scared of the same thing happening again…
I would first trust the midwife. I was told by another midwife that an unconscious woman could birth a baby. Think big mouth, wide squats, relax and don’t be so eager to get it over with. At first I really didn’t have the urge to ‘take a dump’ with my first 3 hrs of contractions. Maybe do some minor house work for the first part, but like I said, trust your midwife. They’ve been around many moms through various situations. And don’t worry about your poop or you pee, it’s all part of the program ; ) Many blessings your way ; )
i think its under TULIP as a user name…
but both my labours were loooong! ..and I think all I can remember was the midwives telling me that I had to push….I don’t think I have ever had that URGE!. especially when the contractions stopped for at least an hour with my first. Would you go for a c sect next time (if you were to have another)
I think it is important to not have any vaginal exams. It doesn’t matter what cm dilated you are, the baby will eventually come out, whether you are checked or not. With my second pregnancy (twins) I was checked at least every hour. Baby A was breech. I got to 10cm and was told I was ready and had to push. I had ZERO urge, but I was basically on a timeline by the doctor and he was so ready with a knife for a c-section even if both babies and myself were handing labour perfectly, so I felt I had to push. For 2 hours they had me on my back, pushing with all my might and nothing happened. Finally a young nurse came in and had me get up and squat, and the baby started to come out. It was still so much forces pushing it was terrible. I eventually pushed her out ion 2 more hours, and her brother was pulled out using vacuum extraction because they were done waiting. I am glad I did not have that c-section, but the birth was less than ideal. My family doctor afterwards told me at my 6 weeks check up that my cervix looked like a war zone…nice. Makes me wonder if it is a possibility of dilating PAST 10cm, maybe 11 or 12 (why is 10com the golden number and how do we know that is all that the cervix can do?), and then I would have had the urge and my breech girl would have come out on her own.
With my next pregnancy it was a planned home birth. I laboured on my own at home with NO vaginal exams. I got an extreme urge to push, in fact I wouldn’t consider it an urge to push, I would say I did no pushing, my body pushed the baby out on it’s own. There was nothing I could do to stop the pushing as I was not pushing, my uterus was contracting and pushing down on the baby so she came out.
I would highly suggest to anyone to not have any vaginal exams. Eventually you will know the babies birth is imminent because they will start to come out with no conscious force of your own. Birth is not an exact science, no one really knows how dilated a cervix needs to be for any given baby and position, and no one really knows how long it should take to birth a baby, except your body.
*Like*
But if you don’t have any vaginal exams, how will you know if the lip needs to be moved out of the way?
I think the point of this whole article was that the lip does NOT need to be moved out of the way and the mom does not need to be told when to push or told her body is dilated enough to push. Left alone a mom will labour in various positions, move around, and eventually the lip will go away on it’s own with contractions. Even women in comas can give birth with no conscious effort, the uterus will expel the baby. I had a lip with my twins but it was never moved out of the way, I just laboured for another hour or so and it was gone. I am sure in the long ago past vaginal exams were never done, and yet babies were born and the human race went on. In MOST cases left alone to labour, a baby will just come out, no medical interventions needed and no checks at all, that is birth, it is made to happen.
Is there ever a valid reason for vaginal exams? I had a horrible birth experience in January at a freestanding birth center. I requested no vaginal exams and they initially agreed to it, but during labor they kept insisting that I needed them and bullied me into having AT LEAST 10. The exams were excruciatingly painful–7 months later I still cry thinking about them. They midwife also manually dilated me from a 7.5 to a 10, which was even worse. For my next birth I want to just not allow ANY exams whatsoever, but I need help to figure out whether that is a safe thing for me to insist on. My baby crowned for over an hour–I can’t describe the pain–before the midwife did an emergency episiotomy, and practically pulled him out onto the tile floor of the bathroom. I had planned for a peaceful water birth and feel traumatized by what I ended up with. Baby’s heartrate had fallen to 50 bpm hence the episiotomy. The entire birth experience was just so horrible that I am tempted to just do a hospital birth with epidural for the next one, but if you can help me figure out a better way to do a natural birth I would love that.
I am so sorry that you were abused during your labour. Manually dilating someones cervix is disgraceful practice. I really don’t know whether your baby was in distress or not without having been there – however, I wouldn’t be surprised considering how much distress you were in. The only suggestion I can offer for your next birth is to choose your caregivers very carefully.
Another question: I never felt the urge to push, but was told I had to because my baby was going into distress so I pushed with everything I had for several hours. Were my midwives wrong about that too?
Thanks for this post. The scariest part of birth for me is near the end when I’m 9cm or so and I feel like pushing and they tell me not too. Swollen cervix, severe hemorrhaging etc is what I was told could happen. Scared me to death. I didn’t want those things to happen, but felt almost powerless to stop the pushing.
Laboring to 7-8 cm doesn’t scare me. Pushing baby out doesn’t scare me. It’s that time in between when things are so intense and they tell me not to do what it feels like my body is doing on it’s own. I feel so out of control and terrified that I’m going to hurt myself because of it.
However, I have had 3 births where I did not wait for them to tell me to push. For my 3rd daughter they told me I was at 9cm with a lip. I heard on a tv show that a mom was told it was okay to push at 9cm. I figured it probably would be fine for me too. So when I felt my body pushing baby down, I didn’t stop it. Things were just fine. No tears and baby was out in 2 “pushes.”
Then with my 4th & 5th child same thing. With my 4th, I had 3 strong contractions in a row and my water broke and I felt baby move right down into the birth canal. I just said, “Water broke” and “pushing.” The room immediately filled with staff and as soon as there was someone in place to catch baby I delivered.
With my 5th, I was 7-8 cm and my contractions were spaced out. I remember thinking that I was expecting them closer together and was very relieved that I had a longer break than I thought I would. My dr, of course, was worried and so he broke my water even though I asked him not to (he had a c-section scheduled a few hours later).
After that, I did not let them touch me at all. I stayed on my side. They said they wanted to check. I told them not yet. Then I felt pushing contractions and just said, “Pushing.” Of course, dr and nurse said, “Wait! Let us check.” By then baby was pretty much on her way. I had no checks after 8cm and again, everything was fine.
I was upset that dr made me feel like my body wasn’t working since contractions were spaced out even though I KNEW I was doing fine. I was upset that he broke my water after I specifically asked him not to.
In my head I think I’ve always known that my body knows what to do. I’ve had 5 births with no drugs. But that 5th one left me with so many doubts because of things the dr said and did that I had so much anxiety leading up to my 6th.
I chose to get an epidural that time because I couldn’t shake the fear of not being able to not push when they told me I shouldn’t.
Now I am pg with #7. I found that I still had a lot of anxiety surrounding the idea of birthing. Hard for me to accept after having 5 wonderful non-medicated births. I hated that I was so scared. Even if I just laid down to practice relaxation/breathing, I would feel so anxious. I could feel myself breathing in and out nice and deep yet I still felt like I was getting no air.
It’s articles like this one that have made me feel more confident in my body again. I can now lay down and do visualizations and breathing without that feeling of anxiety! I know that I probably do not have to fear that part of labor when my body is pushing all by itself. I’ve done it before and was always made to feel like it was “wrong” or “risky.” Now I am more confident that I can trust my body. I’m looking forward to having another non-medicated birth.
I’ve forwarded this article to my midwife in an attempt to get some additional feedback on my first birth that ended in a c-section. After 5 days of intense back labor at home with a posterior baby and my bag of waters popped by the midwife, I finally made it to 9 cm before the swelling began. When my midwife checked me she said she felt a lip which I’m assuming was this anterior cervical lip that you have described. I never had a strong urge to push and even tried to push before transferring to the hospital without much avail. When we arrived at the hospital they said I was only at 6 cm and I received an epidural which got me to 9cm again before the swelling reappeared. I even tried pushing again before being wheeled into the ER for a c-section. When they pulled the baby out it was evident that she had been stuck. Now I’m at loss as to what to do with baby #2. We really want a homebirth, but I’m fearful that the same thing will happen again. Any suggestions?
Is this the same midwife? She will have a good idea about what was going on in your first birth. You didn’t have a urge to push which suggests your baby was not deeply in your pelvis triggering the urge.There is no reason that this will happen again. Every birth is unique.
Just wanted to say I delivered my 7th baby last week… he was posterior, so the labor was slow. Short contractions, further apart. I did alot of position changes and forward leaning, hip hula-ing stuff during ctx… and praying/trying to turn him around with my hands in between. Finally got tired and decided to just give it a rest, sat back in my waterbirth tub, started relaxing to the max during ctx and zoning out in between. About 4 ctx into that, he turned spontaneously!
Then my labor picked up and I went into hard labor. I was checking myself as things got further along and all I could feel was this squishy thing… wondered if some small soft part was presenting? Didn’t feel like water bag.. no pulse in it, so not the cord and way too softy for that anyhow…
And yes, baby was for sure head down as I could feel his hard round head by palpating just above the pubic bone…
Eventually I realized it was my cervix, all swollen up and in the way. Baby was moving down onto it, and it hurt like heck. More forward leaning positions!
As baby moved down I could feel the rim of my cervix, tight & with a fat swollen anterior lip in the way… hurting! lots!
Massaged & pushed the swollen part back past the pubic bone, trying to push baby downward so it would stay in place… cervix started to bleed a little. So I waited through more ctx, holding cervix back the whole time to allow baby’s head to descend further on it’s own..painful, but it was what I had to do!
As the head descended further, I could still feel cervical rim tight; not quite all the way dilated…I massaged some Arnica oil into it, took about 6 droppers full of Lobelia tincture, and felt it relax some. Stuffing swollen part up past pubic bone… but I somehow *knew* that I did not need to worry about it anymore, even though I could still feel a little tight rim….. Then baby came past it and we were onward to pushing! This labor took about 4 hours more than my usual 8-9 hour labors, and was harder. Baby was born after about 14 hours of labor and came out smiling! A handsome 9lb, 5oz strapping baby boy! Gotta Love it!
I have held back my own cervix before, but this was a tougher case and swollen. It works.
C-section not necessary.
Although, I must say that after 5 days of back labor! (wow) I think I just might be willing to do a C-section! So Sorry you had to go through that!
forgot to mention that I popped the bag of waters somewhere in there before I did the Arinca/Lobelia, just got to a point where I felt that it would be a huge relief if I could just get that water bag popped… so I popped it.
That sounds really painful!
“I am yet to find any evidence that pushing on an unopened cervix will cause damage. ”
I went natural 9 months ago, in a hospital, I was at a 0 for dilation when i arrived and delivered within 4 hours. Very few cervical checks since i labored quickly. I hadn’t fulled dilated when i needed to push and was encouraged to push by the doctor due to lots of meconium coming out, baby was fine, no fetal distress or issues once out, but I ended up tearing my perineum and cervix and had to be sewn up. I know he sewed my cervix, i felt that and remember it clearly! hah. I was only dilated to about an 8 or 9 when I pushed. I did labor on my back , i didn’t want to squat or do any other positions. But i just wondered what you might think have occurred then since you’re not positive that an unopened cervix may cause damage?
I was also taught in nursing school about cervical tears and damage that may occur with not complete dilation, but i always like to do my own research outside of what i was taught so very curious about what you think.
Hi Jessica
I think that there is a real difference between spontaneous, uncontrollable, physiological pushing and that which is forceful and directed by care providers. I would say that forceful directed pushing could damage a non-fully dilated cervix, as was clearly the case in your labour/ birth. I am glad that your baby was ok and am sorry about your injuries, I hope you have healed well.
What Bella said…
When a woman is birthing physiologically without instruction (or encouragement) she is unlikely to damage herself. Women often feel that they need to push but eventually this ‘feeling’ becomes a doing without ‘effort’ and care givers should wait rather than encourage pushing at the first ‘feeling’. Gloria Lemay describes this well in her audio. If you read the comments here lots of women have pushed on an un-dilated cervix without tearing. I don’t think it is fair to instruct all women not to follow their natural urges just in case they are the rare woman who may cause damage… it is also impossible to not push anyway.
Very interesting. I started pushing when I was 8 cm but all was pretty much mush at that point with my last birth, and as soon as I pushed through one cx while on the toilet his head pushed the rest of my cervix out of the way and he was born 15 minutes later (this was after 2 1/2 wks of off/on labor with a funneling scarred cervix), and I was so happy that my midwife actually suggested trying to push a little bit to see what would happen. Not sure how much longer my labor would have lasted if I hadn’t done that! It’s fascinating how the cervix can react so differently in each woman and each birth!!
In a lot of cases, nature does know best… and when you have patience… things have a tendency to fix themselves… it is a matter of trusting and holding everything in that space of total trust that hings enfold in the best optimal manor. We do have a role in choosing how we hold the space as care provider if we are conscious of how we make an impact on birthing woman and companion and of course baby. Keeping our mind/heart clean is good
I’ve had 3 vaginal births and any day now about to have no.4. I have never had that uncontrollable urge to push. I get a little bit of an urge with the pressure of the baby’s head once fully descended but it’s certainly not an uncontrollable urge. I could sit at full dilation and do nothing, which is what I am thinking I will try this time around. My first never descended after hours at full dilatation and had a below average head size but very large shoulders and abdomen which were more painful and hard work to get out than the head. We tried different positions to move baby. Didn’t work. Baby started to descent during last stages of pregnancy and then stopped and moved back up. Tried different positions to encourage it down. I actually felt that the squatting position ‘closed’ me up instead of opening my pelvic area. My Dr was very flexible in allowing me to go vaginal birth but after wards said maybe it should have been a c-section because of the birth trauma. I was extremely bruised and battered below from his large size, lost huge clot and blood and had lot of stitches as forceps were needed – baby was just stuck, did not budge. He is now a really big boy anatomically. I was anemic and it took my body longer to heal from that vaginal birth than my friends who have c-sections. I would never want to birth a huge stuck baby again, just because it is ‘natural’. I will of course try my hardest and try all the things there are to try. I have since had another ‘big’ baby who came out easier but was certainly more difficult to get him out than my smaller average sized baby on my knees leaning forward which may have helped in me only having a few small grazes, which was lovely for recovery afterwards. What I want to say is, sometimes ‘natural birthing’ does require help and that’s o.k.! I have had midwives from Africa who say, women give birth naturally under trees in Africa but they also die by themselves under trees because they have no help when needed. Why do they have to have Fistula clinics in these countries? Maybe there is a reason why mother and child mortality rates are significantly less than 2nd and 3rd world countries. I think the concept of ‘natural birthing’ is a little confusing. Whether I have assistance or not during a vaginal birth, it is still my body that is ‘naturally birthing’ the baby, no one can do that except me and women need to be encouraged that they tried their best at the time regardless of the intervention they received. I’m all for natural birth, don’t get me wrong, but I have experienced birth trauma because we tried to do it without intervention. Birth is only one part of a child’s life time. I am very greatful for happy, healthy and whole babies after delivery. I am about to birth baby no.4 with a very recently fractured rib and if I can’t do it because the pain in my chest is too great then I may just opt for assistance and that is o.k. As long as the baby comes out and we are all o;k; afterwards.
Hi Louise. I’m not advocating that natural is always best. Intervention is required in some cases. The point I am making with this post is that we have created a problem where one may not exist. I think you should read my ‘judging birth’ post
Yay, this makes me feel so much better and not alone! I had my first baby 8 months ago and ever since have felt like I didn’t do very well during labour. I was really worried about going into the hospital “too early” and the midwife told me over the phone that I was in early labour, so I suffered on at home while my husband and mother thought I was making a big fuss over nothing. My contractions were really intense for four hours, but lasting maybe 20 seconds and hardly any time between them. When I really couldn’t stand it anymore, I got my husband to tell the midwife I was coming in. When I got there I was examined and told I was at 9.5cm and that the baby would be here ‘any minute’. I asked for pain relief, but wasn’t allowed any. Pretty soon, without further examinations or changes in how I felt I was told I had to start pushing. I had no urge to push. I felt like I was getting told off for not pushing properly, but my body wasn’t telling me anything, so I was pretty much doing it blind. I was getting told, the baby is stuck, you have to push and get the baby out. I asked for an assisted delivery, because I really COULD NOT DO IT, but it was refused. Finally after three and a half hours of pushing my waters broke and I started to FEEL the urge to push. My baby was born within thirty minutes. So what I want to know is, was I told to push too early and should they have waited for me to feel the urge to push? Coz once my body had the urge to push it was so incredibly easy to move the baby and deliver her. She had a bruise on her head from getting stuck, but I feel she was only stuck because I was pushing before my body was ready.
excellent post, very informative. I’m wondering why the opposite specialists of this sector do not realize this. You must continue your writing. I am confident, you’ve a huge readers’ base already!
Thankyou for the informative article.
I hope you dont mind me asking a question about the birth of my son 10 months ago.
16 days past due date, inducted with protaglandin. Went into Labour all good. Began spontaneous pushing apparently when my cervix was only 9cm. Baby apparently posterior.
After 2 hours midwife felt that things weren’t progressing, so I had to have CTG monitor (aargh not liking not being able to move). Baby was “in distress”.
Heart rate decreasing on every contraction.
Obstetrician called in. She then proceeded to try and manually open my cervix whilst I was having a contraction.
I cannot explain to you the experience in words.
Anyway, ended up being a forceps delivery. And he was not posterior, but asynclitic I think the word was??
I had a healthy 8.4kg boy.
Yet I have questions regarding the manual opening of my cervix – is that something that is often done? I just cant imagine it would be. But Id like a professional opinion. The docs I have asked seem to dismiss me. I got the “well the main thing is youhave a healthy baby”….goes without saying..
The reduction of the babies heart rate during a contraction – is that something that happens?
Thanks again for your article.
Also something I found interesting. I feel that during labour a woman is very open to suggestion, and therefore the language that is spoken is critical to ensure she remains in a safe space.
I was in well established 1st stage. There was a shift change on the ward, and as the midwife was leaving.. I heard her say to my partner.
“Everything is going great. Soon you will hear a psssssh sound – like she is involuntarily pushing, bearing down”.
Within a minute I was spontaneuously pushing.
As much as I theoretically believe that we are so open to suggestion, I am not decided on whether that comment pushed me into that second stage. …
But I find it very curious.
Hi Rachel. As I previously stated, it is very difficult to comment on a birth I did not attend. Your midwife and obs may have had very good reasons for doing what they did. However, a few points jump out. You were not having a physiological birth ie. you were induced. Your baby had not triggered labour and induced labours require additional monitoring and sometimes intervention. Manually dilating a cervix is not common and very controversial. Personally I have never done it. Decelerations (dipping of the heart rate) is a normal response to the umbilical cord getting squashed during a contraction and/or the head being compressed during a contraction. Decelerations alone are not worrying – it really depends on the context and what other features of the CTG are showing. Most babies will have decelerations at the end of labour when their head is in the vagina. Can you get a de-brief with the people involved to find out more?
Thanks for replying. And after I sent this email this morning, I realised that as you say without the context it is impossible to comment really – so I really appreciate you taking the time to reply anyway. I guess I still have some lingering questions – and you are spot on – I should have requested a de-brief from my care-providers.
I was just intrigued by your article, and jumped on the comment page quickly!!
I was under the care of a birthing centre with a case-load midwife for my pregnancy. But at 14 days past the ‘due date’ I was unable to attend the birthing centre. I requested to wait as long as possible for induction, and I ‘negotiated’ 16 days. Following the birth my baby was taken from me for 2.5 hours due to a staffing issue. So the midwives that were at the labour I didnt feel any real connection with – and that perhaps is why I just wanted to get home and get on with the beautiful intense growing experience of being a mother.
Thanks again, Rachel
On the “asking if you are pushing” thing, when I was in labour, when it got near to the end, I was sitting on the toliet, and my doula was helping me thru contx. at the beginning my body would push a little, happened a few times, when she was out of the room, then she was with me during one and it happened again, she said” oh my goodness that scared me! are you pushing?” I was like, oh thats pushing? I guess I am, but its just my body doing it! after that we danced back to the pool, and they checked me using the butt line method( we did no VE’s) yup she’s complete, you can go anytime, just follow your body, they said.
I really loved my midwife and my doula. my mf was really the hands off, stay out of the way unless needed type, just checking babys heartrate once in a while, suggested a cpl different positions during pushing.when no progress was being made. all 4s, squatting, leaned back. I ended up giving birth leaning back on my hubby. Unfortunately, she was not breathing after birthm, so they had to do resuscitation, and we ended up going to the hospital just in case, she started breathig on her own maybe 10-15 min after birth, placenta still attatched for most of it, pinking well, good heartrate, but man it was scary for a while!!!!
I’m on my second boy, my first wast a c-section due to hospital screw-ups and mistakes, I was 4cm and they gave me petocin to speed things up, then an epidural because the pain from the petocin causing stronger more painful contractions, after about 4hrs of the petocin my body just stopped…. doing anything. I still steer FAR away from that particular hospital due to their incompetence in listening to the patient or their requests. I was really kind of scared in the beginning of this pregnancy due to prior issues, but after doing some VBAC research and reading all the posts here I feel much better in wanting a natural drug free, “let my body do it’s thing” birth. The feedback is on everything is just wonderful. Thank you
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This could have been a play by play of your birth. I wish I would have had a doctor or midwife to encourage me, maybe I wouldn’t have had to have a C-section!
I have had 7 children and an anterior lip with all of them. The first three were held back for me (painful!) The fourth was an unattended homebirth and I thought if I just followed my instincts the lip wouldn’t happen. Well it did and I had it for about 8 hours. 6 hours in I broke my water but still didn’t push. I thought it best to wait for the urge. Hour 7 and my water turned green. By hour 8 I felt scared and just started pushing – hard. Then in a light bulb moment I reached in and held back the lip while I controlled the pushing. I could stop when it was too much and work the cervix over the baby’s head in a way I could tolerate. In 3 contractions that baby crowned. I never did have the urge to push. I have used this method squatting in a deep hot bath tub for babies 5, 6, and 7. Each labor was only about 2 tough hours (not counting the manageble early part) all with a lip I held back after breaking my water. I felt no urge to push with any of them but pushed anyway. The hard part is making it hurt more to get it over with. I think holding back your own lip is the way to go. It shortens labor in a tolerable way. The exaustion from 8 hours with a lip is something I will never forget nor will I ever forget the pain of someone else holding one back for me.
wow
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With my 3rd labour, the baby was posterior throughout the entire labour, and I didn’t get the urge to push until nearly completely dilated and on my hands and knees – just before I turned over, the baby rotated into the correct birthing position, and I started to feel the need to push. Until that moment, there was nothing to push against. As I began to push the doctor told me there was an anterior lip, and I just reached down and started pushing it back myself without even knowing what I was doing. he guided my hand, pulling it back when it looked like I was being too rough, just encouraging me to be gentle, but my instinctive response worked, and the lip was pushed aside, and I was able to birth my girl without any difficulty at all. I was blessed with a doc who was extremely passionate about a woman guiding her own birthing process.