The Anterior Cervical Lip: how to ruin a perfectly good birth

Edited and update: November 2013

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 advised 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 now she is coached to push. The end of the story is usually an instrumental birth (ventouse or forceps) for an epidural related problem – fetal distress caused by directed pushing; ‘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 assumption has been taught to midwives since the 1930s and Ina May herself warned against ‘early pushing’ in Spiritual Midwifery. 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:

  1. Dilatation of the cervix
  2. Rotation of the baby through the pelvis
  3. 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 2011). 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 tilted – 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 sometimes 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). There is very little research about pushing before full dilatation. Downe et al. (2008) report research conducted in the UK in 1999, and recently Borrelli, Locatelli & Nespoli (2013) published a small observational study. These studies found that the incidence of ‘early pushing urge’ EPU (as it is referred to in the literature) is between 20% to 40%. Interesting Borrelli et al. (2013) found that the sooner the midwife performed a vaginal examination in response to a woman’s pushing urges, the more likely they were to find the cervix still there. They also found that ‘early pushing’ was much more common with primips (first labours)… perhaps because they are likely to take longer pushing, therefore be more likely to have a vaginal examination? And early pushing occurred in 41% of women with OP babies.

Spontaneous pushing before full dilatation is a normal and physiologically helpful when:

  1. 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.
  2. 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. Borrelli et al. (2013) found no cervical lacerations, 3rd degree tears, postpartum haemorrhages in the women with an EPU. 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 anyone’s 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, it is not based on physiology or research. For example, in some parts of the world 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 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. It is like telling someone not to blink. 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. She may be in a forward leaning position because it relieves the back pain associated with an OP presentation and be reluctant to move. This is one of the rare times a suggestion/direction is appropriate.
  • 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 – by her or you. This is extremely uncomfortable! Be aware that this may allow the baby’s head to move into the vagina before he/she has rotated which could create further problems.

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 a cervical lip are caused by identifying it, and managing the situation as though it is a problem.

You can download a pdf version of this article here

This post is also available in French

About midwifethinking

independent midwife, lecturer and student of all things birthy
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328 Responses to The Anterior Cervical Lip: how to ruin a perfectly good birth

  1. Pingback: Pushing – leave it to the experts | Midwife Thinking's Blog

  2. 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

    • shannon says:

      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!

  3. Sarah says:

    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 :)

    • comadrona says:

      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!

    • Lisa says:

      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!!!

      • prags04 says:

        Nice to know that vaginal birth was possible at 8cm dilation. I was 9.5 cm dilated for 3 hrs and the doctor didnt allow me to push. I was in great pain as epidural also weared off by that time. They called it failure to progress and c-section was performed. After reading your post I feel that mine could have been a vaginal delivery too with a little help.

  4. Cassandra says:

    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.

    • crobinator says:

      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. :(

      • Monica says:

        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.

        • Jamie says:

          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.

  5. 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!

  6. Rahni says:

    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 :)

  7. Sara Kay says:

    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?

    • teamup4moms says:

      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!
      :o)

    • 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.

      • Blair says:

        I learn something new everyday. That is amazing.

      • Anisa says:

        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.

        • jagadamba says:

          well at least she must have been very relaxed! which is a lot better than creating a real holy environment outside and inside the mother to be is full of fears. Relaxed and in front of the telly might sound more mundane but ultimatelly a lot better for mum and baby than a fearfull struggling mum.

        • midwyf says:

          TRUTH and so sad for the baby!

      • Marcie Redgwell says:

        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! :)

      • Tracey says:

        The muscles in the utereus (smooth muscles ) work in the same way as the muscles in our heart or digestive tract. We have no concious control over them and we cannot physically push these muscles. I had no urge to push with my babies I was directed to push with the first 4. With my 5th baby I did hypnobirthing homebirth. The midwife who came out to assess me when i was in labour did a VE and informed me that I was less than 1 cm dialated. She then went away and advised me to get some rest while I could. 40 minutes later my daughter was born. Unlike my other births there was no directed pushing my body just expelled her naturally and my partner Jon delivered her :) I am now a student midwife and due to qualify next year :)

    • Shawna says:

      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.

  8. 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!

  9. teamup4moms says:

    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

  10. Jen says:

    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!

  11. Pingback: "Premature" urge to push... - AllDoulas.com

  12. Doula says:

    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 :)

      • Doula says:

        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!

      • MamaToBe says:

        Hi Rachel,
        I was wondering if I could please gain your thoughts on the issue of cervical scarring. While I am not sure if I have cervical scarring, I have had cervical procedures performed (biopsy, removal of abnormal cells CINIII) and I am concerned this MIGHT present itself as an issue in labour. My question is – at what stage do you suggest I seek assistance (eg. massage of the cervix)? Once early labour has stalled after X hours? Or should it be done late in pregnancy, eg week 39, to break up the scar tissue and help stimulate labour? And if my cervix is scarred and preventing dialation, what role do you think VEs will have in my labour? I am pregnant with my first baby hoping to have a physiological, active birth with no intervention or drugs…

        • Hi MamaToBe… I have looked after a number of women who have had cervical biopsies and it rarely causes a problem. Scar tissue from a biopsy will not prevent dilatation. It just may slow dilatation for a short while until the tissue ‘gives’. However, meanwhile the rest of the uterus continues to pull up and thin out so that when the tissue ‘give’ the cervix quickly catches up. As for preparation – as you get close to labour your hormones initiate structural change in the cervix. Leucocytes and macrophages release proteolytic enzymes that cause collagen degradation; hyaluronic acid and changes in blood vessel permeability increase the water content of the tissues; glycoaminoglycans reduce the ability of collegen fibres to bind together. These changes = natural softening and preparation for opening. I suggest that you allow your body to do what it needs to and avoid VEs in pregnancy and labour as they won’t make any difference. I can’t advocate massaging the cervix as I cannot see how this would assist and would be very uncomfortable. I have never looked after a woman who ‘prepared’, and so far I have not come across a cervix that did not dilate because of scarring. Good luck… come back and let us know what happens :)

          • MamaToBe says:

            Thanks so much for your reply :) I did have either LEEP or Cryo performed (I should know which one!) however this was 8 years ago and as a 22 year old was very blase about the whole matter. All I remember them telling me was they were “burning off” the abnormal tissue. I suppose my concerns are that this being my first baby, I won’t know if I am having a *normal* early labour period, or a prolonged one where dilation has stalled – particularly because I am opting to not have any VEs. Of course this could all be moot and I have a trouble-free, quick labour! I just want to be as fully armed with information as I can so that I can listen to my body and stand my ground if needed. I am so thankful I stumbled across your blog and a few others like it, it’s been the most wonderful education. I am due in early December so I will let you know how I go!

    • I think it will be important for this mama to find a way to be at peace with the first birth experience so she isn’t holding that fear going into the second one. Hypnobirthing has some great meditation tools for coping with labor from a place of acceptance, instead of fear. Maybe even just a gentle reminder to trust her body.

      I wonder also if the AROM could have led to the “uncontrollable” pushing you described? While it can be a good alternative to more invasive interventions, it still has potential adverse effects. If this mama’s cervix was coping with scar tissue, then an AROM might have been too much for the body to handle? I’m very impressed with your use of Nitronox to calm her out of this phase–it’s a shame that this isn’t used (to my knowledge) in much of the US.

      Thanks for sharing, and best of luck to you & her on the second birth!

  13. Yoruba Doula says:

    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.

  14. Ivy Clinger says:

    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!

  15. doulanic says:

    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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  17. doula dawn says:

    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 :)

  18. Mavis says:

    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!

  19. Shelly says:

    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.

  20. Bliss says:

    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).

  21. Bliss says:

    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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  23. Christine says:

    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!).

  24. 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.

    • Krista says:

      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!

    • Sarah L says:

      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.

  25. Anki says:

    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!!!

  26. Sally says:

    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.

  27. Helena says:

    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 :)

  28. cbf says:

    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. :)

    • crobinator says:

      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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  30. andrea says:

    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 ~ ~

  31. Janelle says:

    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

  32. 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.

      • Sarah L says:

        “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.

  33. Anna says:

    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.

  34. crobinator says:

    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 :)

    • Yes, trust in your body. You can do it!
      (If baby was thisclose to coming out vaginally, I doubt you fall into the 10-15%…it sounds like you just need a little more trust that your body will tell you what to do…instead of someone else telling you…)

  35. Jamie says:

    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!!!

  36. 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 think this brings up a really interesting topic. The more comments I read, the more I am inclined to think that labor progression is not quite as linear as the medical community makes it out to be… I find it interesting that so many women are commenting on being told to fight the urge to push—for hours! As a student midwife just starting out, my experience is limited but what I can say more than anything I believe women need to own & trust their bodies first; babies were born long before hospitals existed, but somehow we’ve given control and understanding over to men in white coats. I’m definitely curious to know more about pushing with that urge to push prior to reaching (an arbitrary & subjective) 10cm. Thanks for spurring the cog wheels! :)

  37. 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

  38. ezmama says:

    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. :)

  39. ACsMama says:

    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!

  40. erinmidwife says:

    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!

  41. M.D says:

    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?

  42. 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. :)

  43. Mandy says:

    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!

  44. mom of 4 says:

    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!

  45. Katharine says:

    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!

  46. kate says:

    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?

  47. 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

  48. sara says:

    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…

  49. 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.

        • Shan says:

          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.

          • kgjames says:

            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.

  50. 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

  51. Pingback: Good article! - Pregnancy - MilitarySOS.com

  52. Lisa says:

    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!!!

  53. Wendy Sue says:

    I had lips with 2 of my births, doc just had me push through them, no problems, a bit more burning.

  54. Fiona says:

    My favourite bit – “This is called the ‘Ferguson reflex’ – probably after some man.” ROFL!!!

  55. Sarah: Labor RN says:

    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

  56. Michele says:

    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 :-)

  57. 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

  58. Lauren says:

    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.

  59. sodagirl says:

    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.

  60. Brenda says:

    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?

  61. bella says:

    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.

  62. sara says:

    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.

  63. Ella says:

    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.

  64. Ella says:

    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!

      • Ella says:

        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!

  65. Suzan says:

    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.

  66. 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 :)

    • Suzan says:

      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!

  67. Laura says:

    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!

  68. karen says:

    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.

  69. K says:

    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.

  70. Carolina says:

    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!

  71. sara says:

    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.

  72. Megan says:

    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.

  73. Diana says:

    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!

  74. Laura says:

    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!

  75. Sara says:

    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 :)

    • Sarah L says:

      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.

  76. Kim Phelps says:

    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!

  77. alison edwards says:

    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.

  78. Beri says:

    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.

  79. Sunshine says:

    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.

  80. comadrona says:

    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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  82. tulip says:

    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. :)

  83. Alice says:

    That described my 1st birth to a T!!!
    Tho second birth still had anterior lip and instrumental birth altho short labour and no epidural…

    • Alice says:

      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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  85. Kristin Kali says:

    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.

  86. Donna says:

    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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  88. Kathie says:

    “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.

  89. Culla says:

    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.

  90. Laura says:

    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!

  91. 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!

  92. 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!

  93. Gina says:

    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.

  94. Chrissy says:

    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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  96. Aspen Marks says:

    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.

  97. cooper says:

    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…

    • Aspen Marks says:

      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 ; )

  98. cooper says:

    i think its under TULIP as a user name…

  99. cooper says:

    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)

  100. MR says:

    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.

  101. cooper says:

    But if you don’t have any vaginal exams, how will you know if the lip needs to be moved out of the way?

  102. MR says:

    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.

  103. Agnes says:

    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.

  104. Agnes says:

    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?

  105. 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. :)

  106. Kristen says:

    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.

  107. shannon says:

    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!

  108. “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.

    • Bella says:

      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. :)

  109. Tara says:

    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!!

  110. 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 :-)

  111. Louise says:

    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 :)

    • Edith says:

      What part of “Africa” exactly? Americans and Europeans seem to ignorantly think it is one big similar country; it is the largest continent in the world! You’re comparing a whole continent’s outcome with a single country?? That is statistically a grossly disproportionate comparison. Also, any farmer will tell you nutrition is the most important factor in a healthy pregnancy and birth. Many women in developing countries have less than optimal nutrition levels during birth and this obviously adversely effects outcomes, it is not the fault of the natural birthing process.

  112. Madz says:

    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.

  113. 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!

  114. Rachel says:

    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.

    • Rachel says:

      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?

      • Rachel says:

        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

  115. Nicole says:

    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!!!!

  116. Marissa says:

    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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  118. 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!

  119. Amie says:

    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.

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  121. Ruth says:

    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.

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  125. Emma says:

    It’s funny but as a midwife, when I gave birth to my son and was told I had an anterior lip and to stop pushing I became really upset with myself as I thought that by pushing on a lip I would cause the labour to digress and become obstructed and therefore far more medicalised than I had wanted. I knew I couldn’t stop pushing even if I had wanted to and up until that point I had been very relaxed and calm during my labour, with no need for any pain relief. However that last half an hour of my labour was quite stressful for me as I started to panic that it was all going to go wrong at the last moment. I knew deep down that i could push the baby out and that the anterior lip was not going to cause any trouble but I felt that I was letting the midwife down by not being able to control my body and stop pushing when asked to do so! It’s crazy looking back!

    In total my labour was 6 hours long, second stage was half an hour. I guided my sons head over my perineum with my own hands, my midwife didn’t get a look in!

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  127. Wendy says:

    Thank you so, so much. I have been diagnosed with PTSD after the birth of my daughter. Many, many issues with poor care, or completely absent care for a few hours. One of my worries has been about being unable to stop pushing while I was shouted at (over excited husband), and told again and again not to push because of the lip on my cervix. My beautiful contractions that I feel could have pushed my little girl out disappeared after I was told I had to get out of my lovely warm birth pool for an exam. I was very lucky to avoid an epidural that I was told I had to have as some other woman was needing the attention of the anaesthetist. I think I pushed her out from just force of will in the end! It was only afterwards that a midwife from the same hospital came to visit and told me that my pushing was involuntary and explained some of the physiology of it that I started to feel better.

  128. A says:

    This article has been a godsend for me. I had an extremely traumatic birth a few months ago. My midwife would not listen to me at all. She forced me to labor entirely on my back and when the cervical lip issue came up. Having dealt with the manual pull-back issue on my first birth where I also had the cervical lip thing, I specifically asked if I could try a lunge to ease it out and she chastised me and then manually pushed it back herself – over and over again as I writhed in agony and eventually pushed the baby through it. there’s more I could say about the trauma of that experience but I digress. Anyway, we had always wanted one more but I didn’t believe in my body anymore after that experience. I kept thinking that if my body requires someone to go in there and do that every time I have a baby, then maybe I was not meant to give birth. This article has given me the confidence I needed to have one more baby (provided a few years down the line), and also restores a little of my faith in midwives and midwifery, and that makes my heart happy. Thank you.

  129. Carrie says:

    Just found this post through searching about cervical lips. I have had 4 NCBS with midwives in a hospital. (my most recent just 5 weeks ago). I have had a cervical lip with all my labors. I think there must be a spectrum of severity with cervical lips, because my first 2 labors, my MW gently pushed the lip to the side while I pushed and it pushed the lip over. 3rd baby I experienced a labor “lull” where I wasn’t contracting much, baby was descending but I wasn’t feeling the urge to push. I had never experienced this labor lull… but read later it is quite common. My MW even commented “it might be that lip is taking it’s time to move” But we didn’t push it aside this time. But with the labor lull it was nice to not be rushed to push just because I was at 10cm. We waited until I felt the urge to push. Then with my 4th baby I had a water birth, and my MW checked me at 8cm and confirmed “there is your lip you told us you always get” but I just stayed in the water, and labored along. Water broke on it’s own and I began feeling the urge to push. At one point I looked at my MW and said “hope it’s ok that I’ve been pushing, cause I am” She just smiled and said “I can tell you’ve been pushing for a while, and you’re doing great” I was so thankful to have a MW trust my body.

    But just today talked to a first time mom who had an experience of going to hospital at 8-9 cm, dilating to 10 but with what she said was a “significant cervical lip” She had the urge to push, but She said her OB instructed her not to push or she could rupture her cervix. I didn’t get into my experience with her, since she JUST had her baby and I honestly don’t know all the facts and didn’t feel it was necessary to cause more disappointment,etc for her. After an hour of trying not to push, she got an epidural (which she regrets) and said she had to wait another 5 hours for the lip to move. I had never heard of such a thing…until reading of the instances here. but can you speak to whether or not Cervical lips can be more severe? Obviously mine are just slight lips, and move easily or on their own causing no problems. So I don’t want to tell her “oh, your ob is wrong, and you could have just pushed” if her lip was very severe.

    I just hate that she missed out on the birth experience she wanted. But if there truly was a concern about cervical rupture, I don’t want to just brush it off. How can I encourage her to think differently in the future, or to possibly find another OB or MW who is more friendly to NCB?

    • This is a difficult question and a difficult situation. It can be really hard to challenge a woman’s ‘birth story’ when it may mean her realising that it was not her body that was a fault but those around her.
      What you experienced was a normally dilating cervix and a vaginal examination at the time just before the last bit of cervix finished dilating. The way in which the cervix dilates = all women have an anterior lip at some point. I’m not really sure why you were having vaginal examinations…
      Anyhow – your friend has been told ‘the story’ and she may need to believe it for a while. There is no evidence that the cervix will rupture and I have never seen this happen or heard of it happen. Perhaps some readers have and can share. By ‘significant’ I assume she means swollen – which can happen. I have seen extremely swollen and fat cervixes disappear within a few contractions. I know one midwife who could actually see the cervix coming out of the vagina it was so big… and the woman birthed no problem. However, women are often given an epidural = slows everything down and end up waiting for hours for the lip to move. Unfortunately your friend engaged the services of an OB – an expert in pathology not physiology.

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  132. I get your point, understand where you are coming from, but disagree. As a midwife working over 20 years in a home-birth setting, I’ve seen many swollen cervical lips from premature pushing. I was also once in a clinical setting for an internship where they did not allow a vaginal exam to see if women were fully dilated, and, as a result, saw more than one cervix visible in the vagina after the delivery where it had been dragged down by pushing too early. Women’s bodies are awesome, but, being a fallen world, not perfect. Sometimes they do get a premature pushing urge. A quick exam, maybe breathing through a couple of contractions in a knee chest position while the lip is small. a little evening primrose oil, or once in a while holding the lip back while the mother pushes can save hours of delay from premature pushing causing a huge painful swollen cervix. A good midwife can do this as a natural birth facilitator, without trauma to the woman or causing her to lose her focus or faith in her body or the process. That’s why the family hires her. If it was all just a matter of following maternal instinct and that worked every time, there would be no need for midwives at all.

    • Thanks for sharing your experiences. In my post I include strategies to manage an anterior lip if it is need and I have actively managed one more than once (pushing it back etc.). There is always a place for intervention and as midwives we need to identify when it is required. However, in my experience most of the time it is not needed and ‘breathing through’ should be impossible if she is truly spontaneously pushing – not just ‘thinking’ she needs to push. Which is the main point I am making… you cannot stop physiological pushing in the same was as you cannot stop someone from blinking. It can be very distressing when midwives try – as many of the women’s experiences demonstrate. I guess we all construct your reality and ‘truths’ from our experiences. My reality and truth is that I don’t encounter problems with swollen cervixes (touch wood ;)) and I hope it continues.

  133. Chelsi says:

    I had an anterior cervical lip with a drug free birth.. And this caused me to have STRONG pushing urges at 7cm. My body was literally pushing with everything it had, on its own. The nurses told me over and over not to push with it, that it would cause my cervix to swell. 2 hours later, after much agony, screaming, and holding back my pushing, I was 10cm and ready for birth. It was the most exhausting experience in my entire life trying NOT to push when my body was doing it on its own… of course I was on my back from 5cm-10cm (stayed at home from 1-5cm).. and I know this more than likely caused my lip. I didn’t move around. Didn’t listen to my body. Next time, I definitely am holding out at home, possibly even till birth. I progressed fine till I hit the hospital.

  134. Chelsi says:

    In addition to my previous post… my dr. broke my water at 5cm when I didn’t dilate any more after 2 hours. I’m not sure if this had something to do with my ordeal or not.. but I sure wish they’d have left my waters alone to burst when they were ready.

  135. Samia says:

    Great post. Not sure if this question was already answered, but have you ever heard of doctors using pitocin to help speed along the shedding of the cervical lip? I was pressured into being put on a oxytocin drip when I was 9 1/2 cm dilated ( I was feeling the natural urge to push at this time) and it has had serious consequences on my ability to breastfeed and my daughter’s stress levels at the time of delivery. Her cord was wrapped so tightly around her neck they had to cut it before she left my body. They ripped my placenta out of my uterus and it tore in half…. a miserable experience…. and I went in knowledgable and confident… I left defeated.

  136. Quest says:

    I questio my childbirth choices everyday and my son is 10 mnths and it ended in a c-section of course dr. wrote cpd op position and 2 other things which i didnt know they used an internal monitor. My husband is against homebirth period and i feel alone on my decisions with little support im not even pregnant again but i feel i must plan ahead for a vbac but i was told not push when i had the urge and ended up with a swollen cervix and wasnt allowed to moved thanks to nubain which i didnt know that would leave me restricted. I just feel frustrated and mad sometimes at myself and other times at my husband. If we ever have another baby i feel lost when it comes to op and swollen cervices and should i push. I also told my friend i wanted to decline from vaginal exams and she told me that my dr would probably fire me! I need a person with wisdom advice. Esp when it comes to the hospital my husband and i had the argument that i felt rushed even though he says i wasnt but my water was broken early thus the clock. im rambling sorry but i really do find vaginal exams violating during labor and towards the end of pregnancy and idky if it has something to do with my past being somewhat violated as a child.

    • It sounds like you had a very common experience. It is a shame that it is common to suffer abuse and bullying during birth. As for VE’s – many women find them violating not only women who have previously been abused. I wish practitioners would consider this when undertaking what is to them a ‘routine procedure’. I hope you can find the support you deserve for your next birth.

  137. summer says:

    With my first birth, I was told not to push yet, but my body was telling me “push!!!” So, I ignored everyone and just pushed anyway. No harm done to the cervix as far as I can tell :) And pushing felt so good!

  138. Cindy Mulder says:

    Hi, I recently had a homebirth after my first birth ended in an unnecessary cesarean.. I usually love everything you write but this article kind of hit a nerve with me after I experienced an anterior lip during the birth. I was pushing with my bodies urges for an hour and a half with no progress.. I asked my midwife to check and see what was going on and sure enough there was a swollen lip there that had been pinched between bubs head and my pubic bone as she descended.. I’d had no interventions or drugs but I didn’t get any instinct to change positions, it was quite the opposite actually, I didn’t want to move from being on my knees leaning forwards over the edge of the birth pool.. If my midwife hadnt suggested I get out, lay on my left side and try not to push for a couple of contractions, I think I might have been there all day putting lots of pressure on my cesarean scar.. I guess I feel like I want women like me to be acknowledged in this article too, that even with all my instinct uninhibited, I still didn’t move instinctually and I had a real barrier preventing descent of my baby.
    Once the lip dilated out of the way after those few contractions on the floor, she flew out in 3 contractions quite easily and it was a lovely, healing homebirth but I feel like according to this, my body should have told me something was wrong.. Love your work, thanks for informing so many women!
    Cindy

    • I am sorry that this post ‘hit a nerve’ but thanks for letting me know. I also suggest that women change position if I suspect an anterior lip (from forward leaning to side or back if in water). Often women stay in a forward leaning position to reduce the back pain associated with OP position – related to anterior lip… therefore need encouragement to change into a position that is often more painful for a few contractions. I have obviously not made this clear in my ‘suggestions’ list. I will edit the post in the near future – so watch this space :)

      • Cindy Mulder says:

        That’s good to know you also suggest the woman moves, I just thought it sounded like I should have known to move myself.. I was a bit strange with my labours in that my first was posterior and I had no back pain at all and my second was anterior and I had quite a bit of back and hip pain. They were both however asynclitic (the problematic kind with an “abnormal” labour pattern) and both came out with a bruise on the side of their head. The main difference was the hospital got impatient during my first birth and I was at home for my second so could have all the time and “abnormal” labour I wanted! :)..
        Thanks for the acknowledgement and again, thanks for the great work you do!

  139. JJ says:

    Wow. I just stumbled across this because I am 40 wks & found out baby is Sunny Side Up. I read your post about that before coming here. This is such an amazing post!

    With my first, I had a relatively quick labor. I labored on my side, relaxed and breezing through early labor. My midwife advised that I take something to help me sleep, assuming that my labor was going to be much longer than it ended up being. At that point, I began to have trouble dealing with the contractions. However, I made it through and a couple of hours later, the medications had worn off. When I announced that I had the urge to push, my midwife checked my cervix and found that I had a remaining lip. She attempted to hold it back, but I was so miserable that I begged for her to stop. Thankfully, she did. I continued to allow my body to push (there was no way I could help it!), but I didn’t force myself to do anything “extra”. Sure enough, the lip was gone in a couple more contractions and I birthed our baby just a few moments later.

    I have been tempted to not tell anyone that I feel ready to push this time around, though I know each birth is different. However, I still believe that had my midwife at the time just allowed me to do what came naturally to me, I would have been better off. Granted, I still had a wonderful birth experience, but who wouldn’t prefereven a little less discomfort?

    • Sounds like your body works perfectly without measurements or instructions. How about putting ‘no vaginal examinations unless I specifically request one’ in your birth plan? That way no one has to know what your cervix is doing or get stressed about it :) Good luck with your birth and new baby!

  140. Felicity says:

    Hello there
    I would like to share my recent birth story which still leaves me perplex…Not sure what happened in my body. I had my first baby 3 and a half week ago. I am a midwife myself in the UK working in the community and after a great and healthy pregnancy, I planned on having a homebirth. The only little concern I had is that my baby’s head never engaged in my pelvis. When I say engage, it never fixed in the pelvis and every morning his head would be in my right hip. I was practising all the Spinning babies postures as well as having craniosacral therapy sessions, attending yoga classes, walking lots…However when the latent phase started and my waters broke 36 hours later the head went down and although still high would not move from the pelvis. Pheww!
    THe contractions established overnight and at 9.30 in the morning the midwife can and my cervix was then 4 cm dilated and effaced with a well applied head. Labour went on really well, I used the pool, went for walks outside, did lots of supported squatting and by 5pm my cervix was 9.5 cms, ie with an anterior lip. I had felt a transitioning coming from 3pm, getting more and more uncomfortable and getting increasing pressure in my pelvis – very intense sensations…so I was glad to hear that the transition was almost over and I was gonna move on to the second stage….I continues with the squatting which helped and lots of leg lifting and all sorts of positions I can’t even remember, plus using the pool.
    Well at 9.30 pm my anterior lip was still there and I didn’t have urges to push (or extremely mild ones with “nothing to push on” as it felt) and contractions were maybe not as regular as they were. The baby was thought to be OA facing back, so the ideal position, and with a flexed head.
    I was transferred in hospital at about 22h30 where a drip and a much appreciated epidural was then offered…being in transition for 7 hours had used all my reserves, especially after a long latent phase and 2 sleepless nights. MY body completely relaxed with the epidural and the oxytocin drip did not need to go very high to have “good” contractions, ie believed to be effective ones.
    A few hours later, my anterior lip was still present and there was excessive moulding and caput on the baby’s head apparently. The doctor said the baby was in a perfect position and with ‘good’ contractions he couldn’t explain why he wasn’t coming lower (his head was at the ischial spines) and the cervix was not opening. He said the labour had gone on for too long and was worried about the baby and my risk of bleeding. My baby was born by emergency cesarean at 3.15am to my great disappointement but what else could I have done and why did the anterior lip not go? He was 8lbs12 (3.950kg) and I do have a small frame (yet my mum who is the same had 4 normal births of 8lbs babies). My partner is 6ft7 though. Do you think like the Dr said there was Cephalo Pelvic Disproportion ? Which in the UK is not really believed to be true as opposed to North America for instance. It is very rare that doctors make this conclusion here. I am left without really knowing…Myself I never believed in CPD, I always thought it was the baby’s position, the strength of contractions etc. that determined how the labour goes…
    On the other hand, force is to recognize that my labour was not ‘physiological’ after a while…so I was wondering what your thoughts were, although without having been there, etc I know is a hard (if not impossible) thing to do!
    Many thanks for your time and for your blog!
    Felicity

    • Congratulations on your new baby!
      I think there are occasions when a baby just will not move through a pelvis despite all the best conditions… and often you don’t know why. I’m guessing your anterior lip was more to do with baby not moving down and allowing it to dilate over his/her head rather than the lip holding baby back. The only way to tell if it really was CPD is to try and birth again with a similar sized baby and see if the same scenario plays out… not very helpful I know. Sorry I can’t give you a good answer. I hope you are enjoying your new baby x

  141. Felicity says:

    Many thanks for your reply! Yes I guess the future baby (!) will tell…I have already dreamt of giving birth naturally to my next baby! Part of me doesn’t want to believe my pelvis was too small for the baby that my body grew, but then occasionally it does happen, so why not to me? I just have to get over it and accept it which is hard. I was so looking forward to giving birth…
    Yes I love him soooo very much, and we are now facing new challenges as he cries so much for hours on with tummy pain, but I am sure things will settle soon.
    Thank you for your blog again x
    .

  142. Sara says:

    Wow, what an awesome post – still two years later! My question is, what can I do as a doula in a situation where a mom with an anterior lip has an overwhelming urge to push but has been instructed/ordered not to push? I would like to gently whisper to the mother to listen to her body and follow her instinct, but in this instance it would almost amount to giving medical advice (out my scope of practice as a doula), and in direct contradiction to her care provider’s instructions. Thoughts of how to handle this?

    • That is a difficult question… of course if the mother has not given consent for a vaginal examination then the situation won’t arise. Maybe this is something you need to talk to women about antenatally so that at the time they might remember that they don’t have to obey their care provider’s instructions. I have been in this situation with a woman in hospital under a hospital midwife’s care and I just told her to follow her body and ignore everyone else. It didn’t make me popular but the baby came out. I wouldn’t consider telling a woman to trust herself to be medical advice nor outside your scope :)

  143. Tanya says:

    This explains so much! Thank you for the article. I’m getting ready to have my third baby and recalled from my last labor the doctor telling me “you’ve got a bit of a ridge there, stop pushing” and I absolutely could not. I was frantic trying to stop. Baby was born with the next contraction (cervix unharmed) but I decided to search “how to stop pushing” in case it happened again and came across this!

    Most importantly, you remarked on the nipping pain and I am certain that’s what I felt the last few minutes of my labor. It was so bad I took nitrous and kept asking the nurses “what is that pain? it’s so sharp!” I felt nothing like it with my first (9lb 7oz). I wish someone had been there to explain what I was feeling and offer help. Instead, they catheterized me after the birth, thinking my bladder had been full. It wasn’t. Your article has really put my mind at ease in case this happens with #3 and I’ll be discussing it with my doctor at next appointment.

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  145. koli says:

    BTW: The “Ferguson Reflex” was named after Dr J.K.W Ferguson, physician/pharmacologist. He discovered it in 1940 in Ontario, Canada.

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  147. Charisse says:

    This article is so interesting. I have had 2 labours now. My first I started pushing at home, went to hospital and I was told I was 4cm dilated. I pushed all the way through to delivery. Second labour, trying for homebirth but had to go to birth centre due to staffing shortage. Again I started pushing at home. This time I was declared to be 7cm after a VE, baby was born about 20 mins later!

    With both births I was told not to push by my midwives, the second was very adamant about this and told me I would tear my cervix. She was about ready to send me to the labour ward for more interventions when the baby started crowning. With both births I did have bleeding as well which concerned the midwives, although I did not bleed excessively and both my births in the end were considered straight forward.

    I hated being told not to push by the midwives as I was not consciously pushing. It honestly felt as if my body had just taken over and I could no more stop it than you can stop yourself vomiting if you have a sickness bug. I asked the midwives how to stop pushing and all I was told was to use the gas and air. It did nothing to stop the pushing, I was high as a kite on the stuff! I wish the midwife at my second birth had been more understanding as I ended up feeling incredibly scared and out of control.

    Reading this article has made me think if I do have a third child I will just refuse VEs and then nobody can tell me to push/not push. I feel reassured that my body knows what it is doing.

    Btw, that second birth where she said I would tear badly? Tiny tear requiring no stitches.

  148. Pingback: The Anterior Cervical Lip: how to ruin a perfectly good birth | Midwife Thinking | Lotus Midwifery • Rowen Holland, LM, CPM

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  150. Jan West says:

    wow thank you so much for these wonderful comments. I am a 3rd midwifery student and have seen many instances of women being advised not to push because of an anterior lip. I have also been present with the m/w holding the lip back which did seem to facilitate the birth but was also clearly painful. Women are so vulnerable at that time and I love the empowering suggestion that they hold it back themselves; I also appreciated hearing how common this experience is, and how it can be managed – especially acknowledging the role of (not doing) VE’s in all this. Birthing women rule, and midwives rock!. Jan.

  151. crazyjanice says:

    With my 3rd son, right before he was born (for one i knew he was going to be born face up, as i heard him hit the fetal monitor) when I was 7.5 cm, I def had the urge to push. My nurse in the hospital told me I wasn’t ready. I wasn’t dialated enough! I told her to go get my doctor, I had the urge to push, go get him now! with in 10 minutes my son was born. I had fully dialated and my cervix was fine. (though I did tear a lot because he came so darn fast! my doctor almost dropped him!) I literally pushed twice. my labor with him was 6 hours 45 min. my other sons were 15 hours and 30 hours. i did not tear with any of them and they both were born face down. (though they were both home births.)

  152. Mamajax says:

    This sounds so familiar. My labor was a planned homebirth. After 12 hours of early labor my doula had me do the Miles circuit. Immediately I had contractions a couple of minutes apart and back labor. Baby was in a good position before labor started so I don’t know why I had back labor unless the Miles circuit screwed something up. Anyway, after 12 hours of active labor my body started doing an intense spasming push at the end of each contraction. I tried to relax and moan through it but it kept happening. My midwife seemed confused. I was dilated at 9 for a long time. We tried pushing with my midwife stretching my cervix. She was afraid of swelling and gave me arnica. We stopped pushing because no progress was being made. The last option my midwife wanted to try was a birth stool. I was in so much pain and exhausted with literally no break between contractions I refused the birth stool. We did a hospital transport where I got an epidural. I stayed at 9 cm and got some rest. Contractions slowed to 3-5 mins apart so we did Pitocin to try and keep it a vaginal birth. That worked and I felt rectal pressure as the epidural was wearing off. The nurse checked me and I was at 10. I pushed for 10 mins and baby was out. I can’t help but wonder about the spasming my uterus was doing and being “stuck” at 9cm. What does that indicate? Is it possible I could have pushed more?

  153. robin says:

    I was in TRANSITION for 5 hours with an anterior cervical lip and dilated to an 8 that whole time. I had an UNMEDICATED labor and delivery and DISAGREE with your first two suggestions. I was asked NOT TO PUSH for a good 30 minutes which was AGONY. I was only checked 1-2 times during transition and once the lip was discovered, the nurse put her fingers on the lip and told me to push on it with the next contraction. When I did, she cleared the lip for me. I DID NOT feel this, even without medication and I immediately completed dilation and started pushing with my swollen cervix. Fortunately, I think my body had gone through so much pressure, it numbed itself and I felt only pressure to push. I was delirious the entire transition (imagine!) and once I felt the head with my fingers, I “woke up.” My suggestion is to get checked and if you have a cervical lip, have it cleared for you. I didn’t feel it at all, and it relieved a LONG transition. I would have had a 5 hour labor as opposed to a 10 hour labor (with my first) if this had been cleared earlier.

  154. Clare says:

    My first and only baby is 5 months my labour was awfull I have hyper mobility I saw specialist during my pregnancy gave me the epidural probably will not work all that could go wrong as I needed to be prepared for that, one of the good points was a very quick pain free labour. Now I know my body so the day before I went into labour I said to the hubby she will be here tomorrow well I was nearly right lol she was 2.45am( firstly I live an hour away from the hospital and traffic is bad) I phoned them explained my situation ie quick birth and high risk and got “no first labour is quick” come in when they are 4 mins appart an 30 secs (I think don’t quote me) lol or if my waters break well good job I did not listen my labour was 21/2 hours long and 3 pushes and my waters broke 10 mins before she came I stopped breathing 3 times (and actually thought I was going to die) when I walked n they seemed very unimpressed I was 1 cm dilated I tried to explain the complication my hms could cause, to them I was a first time idiot that was clear. 2 and quater hours later I was 4cm dilated, suddenly tho I needed to push she examined me I was told not to push, I could not push I had a lip she scared the hell out of me when she said I would hurt my baby if I continued, I could not help but push she had a real go at me and shouted “I said you are not ready to push you dont want to hurt your baby”, now I don’t like being spoken to like crap at the best of times so when I’m in agony scared to death (my language was not nice) I shout at her “then tell me what the fuck is between my legs” she looks hits my buzzer and pannicks telling me to breath slow down whilst running getting every thing sorted my baby’s head is there I new it was I could feel it, my husband is like omg it’s her head. My lip had obviously gone she did not listen to me I will not have another baby I am now to scared I was not listened to I was basically treated like I new nothing now I went from 4cm to 10 in 15 minutes and delivered in 3 pushes I tried to tell them but they new best my mum tried to tell them that both her mum her my sister had all had quick labours my sister had her first in her sleep, now midwives say that’s not possible i just don’t think they need to scare you the way they did me. Question how could I have hurt the baby? This was obviously not explained

  155. Anna says:

    Thanks for this great discussion. It is true that topics like this are not often discussed and are so important! I realize this discussion is older so maybe no one will see this, but I thought I would chime in anyway. I am a homebirth midwife and recently had a primip birth with an OP presentation. Mom got an incredible (very, very strong!) urge to push at 6 cm dilation. We tried many positions to quiet the urge and different positions to get baby to turn etc. She stayed at 6 for several hours with an extremely swollen cervix and was exhausted. We went in to get an epidural and she remained at 6 until a c/s many hours later. Anyway, there is alot of discussion here about cervical lips and late stage dilation and pushing but I didn’t see much about really early urges to push and if there is any time that is too early. I have had multip births where mild pushing urges come early on and come and go with no problem, but this was very different. Have you ever seen someone with that early of a very strong urge to dilate completely and have a vaginal birth? thanks for any insight!

    • Charisse says:

      Both of my births! The first I arrived at hospital already pushing and was 4cm. Second I was 7cm on admission and already pushing. I had vaginal births both time, second degree tear with first (which I think was because I was on my back rather than anything to do with pushing early). Second I had a graze but no need for stitches.

    • Hi Anna
      The post was specifically about anterior lips… however, the only research in this area is on early pushing at any dilatation. I have attended births that resulted in c-section for a swollen and undilated cervix – in a few of those cases the woman was pushing ‘early’ – but not most of the cases. So, I think the early pushing is a red herring and when it is present we use it as the ‘reason’. A bit like a nuchal cord. In the example you gave the woman had an epidural – so presumably stopped pushing but still did not dilate. And yes, I have seen lots of women have an early strong pushing urge who went on to have a vaginal birth. In general I don’t do VEs so many of the women I attend might be pushing with an undilated cervix but ‘undiagnosed’:)

  156. Heather says:

    As a midwife I know if I have supported a women to be in control of her own birthing then dilatation is a natural process and involuntary pushing is part of assisting dilation of an anterior lip. Intervention is like the children’s story “There was an Old Lady Who Swallowed a Fly.” Once you start there is no going back.

  157. Alan says:

    The ‘Suggestions’ are absolutely spot on!
    I’m a father who has witnessed 2 births – the first, in a hospital, was horrific. The attitude of the doctor and mid-wife almost medieval. Stressful for everyone concerned, including the baby. The second (to the same woman) a home-birth. Not only a home-birth, but with no medical people in attendance (at the mother’s insistence). It was a truly beautiful thing – nobody shouting “push” or “breathe”, no crying or screaming, the mother doing everything in her own time and making the delivery with her own hands.

  158. Jennifer says:

    Thank you for this article! I totally 100% agree with what you said. I’m a doula but I’ve birthed 3 babes. One vaginal/epidural in a hospital, one drug free in a birth center and one homebirth. The last one baby was in a OP. I was only 2cm (checked when I didn’t want to be) and had an urge to push. The urge was enough of a one that was hard to stop but not a forceful one that felt like I really had to bear down with all my might. I was told that I needed to stop pushing and I was said ‘HOW?!’. My midwife said my body will stop on it’s own if I just resist the urge. The urge did eventually go away and I labored for another 24hours trying to get baby to a favorable position. Everyone had left including my doula (for some coffee) when I got the urge to do small pushes again. I at first, since it felt the same as the last time and I had only been 2cm, was scared to trust my body. But I gave in since it felt so unbearable. As I was pushing little small pushes about 5-10minutes into it I felt the baby descend/move, it was such a quick movement that it felt like a pop and was very painful. I knew he had moved into a favorable position and then my the pushing became more intense and I felt like I needed to push harder. Midwife barely made it there to deliver baby. In hindsight I’m almost sure if I had been let to push just a tiny bit that my baby would have moved to that favorable position. I wish my midwife would have let my body do it’s thing and trusted it. I can’t imagine how my birth would’ve played out at a hospital and I feel lucky I was not at one. But I also have a lot of resentment about my last birth. This article was very healing and reassuring for me to read. Thank you!

    • Jennifer says:

      Wish I could edit, should’ve read it over before posting! *I’ve birthed 3 of my own babies* and *My last baby/birth, he was in a OP position*

  159. Sharon Finkelstein says:

    In practice, i have noted woman 10 cm. Dilateted not having suficently strong lasting contractions therfore we have seen the baby coming out and retracting because the contractions last 20 sec the most. We have tried many possition, but woman seemed tiered of pushing, she does not feels the irge to push but pediatritian and gynecologist start worrying about the baby, what do you suggest is causing this condition and how can we prevent it.

    • Your question raises further questions. How do you know the women are 10cm dilated – are you doing routine VE checks… and why? Are women being directed in how to push once 10cm is diagnosed? I am guessing that what is happening is the normal physiology of birth. That there is often a lull or reduction in contraction strength until the baby descends into the pelvis and triggers the ‘ferguson reflex’. This is not a ‘condition’ and is normal. I suggest that you just wait. Let the mother rest. Don’t direct pushing. Even better don’t ‘diagnose’ 10cm. Once the ferguson reflex starts working the contractions will be strong and baby will be born. :)
      You might find this post helpful: http://midwifethinking.com/2010/07/30/pushing-leave-it-to-the-experts/

      • Jen says:

        I can attest to this with some personal experience. During my second birth, there was a full five minutes when we were all sitting and waiting not only for me to have an urge to push, but for my next contraction once I was fully dilated. I had read about that happening, but when it happened to me it felt so bizarre. It was as if there was a huge lull in the action. Had I not known that could happen I would have been very scared because my nurse was confused and kind of freaking out. My midwife was calm, though, and it definitely helped me to just relax and not rush the process.

        I think it’s so important to listen to the mother. There’s no way another person can know what a person’s body is telling them. If there is no urge to push, there is usually no urge for a reason and vice versa. In my humble opinion, calmness and flexibility is the best gift someone can give a birthing mother.

        • Siggi says:

          One of my clients had a big pause between the transition and the next contraction, she slept for about 40 minutes and , then in just a moment she shouted: “Siggi my baby is coming” it was awesome!

  160. alli says:

    Wonderful article! When I was fully dilated and was instructed to “push” two hours before I actually had that amazing feeling of my body pushing on its own! Luckily it all worked out well and I did experience my body doing everything on its own, but for my next birth I now know to completely listen to my body and wait for it to tell me when everyone is ready!

  161. Laura says:

    I used Hypnobabies to prep, and I’m soooo glad I did. Even though I ended up with the “showing up at the ER and they don’t know I’m coming” hospital birth that I did NOT want (due to a late term move across the country and the doctor we’d planned on refusing to take me when he found out how heavy I was), we got there so “late” that they didn’t have time to do anything. I mean, ANYTHING, not even get the IV line in my hand, and they were trying… the doctor didn’t even have time to really get all of her gear on properly. Ended up in the lithotomy position and everything, and still everything happened SOO fast. I am absolutely determined to have my water birth (ideally at home) with the next one, because I really believe that had I not transferred to the hospital and been sitting in a wheelchair at an intake desk when things shifted gears on me, I wouldn’t have gotten scared and fallen out of the hypnosis and started to hurt. (Seriously, I had an intake nurse smirk at me and say “sure honey” when I told her we didn’t have time for paperwork.) I hit triage at 6cm, but the contractions were so close they couldn’t get a heart rate on the baby… he kept moving every time they got the ultrasound in the right place. In the time it took to move me to delivery, I went from 6cm to crowning, and that was with the idiot nurse stopping the bed every time a contraction hit to yell at me not to push. (I couldn’t NOT push, I wanted to kick her in the face.) Crowning to birthed baby took all of two pushes, and the placenta came right behind him on the next contraction, all at once without any problems. Mostly, I think, because by the time the people who want to interfere were around… I wasn’t in any state to hear them. I *remember* most of what was going on around me, but it’s got that distant feel, nothing really quite registered in the moment. We were at the hospital for a grand total of 23 minutes from ER doors to birthed baby. My poor husband got chewed out by half a dozen nurses for “waiting so long”, and he had to explain that I’d only woken him up at 3:30 and said we should go at quarter of six.

    Oh, and I am never ever EVER giving birth lying on my back again! There had to have been at least three different people trying to “position” my feet and they couldn’t make up their minds. Really annoying, and the resulting bruised tail-bone was the worst part of the whole recovery!

  162. Reblogged this on NCT Kent Doulas and commented:
    Great article, especially the conclusion at end about VEs

  163. Dee toews says:

    5 children never felt the urge to push. They always told me I was ready. In fact I was asleep when one of my children just slid out. The nurse delivered that one LOL !

  164. Siggi says:

    Hi Rachel!
    I loved this post, I only had access to this right now, but it was to the right time!
    I have a very great friend and we have been counselers one to another. I am a midwifewith few expirience yet, and she was pregnant to her second child. I didn’t want to assume a homebirth because she is O negativ and so I was a little afraid that the baby could be positiv and in this case I don’t know how to proceed in homebirth here in Brazil. So I told her that I would accompany her in hospital, but when it was the time to go to hospital, she called me that she had contractions every 20 minutes at 8:00 PM, so we combined she would call me later, when it was 11;30 PM she called me and said the contractions were 8 minutes when she was alied and 3 minutes when she was walking, so I rushed to get ready to go, but when I was ready her mother called me and said: meet her at the hospital, they are going right now. So I went to the hospital without checking her before going. When we arrived, they didn’t let me entry, so she went to the obstetrician center with her husband and later he came back and told me that she was on 4 cm. I thought: would be a long, long night, and they told her to walk around for two hours and than come back to be checked again. They only admit women in labor by 5cm. She walked for 40 minutes and than ent back, knocked at the door and said, I feel the urge to push. They checked her and let her husband know, that she was admitted, and said her, that she now was on 5cm, than they applied an enema and told her to hold it for several minutes, but she was not able to do it, and they swear her and applied once again. all the bed became dirty and also the floor, and they said her to take a shower. When the first gush of water felt on her back she called: rush, the baby comes out, and the midwife didn’t believe and told her not to push, and that she would have an edema on the cervical lips, but they onlt could bring her back to bed and the baby was born by two contractions. I don’t know how this were going but it shows, that we can fail checking sometimes, can’t we?
    I’ll follow you to learn more from you!
    with love Siggi from Brazil

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  166. Pushing African style says:

    Look I don’t agree that you should be telling midwives to tell women not to push and to not tell them far dilated they are. I went into have my first child, had no clue how to breath or push so started doing it the “African Way” and pushing with each contraction from the moment they told me I was 2cm. NOBODY told me to stop pushing. I pushed really really hard with each contraction with all my strenghth, thinking the baby would come out quicker, for about 3 hours before I started actually feeling any urge to push. I feel very angry that the midwives seemed to forget that I was new to childbirth and they watched me suffer like that when I could have just been relaxing and waiting for the urges to come on their own, and THEN start pushing when I felt like it. I am annoyed with myself for doing it so wrong I haven’t really heard of anyone else doing that but I think I was also very very scared about giving birth, I didn’t want to do it and I have been asking for an elective c section to avoid a vaginal delivery but was refused so I had no choice but to trust them to communicate with me. After the birth I quickly read up about how to breathe during labor and at what stages (what I was supposed to do). They obviously weren’t prepared to deal with a case where a woman starts pushing African style. what if they get African women going and doing the same thing, I wonder if they will just assume and write down in their notes that they are pushing involuntarily too?

    • If you read the blog post I am not advocating pushing without an overwhelming physiological urge to push. There is no ‘supposed to’ with birth. Your body knows what it is doing… it has evolved to birth without any knowledge or instruction. It just needs the neocortex (thinking) and experts (instructing) to get out of the way.

  167. Susanrachel says:

    I love your blog. I wonder if you would be open to having a volunteer editor. While your writing is generally very clear, you often make grammatical errors that would be simple to correct. Since I read them anyway, I’d be happy to do this for you before posting. Let me know. Thanks for your contributions to sanity.
    susanrachel.condon@gmail.com

    • Hi Susan
      Thanks for your offer. I might take you up on it when I get around to writing another post. I’m happy for people to point out errors in the ‘comments’ area (and they do). I can then edit. So please let me know if you see anything in posts :)

  168. Pingback: MidwifeThinking Rachel Reed The Anterior Cervical Lip: how to ruin a perfectly good birth - Birth Balance

  169. Ben says:

    This is a really well written article and very helpful. Thank you

  170. Caroline says:

    Thank you for this article. I had my first child 9 months ago, and I still replay her birth in my mind daily. I labored at home for 23 hours before going to the birth center. When we got there, I was 9 cm and well on my way to the birth I had imagined. I got in the tub, candles lit, family arrived, then it all changed. My midwife discovered a swollen lip. She tried to push it out of the way, but no luck. She had me get out of the tub. For the next 5 hours, we tried a rotation of lots of positions and arnica. That Ferguson Reflex kicked in, and things went wild after that. The pain was excruciating, and the uncontrollable pushing caused the lip to swell so much that my midwife said it was like I was reverse dilating. We finally made the call to transfer to a hospital. I had an epidural to stop the pushing, and after 6 hours of no progress, we opted for Pitocin. I’m so thankful for our doula because they were putting heavy pressure on me for a csection. We pushed back, and to everyone’s surprise, I finally made it to 10 after 41 hours. Baby girl born vaginally in the end and weighed 8.14. While I’m happy to have delivered vaginally, the experience was not what I wanted. 15 staff were in the room, and students were watching in the doorway because I defied their expectations. Am I likely to have a similar complication with my next pregnancy? Any insight into the complication?

    • This is unlikely to happen again… and even less likely if no one ‘discovers’ what your cervix is doing and you are able to birth undisturbed by concerns about your body’s ability. I’m amazed you managed to birth your baby in the midst of the ‘drama’ :)

      • Caroline says:

        Thank you, that brings me much comfort knowing it is unlikely to reoccur. My midwife said the same, so hearing that again helps. Yes, it certainly was “drama.” After I posted, I read more information about you blog, and I apologize for using this as a place to ask a question. I look forward to learning more through your blog. Thank you!

  171. Edith says:

    “Parts of central Africa”…. Like which parts? Citation needed.

    Focus on the US abysmal maternal mortality statistics to make your point instead of unfounded culturally biased generalities…

    • Hi Edith
      Fair point – although could have been made in a more courteous/constructive manner. I have removed the statement about Central Africa and the US because I can’t find the source (I wrote the post a few years ago). My source for the more generalised statements is my discussions with midwives from all over the world about practice. Thanks for your feedback.

  172. Pingback: A Perfect Birth! Freebirth After Previous Induction & Epidural (Guest Post: Birth Story) | theperfectbirth

  173. Jamie Fanger says:

    Hi midwifethinking,

    I am a big believer in doing things the natural way and listening to your body (not the overweight Dr, sat there telling me that natural fat is bad for me and so is lifting weights etc) . My partner is about 12 weeks with our first child (we have our first scan tomorrow). I came across this article when a friend posted it on FB. It may be a little early for me to be thinking about something like this but I found your article very interesting. What I would like to know is how should I approach something like this if it were to happen to us, as a completely inexperienced father-to-be I would feel a bit out of my depth telling the Dr/midwife what they are saying is wrong!
    I have just emailed the link to my partner and I’m sure she will agree (our nephew was recently removed with forceps) and its something I certainly want to avoid if possible!
    Thank You

    • Hi Jamie
      It is really difficult to ‘protect’ your partner during labour – you are in unfamiliar territory in more ways than one. This is why many couples opt for a homebirth with a known midwife… they don’t have worry about ‘protecting’ as everyone knows the woman’s preferences etc. I think the key is to have a good written birth plan (by the woman). This can be given to the staff, and you can refer to it if they deviate ie. ‘she doesn’t want…’ Having said that when faced with a ‘we need to do x otherwise your baby is at risk’ it can often be impossible to work out if the baby really is at risk or if the labour is just not fitting the set policies/timeframes… and 50% of first time mothers do not (see: http://midwifethinking.com/2011/09/14/the-assessment-of-progress/) which partly explains the high intervention rates and low vaginal birth rates for first time mothers.
      So, if you are choosing to birth in an institution you need to know what their policies are; what their vaginal birth rates are for first time mothers; what your legal rights are (see: http://midwifethinking.com/2010/09/15/information-giving-and-the-law/) – in particular that your partner can decline any intervention offered, even if the baby is at risk; have a clear birth plan; and preferably have a doula with you who can advocate for the woman leaving you to focus on supporting your partner.
      A few helpful strategies during labour are:
      Use to gather ‘BRAIN’ information about a proposed intervention:
      B = Benefits – what are the benefits of the intervention, why is it being suggested.
      R = Risks – what are the risks involved with the intervention
      A = Alternatives – is there something else we could try
      I = Intuition – what does your (the woman’s) intuition ‘say’
      N – Now? – Does the decision need to be made now, can we wait and for how long.
      Ask for some private time and space to discuss any suggested interventions – ie. staff leave the room.
      If the intervention is an assessment to gather information eg. a vaginal examination ask yourself and the care provider ‘what will I do with this information?’ – if it won’t change your plans or what is happening then is there a point in doing it.
      Anyway… that’s a start. Your question is an entire childbirth education session! Good luck:)

  174. Dave says:

    Absolute rubbish. Thinking like this often leads to disaster on labour ward. There is a big difference between focusing on normality versus looking for normality. Assuming that everything is fine will miss a number of problems, and if ladies are transferred to the labour ward too late then significant problems ensue – as healthcare professionals we have a duty of care to both mother and child and peddling this nonsense devalues obstetric expertise when labours do not follow a normal pattern. As an obstetrician, I am not pro intervention and will gladly stand back, however my primary concern is safety for mother and child, not the overall birth experience. What is the point in the perfect birth experience if it results in a fresh stillbirth, massive post partum haemorrhage or other medical complications?

    41 hour labour? Really? I’m surprised mum and baby were still alive at the end of it. Rather than brave and courageous that was stupid. One good outcome doesn’t justify the insanity – perhaps you would like to see me to sort out your prolapse when everything is hanging out…

    We have thankfully moved out of the dark ages of obstetrics with better and better outcomes, yet there are legions of midwives trying to drags us backwards.

    Regarding the EPU discussion – why is a third degree tear a relevant outcome to the study? In my experience the worst perineal trauma comes from the hands off approach from midwives. Before you comment that ‘I’m a doctor therefore I cut episiotomies all the time’ – I often do instrumental deliveries with an intact perineum – getting the head to crowning before removing forceps and delivering normally.

    • An anterior lip is a ‘normal’ occurrence in labour. There is no research supporting vaginal examinations during normal labour or the use of a partogram during normal labour (see the cochrane reviews). Midwives can assess wellbeing and progress without doing a VE. A 41 hour labour ie. full strong contractions for 41 hours is not normal… but a slow build up, irregular contractions moving into strong labour is common. Multips often have start-stop labours over days before ‘the main event’. As a midwife I take into account the entire picture – I assume normality, but it is my duty of care to monitor and refer/transfer to obstetric care when there are indications of potential complications/pathology – so I am looking for abnormality. I think the woman you are referring to re. 41 hour labour was actually in hospital under obstetric care. I think it is unfair and disrespectful to suggest that women are more concerned with their birth experience than the safety of their baby… this is not true of the women I care for and certainly not true of my own perspective.

      As for perineal trauma. My experience is that the worst perineal trauma occurs during poorly managed instrumental deliveries. Perhaps you could check out the research in this post: http://midwifethinking.com/2010/08/07/perineal-protectors/ based on an extensive literature review (which you can access from the page). ‘Hands on’ or ‘hands off’ does not impact on perineal trauma despite what many practitioners think. If we are using experience as evidence. I have not had to suture a perineum at a homebirth in 7 years… and I rarely have my hands on.

      I think the key to good care is that it is woman-centred, evidence-based, and that there is professional respect between the care providers of women. That’s the aim in my practise.

      • Caroline says:

        I’m the 41 hour labor woman, and Yes, I had transferred to the hospital at that point. My midwife did not hesitate to transfer me when she knew I needed obstetric care. The doctors let me labor for so long because the baby and I were okay. I had an internal and external monitor on the entire time at the hospital because, as you mentioned above, safety was the primary concern.

    • Edith says:

      “Dave” is a shining example of the chauvinist self proclaimed omniscience of the OB “profession”. His vitriol and ignorance of natural birth are apparent. I feel sorry for his “patients”. We are still in the dark ages of obstetrics because of men like this.

  175. Ashley says:

    I want to start off by telling you how much I appreciate your website. I signed up and love reading all the articles you have posted during and after my labor. My son was born 2 weeks ago at home and my
    Midwife had to move that last remaining cervix back because I was about to give up, I was done. Once she moved it back I pushed twice and my son was born. I’m a little concerned because my first two were very quick but this last birth was nothing like I had imagined. I was laboring for almost 12 hr before he was born. What concerns me now is that my husband and I in the future want to have more children. Should I be concerned about the fact that my midwife moved my cervix for me? Does that mean that it will be something that will happen from now on? And does physically moving my cervix have a long term effect for my future labors?

    • In short – no, absolutely not. Your cervix will be fine and function perfectly. And it sounds like your baby was in a position that made your labour longer than usual and more difficult for you. There is no reason that this will happen again. Each birth is so different.

  176. Aubrey says:

    I looked all over for a contact form, and couldn’t find what I was looking for, so I hope this comment finds you. I would like to share your article in a childbirth class that I am teaching in a couple of months, is this permissible?

  177. Melissa says:

    Please has anyone out there had a vbac post 2 sections?

  178. Pingback: Ani’s Birth: The Push | Nila Girl

  179. PacMom says:

    Hi I just read through this blog and posts and thought it a good place to ask a question I’ve found no answer to: when I was in labor with my son, I was told by the doctor that I had a “very prominent anterior bone” and was directed to the reclined sitting position to counteract that. Can anyone explain this to me? Is the lithotomy truely the most facilitating position for my anatomy or is there another? I am pregnant with my second and considering home birth so am trying to find information on this.

    • There is no ‘anterior bone’ in the pelvis. I think your doctor probably meant that you had a ‘narrow pubic arch’ – If you find a picture of a pelvis the pubic arch is the bit in the middle at the front where the two large ‘side’ bones meet and are held together with a ligament. Sometimes when a doctor or midwife perform a vaginal examination they can feel this ‘arch’ and they have been taught in medical school that it = problems. But, in my experience it does not. The woman may need to get into a position that maximises the space in her pelvis ie. so that the back of pelvis can move back and out. Positions that allow this are any that do not involve sitting on the coccyx/sacrum. Lithotomy with the woman flat on her back and legs in the air tilts the pelvis back so the sacrum can move a little… more than sitting reclining. But, then the woman is pushing up hill. Being upright and mobile or on all fours allows the pelvis to move and gravity to work with you.

      • PacMom says:

        Thanks for the reply. I have several issues with things my Dr. did during Wyatt’s birth, including her pulling on his head to hasten his delivery. I am not surprised to hear that my positioning was more for her benefit than mine. My son was, however, born with bruising to his chin/lower face and that is something else I question. What is the explanation for this? Could it be due to the narrow pubic arch? Or because I pushed without waiting for the urge in response to their pressure to hurry it up?

        • Lots of babies are born with bruising to their face and head and it could be from a number of things. I doubt it had anything to do with your pelvis… perhaps more to do with directed pushing and pulling on the baby.

  180. Pingback: WANTED: A VAGINAL BIRTH AFTER CAESAREAN. WILL TRAVEL! PART 2 | midwifetravelling

  181. Holly says:

    Thank you so much for your article. Your info and comments are still healing me after the birth of my 1st child in 2012. We’d like to ‘ve another, ideally without a repeat of what happened first time around! Anterior lip at 9cm in water under hypnobirth direction and just gas, felt the urge, told not to push, got very scaredand ended up in hospital with ventouse delivery after failure to progress. Just before the doc sucked her out I had an hour to try and finish it myself but she told me “I wasn’t pushing right”. Scared me even more! I have a question, do you think the (water)pressure of birthing in water could aid to an anterior lip?

    • I don’t think that water has anything to do with an anterior lip forming… they occur in most births because of the way the cervix opens, from back to front. In some births they are ‘identified’ ie. a vaginal examination is performed. Water can assist women to mobilise because of its weightlessness. Women with a painful ‘nipping’ anterior lip (where the cervix is pinched between the symphysis pubis bone and baby’s head) can float on their back, taking the pressure off the lip without ‘closing’ the back of the pelvis as would happen on land.

  182. Ellen says:

    Thank you for writing this.

    My first birth would have been wonderfully as I envisioned it except for 3 things. 1) The midwife not believe that I was feeling an irrepressible urge to push. 2) The midwife instructing me to not push for several contractions. 3) The midwife pushing the lip back during a contraction after she finally believed me enough to check me and finding a cervical lip. I had already managed ~11 hours of back labor, but when she pushed on that lip I was roaring with the pain and felt driven completely out of my mind by it. I vaguely remember 2 nurses bursting into the room because of the sound I made. IT WAS AGONY. And, it was the absolute worst kind of pain: totally, utterly, completely unnecessary. Between barking and writhing in my attempt to do the impossible (not push) to enduring the pain of her pushing my cervical lip – what would have been a perfect unmedicated water birth now has the scar of trauma across it. My husband says the only time he felt scared during the whole process were those contractions where I was fighting the pushing and then the cervical move. Why oh why do even the most “hands off” midwife practices think this is necessary!? Honestly, it’s been nearly 18 months and I still feel upset about it. She told me that I did not have a need to push. Those were her words – in essence, she called me a liar. She called my body a liar. And she was wrong.

    So, again, thank you for writing this.

    • That is not ‘hands off’ midwifery and in my opinion it is abusive to tell dismiss a woman’s experiences and sensations during birth. Is it possible to write a letter to this midwife to let her know how she made you feel? It is likely that she is unaware that this is not OK because it is unfortunately the ‘norm’ for many practitioners. Thank you for sharing your experience – I am sure it will validate many other women’s experiences.

  183. Sarah Jane says:

    I’m a Midwifery student and I have seen a primip push against an undilated cervix and it swelled and she had to have a vacuum extraction. She did not have an epidural and was a low risk woman. A VE was not performed because the midwife thought she could see the baby’s head behind the bulging membranes. After a bit of pushing and no descent seen, an ARM was done but still no VE. Woman was changed positions to all fours as well. A VE was then done after still no progress and then a code was called. The first thing the OB said was why wasn’t a VE done to confirm full dilatation? We are taught to do VEs to assess progress of labour.

    • I am aware that midwifery students are taught the cultural norms of the systems they are placed in (I am a midwifery lecturer). Was this woman birthing instinctively or was she being instructed and assessed? The fact that the midwife thought she could see the baby’s head behind the membranes suggest the midwife was rather close to her vagina. An ARM was performed = not a physiological birth – the membranes assist with dilatation and positioning of the baby http://midwifethinking.com/2010/08/20/in-defence-of-the-amniotic-sac/ An ‘all fours’ position is the worst for an anterior lip due to the pressure exerted on the cervix by baby’s head nipping it between head and cervix. Leaning backwards would have been better. Was there directed pushing?… or even encouragement to push? Again = intervention.
      If the baby was able to be born by vacuum extraction the cervix was not preventing the baby from being born. It would have been interesting to see how this one would have played out if the woman had been birthing undisturbed ie. no interventions (ARM, directed pushing, position suggestions). Sometimes interventions appear invisible because we get so used to them.

  184. Anna says:

    My mom and I both had interesting pushing experiences with our firsts, and I wish I understood more about what exactly happened with each. My mom was in labor for 3 days, which only ended by a c-section. I know she was not fully dilated for a lot of the last day yet felt a strong urge to push and everyone told her she wasn’t allowed to. It was extremely discouraging and painful for her. They ended up saying that she wasn’t progressing and that the baby was too big and she had a c-section. He was her smallest baby, at 7 lbs 9 oz, and she later went on to have another c-section (because she couldn’t find a vbac doctor) and then four more of us vaginally, including an almost 10 lb baby at home.

    Because of my mom’s experience and because we are both very small people (which may or may not have anything to do with it) I tried to prepare for these kind of difficulties and chose an understanding midwife in an out-of-hospital setting as my best option for avoiding a c-section. I had a smooth, fast labor until pushing. I was checked and was at 10cm and told I could start pushing. Pushing felt better, so I started pushing, but I didn’t have a strong urge. I pushed for 6 1/2 hours. We tried all sorts of positions. He slowly, slowly made progress. As far as I know he was OA and there was no cervical lip. He wasn’t that big, 7 lbs 13 oz, but did have a 15 inch head circumference. We did almost transfer to the hospital for a c-section (they said they would probably go right to that instead of doing vacuum) when he started showing some distress, but then things improved and he was born soon after, after more complications with his shoulders getting stuck after his head was born. It was a positive experience over all with a sweet outcome. But I wonder if it was just hard for my small body to do it the first time or if we could have done things differently? I think he was still kind of high when I started pushing (which makes sense if I didn’t have the urge to push) and maybe if I had waited to let the contractions push him down until I had the urge to push, things would have gone more smoothly?

    With my second I was checked when I got to the birth center and was 5 cm. A little over an hour later I had to push and did, completely forgetting and unconcerned about any “being complete” stuff, and she was born 13 minutes later. She was my 2nd and she was a pound smaller than my first – was that all the difference?

    • “I was checked and was at 10cm and told I could start pushing. Pushing felt better, so I started pushing, but I didn’t have a strong urge. I pushed for 6 1/2 hours.” – you weren’t ready to push…

      http://midwifethinking.com/2010/07/30/pushing-leave-it-to-the-experts/

      And I wonder if all that pushing and perhaps pulling resulted in your baby’s shoulders not rotating/getting ‘stuck’http://midwifethinking.com/tag/shoulder-dystocia/
      Thanks for sharing your experience – it highlights that interfering with birth does not only occur in hospitals.

  185. Irene says:

    Thank you for this wonderful article! I am a midwife student on my first year. I hope to be writing this kind of articles throughout my career and challenge the practice! And never to loose my trust on a woman’s body! I have subscribed to your blog :) I find it very inspiring and didactic :)

  186. James Roush says:

    “This is sometimes called the ‘Ferguson reflex’ – probably after some man.”

    This is a great article and I think you’re making a really important assertion.

    I am a labor & delivery nurse. I am also a man. I am not some man, however. As a nurse I am happy to receive your insight and I think my practice and my patients will benefit from it. As a man who happens to be a nurse I am sorry it was necessary for you alienate me.

    • I’m sorry that you feel alienated by my comment. It relates the history of medicine and the naming of female body parts and processes by (medical) men. I was trying to make light of the issue. I would hope that any man working in midwifery or with women would be sensitive to the historical and present day oppression of women via medicine (which until recently was male-dominated). As a woman I feel alienated when my female body parts (e.g. fallopian tubes) are named after a man who does not even have them! I wrote my Hons thesis on Male Midwives – which involved an exploration of the history of men in birth… it was not at all ‘anti-men’, but I do think men need to have an awareness of these issues and how they impact on women.

  187. Missaga says:

    This is exactly what happened during my birth!! Almost word for word. I felt like everything went wrong with my daughter’s birth. It was awful. All my midwives were away. I was forced to go to a hospital just a month away from my due date because NJ cancelled all insurance to birthing centers. The midwife who showed up was never in a hospital before. She forgot my birthing tub and then she left for a few hours to get a waterproof fetal monitor. She took my Douala with her and when they got to the center a woman was there in labor and she couldn’t leave and come back. Meanwhile, everything for me was going wrong. The doctors were telling me scary stuff about my daughter’s heart rate dropping and having a c-section and my midwife was off delivering another baby?!! When my original midwife showed up she examined me and saw the lip as the problem. She put this metal hook inside me and lifted it up. That hurt so friggin much. The heart rate was still dropping. I was only 8 centimeters and I began to push. I remember the midwife saying that when I pushed my baby wasn’t getting oxygen so I had to stop. But I couldn’t! It was the worse feeling I have ever had. I will say that I was repeatedly asked if I wanted the epidural and I refused it. I was in labor for 4 days. I was being prepped for a c-section. My midwife wound up relinquishing her rights to the hosptial (something she said she never had to do before (sadface) Then my daughter’s heart rate went flat and the surgeon wound up just delivering her in my room naturally with foreceps. What a nightmare. But after 4 days, a cervical lip, a missing midwife, 4 midwives on vacation, no drugs my daughter was born vaginally on 11/11 at 11:11 :)

    • I am so sorry that your birth experience was this way. I’m not sure what the ‘metal hook’ was but it sounds awful. I’m amazed you birthed vaginally after all of that. Thanks for sharing your story.

  188. rachel seangsuwan says:

    I’d like to be Notified of new posts

  189. kathleen says:

    I had one!! They did an exam, because I was pushing hard. Said I was 7cm, and to stop. Yeah right I had no medication, I was in pain and my body wanted me to push, so I did. Another midwife came in examined me internally and said “oh its an anterior lip (I think that’s what she called me) and she held it out the way while I pushed past it. If she didn’t come in, I would have had 2 midwives trying to stop my labour… And yes they called for an epidural! This is what we are born to do, we just aren’t allowed to trust our bodies anymore so have lost confidence and its gonna take a lot to get it back!

    • You body was working perfectly. It was cultural norms and misunderstandings that were not working for you. They don’t have to ‘allow’ you to trust your body… you have to ‘allow’ them to interfere. Can you avoid these practitioners/birth setting for your next birth? Or perhaps bring a doula with you to advocate for your wishes and support the physiological and instinctive process of birth?

  190. Sophia says:

    Hi there,
    Having just qualified in the UK I absolutely love your posts, really inspiring!
    I just wondered what you thought of the old debate regarding anterior lip which midwives often use in order to ‘buy women more time’?? I know the whole concept of time limits in labour (particularly a physiological, low-risk labour) are fairly arbitrary anyhow and it feels gutting to have them in place within binding trust protocols, but in an obstetric unit and a litigious culture I have found this ‘trick of the trade’ to be something that happens frequently (even if it isn’t openly verbalised!)

    • Hi Sophia – Midwives are quite inventive when it comes to ‘navigating’ the system for women. Mistruths are common and can protect women from intervention. We really shouldn’t have to do this – but the alternative is often the woman being bullied into intervention. I explored this a little in my phd thesis and referred to what you describe as a type of ‘covert authenticity’.
      Ideally with regard to vaginal examination obstetric units would start implementing the evidence re. vaginal examinations and partograms in ‘normal labour’ ie. not use them. The evidence in there in the form of Cochrane Reviews… I certainly be ensuring that women are aware that although it is hospital policy to offer a vaginal examination, it is not supported by current evidence and is entirely up to them. There baby will be born regardless of vaginal examinations and their findings. :)

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