Have you ever heard of someone’s birth being hijacked by a cervical lip?
She might have been labouring really well and then starts to feel pushy.
Her midwife encourages her to go with her body and she does.
Yet nothing happens.
What Is A Cervical Lip? How It Can Hijack Your Birth?
After a while, frustration and tension build.
The midwife checks her cervix and finds a cervical lip.
The woman is told her body isn’t actually ready to give birth and she should stop pushing.
What is a cervical lip and how can it hijack your birth?
What Is A Cervical Lip?
The cervix is part of the uterus, except it’s made of different tissue.
It sits in the bottom section of the uterus, and extends into the top of the vagina.
When labour begins, the uterus muscle contracts and this shortens and pulls up the cervix.
Over time, contractions will thin and dilate the cervix fully.
To find out more about this check out How Your Cervix Dilates And Why It’s Unpredictable.
As the cervix dilates it’s usually pulled upwards evenly.
Sometimes, however, one side of the cervix is still present, or not pulled up into the lower uterus.
This is a cervical lip.
How Can A Cervical Lip Hijack Your Birth?
In the 1950s doctors decided labour and birth followed a set pattern.
Active labour, when the cervix is dilating, is meant to last a certain amount of time.
The cervix should be fully dilated at the end of the active stage, before the pushing or second stage begins.
The second stage is also meant to last a for only a certain time.
When labour doesn’t follow this set patten, the woman is told her labour is failing to progress. Her body isn’t doing its job.
Interventions begin with a vaginal or cervical exam.
There’s a bit of cervix still ‘in the way’. This is a cervical lip and perhaps the cervix has even become swollen.
Interference continues, with instructions to stop pushing. This causes the woman unbearable pain and fights against her body’s instinct.
More interventions follow, to help reduce her pain and birth her baby.
These might be anything from drugs, to assisted birth (episiotomy, forceps or vacuum), or even c-section.
The birth she hoped to have has been hijacked by a small part of her own body.
What Causes A Cervical Lip?
There are many theories about the actual cause of a cervical lip.
Some women are told it happens because they pushed ‘too early’.
Other women are told it’s due to uneven pressure from the baby’s head.
Dr Rachel Reed’s article The Anterior Cervical Lip: how to ruin a perfectly good birth explores the causes of a cervical lip.
As she points out, simply due to anatomy, almost every woman will have an anterior cervical lip in labour.
It’s generally believed the cervix dilates evenly in a circle.
In fact, as Dr Reed shows, the cervix opens like an ellipse or oval, from the back to the front.
In early labour the cervix points toward the back of the vagina.
As it begins to dilate, the cervix will open forward.
This means the last part of the cervix to move out of the way will be the front part, or anterior.
Unless the woman has a cervical exam, this anterior lip will go unnoticed.
A posterior cervical lip is almost impossible to detect because this area of the cervix is pulled up first and is more difficult to reach in an exam.
Does A Baby’s Position Cause A Cervical Lip?
It’s commonly thought a baby’s position in the pelvis causes a cervical lip.
However, the cervix dilates because the muscles in the top of the uterus shorten and retract. This thins, then opens, the cervix.
The baby’s head and its position have nothing to do with the actual dilation of the cervix.
But the baby’s position can shape the cervical opening as it dilates around the baby’s head.
A baby entering the pelvic brim with her back in line with her mother’s belly (occiput anterior position) is more likely to create a circular shape to the cervix.
A baby entering the pelvis with her back in line with her mother’s back (occiput posterior position) will create a more uneven shape.
Does Pushing Early Cause A Cervical Lip?
Because of the commonly held belief pushing is something a woman needs to work hard at, we have very defined ideas of how and when pushing should happen during labour.
Most birth information and care providers say when you feel the ‘urge to push’ your cervix is fully dilated and your baby can be born.
However, the baby’s head pushing on certain nerves in the pelvic floor triggers the pushing sensation. This is normal (Ferguson’s reflex) and isn’t dependent on how dilated the cervix is.
Perhaps unsurprisingly, research from 2013 found women were more likely to have a cervical lip when they were checked soon after feeling the urge to push.
The researchers also found early pushing occurred in 41% of women with babies in the occiput posterior (OP) position.
In this position, the hard part of the baby’s head pushes against the rectum quite early, which triggers the Ferguson’s reflex.
Pushing early can help a baby in the OP position rotate to the optimal occiput anterior position for birth.
Hospitals usually have a policy to check cervical dilation when a woman begins to feel ‘pushy’.
If the cervix isn’t fully dilated or a lip is found, she is advised to stop pushing to avoid damaging her cervix.
There is virtually no evidence to show spontaneous pushing before full cervical dilation will cause tearing, lacerations or haemorrhages.
A research review from 2015 concluded:
“Pushing with the early urge before full dilation did not seem to increase the risk of cervical edema or any other adverse maternal or neonatal outcomes”.
Swelling of the cervix might occur if a woman is told to push forcefully when her body isn’t yet ready to push.
What To Do For A Cervical Lip?
The best way to avoid intervention for a cervical lip is to refuse cervical checks.
There’s no evidence to support the use of cervical checks, and there are other ways to monitor cervical dilation.
If you aren’t aware of a cervical lip, you can’t be made to feel something is wrong and your birth won’t be hijacked.
Try these approaches instead:
Your body and your baby know what they’re doing.
Most often, time will resolve a cervical lip because what is ‘causing’ it is resolved.
It could simply be your baby’s head needs to move into a better position.
You can employ any of the following suggestions to help take some of the pressure off your cervix.
#2: Position Change
There are several ways you can change positions to take pressure off your cervix.
- Going on hands and knees
- Leaning forward
- Lying on your side
- Bringing knees to chest
Try one or more of these to find out what works for you.
One of these positions might help your baby to rotate into an optimal position for birth.
#3: Water Immersion
If you have access to a birth pool, floating on your back can relieve pressure on your cervix.
It also aids relaxation and allows you to adopt positions for contractions that feel most comfortable.
If your body is pushing spontaneously, it’s impossible to stop this urge.
Go with your body rather than try to fight it.
Fighting your natural instinct to push will cause more pain and, eventually, lead to interventions.
If you can feel pain above your pubic bone with each contraction, this is the cervical lip being nipped against the bone.
Adopting a position that takes pressure off the lip will also help.
A way to relieve the pain of a nipped cervical lip, or even to help resolve it, is to apply strong upward pressure to the area above the pubic bone.
Taking very long strides during contractions can help shift a cervical lip.
This can be very painful, so it’s best to have someone on either side of you.
If you’re unable to walk, try this: lift each foot in turn, stamp it down, then squat.
#7: Manual Assistance
If things are taking too long and you’re unable to cope, the cervical lip can be moved manually.
Your midwife or doctor will push the lip of the cervix over the baby’s head.
It’s very painful and might take more than one contraction to resolve.