Wednesday, August 23, 2006

Don't Give Me No Lip!

What is it with cervical lips?

Are they really an issue, obstetrically, or is it an artifact of vaginal exams that we even know they exist? I do know that sometimes, especially if she is on hands and knees or leaning forward, a mom can get a swollen lip if she is pushing on it and it gets pinched between the babies head and the symphisis. I've felt the swelling. If the mom stops pushing, we can try to "flip the lip" by having her lay on one side for three contractions, the other side for three, and hands and knees for three. This usually requires someone in her face helping her to not push.

Or, the midwife can "hold" the lip out of the way, which is actually manual dilation and is painful for midwife and mother. Who wants to have a baby by pushing with someone's fingers in their yoni the entire time??? Not me, that's for sure.

I was at Pearle Vision getting my daughter's glasses fixed yesterday. I was wearing one of my midwifery T-shirts. The lady helping us said, "You look like a midwife." She told me of a friend of hers that had just become a midwife. She said she wanted to have a midwife but was unable to. I asked why. Her answer? "I have a cervical lip. I never dilate fully. I asked my doctor, but he said that due to this, I should give birth always in a hospital."

I actually laughed. I couldn't help it. I've had 4 recent clients with "cervical lips" (more on that in a minute) and they all gave birth vaginally at home. She asked me if that was stupid. I told her frankly that yes, it was.

So, these last several clients with "lips". I was the primary under supervision. Each time, I would suggest the mom lay on her side to reduce the lip. Each time, my preceptor would tell my I "had to" hold the lip out of the way if the mom was going to push anyway. Without the confidence to know what else to do, I did what she said, hating every single moment of it.

I don't have enough experience to know what else to do. If you leave them alone, will they really harm their cervices by pushing before complete dilation? Is swelling ultimately harmful? Should women resist an overwhelming urge to push?

I am torn between believing that birth works completely and believing there is a time and place for intervention and this may be one of them.

I really invite comments and opinions on this. I am still trying to find my way. I want to be a "hands-off" midwife, but I also want to first, do no harm. I want to be the guardian of normal birth and only interfere when it is absolutely necessary. I am just not completely convinced this is one of those absolutes.


Jen said...

In my opinion if a woman has the urge to push, that is what her body needs her to do. Perhaps it will cause dilation to become complete, but maybe not. I believe it doesn't matter as long as she follows her body's direction.

Also, what about position change? I think a full squat can help some women get that last bit out of the way.

Kelly said...

During my homebirths, no one would've known the difference. Was I potentially hurting myself? Who's to say? I never had a vaginal the entire pregnancy and labor. Attended, but unassisted. I had MY fingers up there, but I couldn't tell you if there was a lip or not. The urge to push is just too strong. And it makes sense that one push can put the baby's head in such a postition to complete dilation.

Modern medicine knows too much here, I think. Let's just get back to letting the body give the signals. Makes sense to me!