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Regarding the information from "The Second Stage Handbook" in Midwifery Today's E-News Issue 6:02�Cervical Lip: Most midwives believe this to be the most prudent move when there is a persistent posterior lip, and because of this, it is commonly used both in obstetrics and midwifery. However, I want to give you a different perspective and an alternative option that is much less stressful and painful for the mother. During my planned HBA2C labour, I developed an anterior lip after eight hours of labour. My midwife tried to resolve it with the technique described. It was excruciatingly painful, and from that point on labour pain was focused on the anterior lip with each contraction. To reduce the pain, I would try and "lift" my baby up off that cervical lip with each contraction. Obviously this strategy was counterproductive, but neither midwife noticed my pulling my sacrum and stomach muscles in while I was doing this. Ten hours and two more attempts at resolving it later, I was transferred and had a cesarean section. In preparation for my HBA3C with a different, more hands-off midwife, I studied the Pink Kit in depth. The Pink Kit is a video, audio and book set published by Common Knowledge Trust (www.birthingbetter.com) that provides the knowledge you need to understand your unique body structure and how it works. From this kit and from e-mail correspondence with Wintergreen, one of the Pink Kit's makers, I learned many things. I learned that an anterior lip is normal because it is the last part of the cervix to move up and out of the way, as per the physiology of baby's movement through the pelvis and the shape of baby's head as it puts pressure on the cervix. I also learned that an unresolved and eventual swollen anterior lip is caused by an immovable sacrum, usually caused by semisitting positions. Baby is moving around the pubic bone, and the anterior cervical lip is caught between the pubis symphysis and baby's head. The pivotal point for me, however, was learning how incredibly movable the sacrum is. I came to believe that my swollen anterior lip was caused by my sacrum not opening up--not because I wasn't in good positions, but rather because I wasn't moving it. I was active and in upright positions, mostly sitting in the birth pool, leaning forward. Today, most women do not move their sacrums or even know how to move their sacrums. With that knowledge, I went into labour with my fourth child and had only one vaginal exam at 5 cm. My focus was on open positions, both for my inlet until baby dropped into my pelvis and my outlet when baby moved down, and relaxation of my inner tissues (also learned through the Pink Kit). When I again felt that familiar anterior lip (the sharp twinge of cervix caught between pubic bone and baby head), I assumed an open position (the dangle or a supported squat) and opened my sacrum to allow baby to move around the pubic arch rather than having to mold around it. I walked around the island in my kitchen between each contraction instinctually. Within a short time I had a strong urge to push, and my daughter literally fell out of me once her head was born. In hindsight, I would strongly urge midwives to avoid resolving the anterior lip manually as described in the E-News except when all else has failed. It caused me to hold in my baby for 10 hours and led to a cesarean conclusion as I tried to avoid the pain it caused me. Teach women to move their sacrums both in and out (in opens inlet, out opens outlet). If you do, please prepare your client, allowing her to tell you when to stop, and watch closely for tension resulting from the procedure. I wholly credit the Pink Kit for my VBA3C. � Connie Banack, CCCE CLD CPD |
