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Swollen cervix

Too often a swollen cervix sends birthing women to the operating room. Here's what to do about it.

 

The cervix opens like an oval ring getting wider and finally more round as the baby's head presses down upon it during fetal descent in labor. Effacement of the cervix is when the cervix gets thinner. Thinning out helps the cervix to open.
 
Because we expect the cervix to get thinner, it can be alarming when the cervix stops opening and swells. 
 
Swelling with contractions and without progress is a sign that labor progress has stopped or stalled.
The swelling may be equal all around, but is usually unequal.
  • Swelling in the front of the cervix is common and usually resolves with time for flexion and molding. Sometimes help to flex the chin is desirable!
  • Swelling all around is not so common and usually means the baby may need more help than simply time. 
  • Swelling on one side indicates that the head is asynclitic. Do the sidelying release for both legs for any of these, but particularly for this one! Afterwards, lay on the side that the swelling is thicker.
 
But it doesn't mean that the baby won't be able to fit once the baby, often needing our help, can find their way through the lower pelvis.
 
 
The uterus continues to contract, trying to correct the baby's position. The baby may be 
  • Occiput Posterior
  • Asynclitic (tipped head)
  • Deflexed (head is in a military presentation or has an extended chin)
 
The baby may or may not be able to fix this spontaneously. Time without helping baby to fit may only stress the womb or baby. But when we understand the need, we can begin to address the issue more intelligently. 
 
 
 
 
 
 
Midwife Carol Gautschi teaching us at Midwifery Today. Jan Tritten and Gail Tully enjoy Carol's direct style.
 
 
 
 
 
 
 
 
 
 
 

Necessary changes include flexion, rotation to a better position, and/or molding better to fit.

 
 

Interventions

When the cervix is swollen this knee chest position helps and we can put a bit of ice in the finger sleeve of a glove and apply to the cervix.
 
We also put Homeopathic tablets of Arnica and or Cimicifuga on the cervix and give orally according to directions.  These must be the homeopathic versions of these herbs to be safe and appropriate.
 
Quieting the environment and letting the birthing mother rest on her side in a deep tub of water between 94 and 98 degrees Fahrenheit. A mature and soothing woman to reassure her and help her doze helps her mind calm down and the cervix to open. 
 
An experienced doctor, midwife or, possibly, nurse (if local protocols allow)
might be available with skills to flex and rotate the baby's head if these things don't work. I haven't found this to be a common need in these situations, but shouldn't be forgotten in cases where its appropriate.
 
An epidural may not solve the swollen cervix but may be offered in the hospital. 
 
A cesarean is offered or recommended when the labor doesn't resume within two hours. Yet, this situation can easily take that long or a bit longer to correct itself using the above position changes and ice. 
 
 

A stall is not CPD

A stall in labor is when contractions come strongly but the cervix doesn't continue to dilate. (A lull is when contractions are milder.) CephaloPelvic Disproportion (CPD) means the baby's head is disproportionately big for the mother's pelvis.
 
A stall in labor with a swollen cervix is NOT IN AND OF ITSELF reason for a cesarean.
Swollen cervixes will become unswollen when the head shifts and allows circulation. We can also move the mother to improve circulation.

The cause of the stall with swelling is often a need for further flexion and rotation for the baby to line up with the lower portions of the pelvis. But we can not forget fear or disturbance of the birthing environment as a causative factor. 

See my article, Will Baby Fit? to understand the signs of a labor in which the baby can't fit to see the difference between a stall in labor and signs that baby is really to big for the pelvis.