Exploring cervical recoil…

cervixes recoilOne of the presentations that I most like to be asked to give is called ‘Cervical Wisdom‘.  This is a session that I have developed over the years in which I analyse the things that textbooks and received wisdom would have us believe about the alleged behaviour of women’s cervixes in labour, comparing these to what we know from practice experience and research about the actual behaviour of woman’s cervixes in labour.  Which is not, of course, to imply that all cervixes behave in the same way, but it is the rare woman whose cervix behaves according to the rules set down in the textbook and my current conclusion is that existing textbook knowledge excludes some important key knowledge and principles.

One of these principles is the phenomenon in which cervical dilation can decrease as well as increase in labour.  In my experience, this tends to be the result of an interruption or disruption to labour, and the two examples I use most often when describing this are a situation where someone with whom the woman does not feel completely safe enters the birth room or where the woman moves (or is moved) to a different environment in labour, such as from home to hospital or from one room to another.  I have seen many situations in which such an event can cause labour to temporarily stop, and if vaginal examinations are being carried out then it can become apparent that the cervix has either stopped dilating or that it is less dilated (open) than it was before.  The explanation for this is simple: all animals need to feel safe from predators in order to relax their bodies enough to give birth, and humans are no different.  Cervical dilation is merely the measurable result of the women’s body making progress in labour.  Given patience, understanding and willingness to follow the woman’s bodily instincts (which may be different from what her mind wants, but that’s another article), labour will often start up again on its own, and dilation will start to increase again.

In the reality of systems of modern maternity care, patience and understanding are sometimes in short supply.  Despite the best efforts of some practitioners, women experiencing this situation may be told that they have failed to make adequade progress and that they need syntocinon (pitocin) to speed things up.  Ironically, some of these women will go on to be very grateful that they were in the hospital because they ‘were in the right place’ when their baby became distressed (as a result of the drugs given to correct a physiologically normal and helpful behaviour).  They may not realise that their body was reacting in a normal and physiologically sensible way in the first place and that they likely would have had a far better outcome and no need to be rescued from anything if they had either been in a different environment in the first place or had received patience, understanding and holistic, woman-centred care once their body had responded in this way.

While midwives have long understood that the dilation of the cervix is not unidirectional, this hasn’t been written about extensively.  It was noted and described in a research study by Betty-Anne Daviss and Ken Johnson (1998), further described by Ina May Gaskin, who discovered that it was called pasmo in parts of South America, and a few other midwives, including myself, have written up our own thoughts.  I am certain that it is a relatively common situation, though.  I have never presented my Cervical Wisdom session to a group of midwives or holistic birth practitioners without there being a buzz of recognition when I talk about this phenomenon, with a few people sometimes realising for the first time that they are not alone in a sea of cognitive dissonance.  Perhaps even more reassuringly, they understand that their fingers are not deceiving them; they can correctly interpret what they are feeling during vaginal examinations, and it is the assumptions laid down by the gentlemen of the eighteenth century obstetric textbooks that are the problem, not women’s bodies or our midwifery skills.

Where midwives have found spaces to discuss this, we have tended to use the terms ‘cervical regression’ or ‘cervical reversal’, but when I presented this session at the 2014  Midwifery Today UK conference, the very fabulous Canadian midwife and researcher Betty-Anne Daviss (who co-authored that study mentioned above) shared that she and her colleagues had decided to use the term cervical recoil to describe this phenomenon in English.  They use this term in order to reflect the fact that the cervix is generally closing because the woman’s body is recoiling from something that is disturbing her sense of safety.  I had somehow missed this linguistic subtlety before and was really taken with the way in which a slight alteration in the terminology can help convey additional elements of the phenomenon, and wanted to share this idea more widely in case others wish to adopt the phrase as well.

 

Useful References:

Bowman L (2006). Cervical reversal/regression. Midwifery Matters, 108: 14.

Daviss BA and Johnson K (1998) Statistics and Research Committee. MANA Newsletter, 16(2): 16-17.

Gaskin IM (2003). Going backwards: the concept of `pasmo’. The Practising Midwife, 6(8): 34-37.

Wickham S (2009). Stepping stones and cervical wisdom. Birthspirit Midwifery Journal (1):39-42

10 comments for “Exploring cervical recoil…

  1. Claire
    July 10, 2014 at 9:13 pm

    Cannot believe I finally have an answer this has happened in both my labours. 22 and 18 years ago. I am now a student midwife at the end of my second year and this is still the first time I have ever heard this mentioned. So glad to know I didn’t imagine it and that all the disbelieving looks and comments I have had were wrong. With my first I cannot give a good example as it was so horrific I still don’t really want to discuss it. With my second I decided on a home birth with the understanding that I would rather die than go through such a horrific birth again. All was going great I was 8 cms and then the entonox ran out I reverted to 5cms which was excruciating and terrifying. So ambulance and forceps for me. I finally feel that I am not a liar Thankyou for this

    • July 14, 2014 at 7:05 am

      I’m so sorry you had such horrible experiences, Claire, but glad if this has helped you make a bit of sense of them.

  2. Gaylene Mason-Hollier
    July 10, 2014 at 10:05 pm

    Thank you for publishing this article. I have had cervical recall happen with a few of my clients & when the registrars have done a ve for ‘lack of progress’ I have been accused of incompetence in my practice with assessing ve’s & no backup or collegial support from midwifery colleagues when accused. There is a lack of knowledge around normal birthing progress in this country in teaching our doctors, who will then progress on to being our next generation of obstetric consultants.

    • July 14, 2014 at 7:07 am

      Absolutely; we need to share more about what’s really normal as far as women’s bodies are concerned … not just textbook ‘normal’, or medicalised ‘normal’…

  3. Roxanne Hansen
    July 26, 2014 at 11:47 pm

    WOW! I love it! How many woman have gone through needless augmentations, believing their bodies had failed them. Truth is their body was reacting appropriately, wisely. Warning us of the importance of psychological, emotional safety in birth. Personally I had a hard time carrying a pregnancy to term, even to the second trimester. The babies that made it to term tended to be born very overdue, yet on time for those babies. My second was born at 44 weeks , my third at 48 weeks and my fourth at 44 weeks. largest weighed 8lbs. with no signs of post-maturity! We must trust our bodies they know what our babies need. I have raised five healthy, strong daughters – I am so blessed!

  4. Bern
    September 4, 2014 at 11:12 am

    Hi I heard a beautiful description of the birth process which made sense – that there were in fact two births – the first is the cervical birth which is the ‘death of the woman as a maiden’ and her birth as a mother who then gives birth – the second birth to her baby. This makes sense in terms of what you say. If the ego of the maiden does not feel safe to surrender she will recoil – tense and that first birth of herself as mother will be stopped – who would want to give birth to her baby into an unsafe world.

  5. Chara_Watson@yahoo.com
    September 19, 2014 at 8:30 pm

    I just saw this post today (I’m new to your blog) and it was interesting timing to me. I have a friend who posted a link to this article just this morning (http://www.brainpickings.org/2013/09/23/naomi-wolf-vagina/) and it struck me as interesting that female genitalia can have an emotional reaction to being threatened or feeling unsafe. Both sex and birth are very psychological and physiological events and I’m so glad to see that there is research connecting those. Thank you for sharing this information.

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