What is cervical recoil?

Our cervixes haven’t read the textbooks

This isn’t the only area in which textbooks are inaccurate when it comes to pregnancy, labour, and birth, but it’s a key one. The textbooks aren’t wholly wrong. It’s true that most women’s cervixes open in the way the textbooks suggest.

But experienced midwives have long observed that this isn’t always what happens.

Sometimes, a woman’s cervix becomes less dilated before labour progresses again.

For example, one woman who I looked after reached eight centimetres of dilation at home, but her cervix was found to be five centimetres dilated when an obstetrician examined her upon arrival at the hospital.

The actual numbers aren’t that important. It’s enough to understand that we see situations where a woman’s cervix has begun to close during labour rather than continuing to open.

Or, to use the medical term, in which dilation goes backwards rather then forwards.

This phenomenon is known as cervical regression, or recoil, and it’s more common than people think.

Observing cervical recoil

Cervical regression and cervical recoil

Cervical regression is a cause-neutral term that simply describes what is happening to a woman’s cervix without assuming a cause. The woman’s cervix was 6 or 8 centimetres dilated, and now it’s 4 or 5. Regression is just a statement of measurement.

The term ‘cervical recoil’ is used when regression occurs after a woman encounters something that disrupts her sense of safety. More on this below.

While many occurrences of cervical regression can just as accurately be termed ‘cervical recoil’, regression does sometimes occur in the absence of an obvious external trigger.

Why do cervixes recoil?

In my experience and that of many midwives, cervical recoil tends to be the result of an interruption or disruption to labour.

Here are the two examples that I have seen quite often and that I use to illustrate this idea.

One, a situation where someone with whom the woman does not feel completely safe enters the home or birthing space. This can be a stranger or sometimes a known family member, birth worker or care provider who disrupts the energy, usually unintentionally.

And two, 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 slow down or pause. If vaginal examinations are being carried out, we sometimes observe that the cervix has either stopped dilating or that it is less dilated (open) than it was before.

A mammalian response

There is a simple, physiological explanation for cervical recoil.

All mammals need to feel safe from predators in order to relax their bodies enough to give birth. Humans are no different. We know from vast experience that, if a woman (or any other mammal) feels unsafe, their labour will stop.

Does the same thing happen in tigers or rhinos? We don’t know. Happily for them, people aren’t generally putting fingers into their vaginas while they’re trying to have their babies. But it’s very possible that cervical regression is a mechanism used to stop labour when a mammal senses danger.

Cervical recoil is beneficial

It follows from this that cervical recoil can be beneficial, in an evolutionary sense. It’s a normal, healthy protective mechanism, not a sign of pathology. Any mammal who feels threatened would be wise to avoid giving birth until they feel safe again.

So cervical recoil is an instinctive, subconscious safety mechanism. Just like pulling your hand away from a hot surface is a safety mechanism. It’s our body’s way of saying, “gosh no, not right now, thanks. Not a good place/space to birth at all. Better shut up shop and wait.”

And so the cervix closes a bit. To keep the baby safely inside until the coast is clear.

Given patience, understanding, and willingness to follow the woman’s bodily instincts, labour will almost always start up again on its own. The woman’s body will soften, and her cervix will begin to open again. In my experience, it can sometime take just minutes for the woman to get back to the same point in labour. As long as we change the setting and situation so she feels that it’s safe to birth.

How should we respond to cervical regression?

The key here is about trying to work out why labour has stopped, what the woman might need, and whether we can change things about the environment or situation to enable her to feel safe again.

Sometimes, she might need a rest, or a meal.

If it’s a person that’s the problem, we could suggest that they leave. That doesn’t always go down well, but it can make all the difference.

Unfortunately, the person can sometimes be someone you’ve hired to help with your birth (or someone they have sent to replace them, as they are busy), or a caregiver who is the only person available to help. Then it gets logistically tricky.

Not to mention personally tricky, but that’s again because this phenomenon isn’t well understood.

If it was, we would be having conversations and there would be more understanding and perhaps less taking it personally. It’s one thing if a caregiver is exhibiting bullying or coercive behaviour. That’s never okay. But if a midwife sounds too much like someone’s unsupportive mother-in-law, or the replacement doula reminds someone of a school bully?

Maybe we could make space for it to be okay to talk about that.

Adapting the environment

When it’s the environment, that’s also tricky. Sadly, most hospitals aren’t set up to feel like safe spaces, and that’s a key problem. They look clinical and uninviting. Wards often smell weird. They may trigger memories of traumatic visits as a child, or of much-loved family members being sick or dying.

No wonder our bodies ‘pull away’ and react as if we were unsafe.

Ideally, someone would say, “well, why don’t you go home again? We can send a lovely midwife with you.”

Or, “how about the birth centre instead? That’s full of scented candles and oil burners, and the doctors have to knock before they enter rooms. They won’t come in unless you and your midwife say it’s okay to do so.”

The solutions are there. My colleagues and I have been writing about them for decades now.

We need people to listen. And we need patience and understanding.

That’s not always easy in the system, though

In the reality of systems of modern maternity care, patience and understanding are sometimes in short supply.

Ironically, some of these women will go on to be very grateful that they were in the hospital. They will be happy that they ‘were in the right place’ when things went awry. We see the same gratitude in situations where a baby has become distressed after medical interventions were applied to labour. Ironically, the lack of progress and/or distress may well be the result of the drugs and interventions given to correct a physiologically normal and evolutionarily helpful behaviour.

These women and families may not realise that a woman’s body was reacting in a normal, protective and physiologically helpful way.

Or 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 if they had received patience, understanding and holistic, woman-centred care once their body had responded in this way.

What’s the evidence?

While midwives have long understood that the dilation of the cervix is not unidirectional, this hasn’t been written about extensively. 

The concept of cervical recoil was named and discussed by midwife Betty-Anne Daviss, and described in a research study by Daviss and Ken Johnson (1998). I have heard variations on this concept being discussed by midwives from a number of cultures, over many years. Ina May Gaskin noted that it was called pasmo in parts of South America, and a few other midwives, including myself, have written up our own thoughts on this topic.

There is some relevant research, even though it doesn’t look at cervical regression/recoil directly. When researchers used transvaginal ultrasound to track cervical length across pregnancy in first-time mothers, they found that women’s cervixes don’t all follow the same trajectory.

Most shortened gradually as expected, but some showed a sudden late reduction, others sped up after 30 weeks, and one woman’s cervix actually got longer over time (Bergelin & Valentini 2001).

This study is a useful reminder that, even outside of labour, cervical behaviour is far more varied than the textbooks suggest.

Midwives’ experience

But many midwives have experience of cervical regression and recoil. I have discussed this topic at conferences with countless practitioners who recognise and have stories about this phenomenon.

When I raise it as a topic, a few people sometimes realise 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.

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.

For more information

You can see all of my resources and articles relating to the behaviour of the cervix here:

Cervical wisdom resources

Bergelin I & Valentin L (2001). Patterns of normal change in cervical length and width during pregnancy in nulliparous women: a prospective, longitudinal ultrasound study. Ultrasound Obstetrics and Gynecology 18(3): 217-22.

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’. TPM 6(8): 34-37.

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

---

---

---

Books to help you become informed and make the decisions that are right for you…

---

---