One 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.
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