I learned as a student nurse-midwife 18 years ago how to, in
most cases, reduce an anterior lip. First of all, though, it
may not be a problem at all and simply needs more time. But
if the mom is tired or has been stuck for a while then I may
try to intervene. I tell her that it is going to hurt but I
ask her to work with me during one contraction. I will ask
her to push as hard as she can and get three good pushes in,
holding her breath and really bearing down. I ask her to lie
in a semi-reclining position. I push up on the lip with 2
fingers while she bears down--usually, I can push the lip
back. I then keep my fingers in-a lip tends to slip back
down. In between contractions I may then try to ease the lip
back. I try this for only 2 contractions. If it doesn't go,
we need "tincture of time." Sometimes using a squat position
can be a successful alternative to the semi-recline. If it
doesn't stay back, I then may try several position
changes--hands and knees, side-lying--to get the pressure
off the lip from the baby's head. I may then re-try the
above after 30 minutes or so have passed. Eventually,
through time or descent of the head, success is achieved. It
certainly is very rare to end up with a c-section for a
persistent anterior lip that cannot be reduced.
-Patty,CNM
Indianapolis
====
Assuming that time hasn't taken care of an anterior lip, I
usually use arnica oil rubbed straight on the cervix. Sit
back and wait a few contractions and if it isn't gone, you
can usually reduce it much more easily. Primrose oil
sometimes works and I used that before I got sick of
stubborn anterior lips, especially in primips, and got some
arnica oil, which is also lovely on a swollen perineum.
-Samantha McCormick, CNM
Brooklyn, NY
====
The best way I have found to reduce an anterior lip is to
lie the women in a left lateral position for a few
contractions. When it's gone she can get into the position
she wants to to deliver.
_G.R., community midwife
England
====
I have found anterior lips appear mostly with ROA or
posterior babies. My best remedy that has worked 99% of the
time for a lip or edematous cervix:
Using a 10cc syringe w/18 0r 20 gauge needle, puncture five
evening primrose capsules, then draw oil into syringe. After
all five have been drawn up, add an equal amount of
gelsimium, arnica and blue and black cohosh into the syringe
(if the primrose caps equal 1cc, add 1cc of each tincture).
Dispose of needle. Shake the syringe to mix remedy. It is
best if mother is in knee chest position. Do a digital exam
and locate the lip or swollen area. Slide the syringe along
your fingers to the spot and slowly insert the remedy. There
will be some stinging sensation, which directs the mind to
attend to that swollen spot. Tell the mother to think about
that spot and melt the cervix away. Massage the remedy on
the lip or swollen area. After administering all the
concoction, keep the mother in knee chest for at least 20
minutes.
-Shine Herfindahl, CDM, CPM
Let me know how your lip melting goes: shine@girdwood.net
====
I have found a few thing that help in this situation.
1. Have the mom WALK during contractions--she will need to
take very large steps and will need to have someone on each
side of her. This really hurts!!!!
2.If walking down the hall is not possible (care provider
wants continuous fetal monitoring), have the mom lift each
leg in an exaggerated stomp, then squat and repeat several
times.
3. If mom is confined to a bed, roll her from side to side
over and over.
I realize the above solutions are NOT fun for mom at all but
they work!
-Mary, doula
====
If the mom is not having a really strong urge to push, just
wait it out with her, doing relaxing breathing as much as
she can.
Try hands and knees, or side-lying to reduce pressure on the
cervix.
Put some ice chips into the finger of a glove, then put this
glove over your gloved hand and hold the ice against the
lip. Mom can be in any position that allows you to reach her
cervix.
If she is having a strong urge to push and the cervix isn't
moving out of the way, you can have her flex her hips more
by having her hold her knees back (she is
semi-sitting/reclining on her back) and put 2 fingers
against the lip and hold it up during contractions and then
put pressure against it in between contractions. I always
keep talking to the mom if I'm doing this because it hurts
her. I try to reserve this for the times I've seen that big
purple cervix pushing out with the baby's head, or the lip
is increasing, or the mom's pain is increasing as she pushes
(they especially say it is hurting more right above the
pubic bone when pushing against a lip that isn't shrinking).
Sometimes "blowing" breathing can help her avoid pushing
against the lip.
Keep an eye on the baby's position in labor-often persistent
anterior lips are seen with posteriors.
-Pat C.
====
Reprinted from Midwifery Today E-News (Vol 2 Issue 23 June 9, 2000)
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