Episode 203 - Swollen Cervix
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD and each episode I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth and postpartum journey.
[0:26] Today's episode of the Great Birth Rebellion podcast has been sponsored by Poppy Child from Pop That Mama.
[0:32] Poppy is the creator of the birth box, which also contains the oxytocin bubble. It's an online course full of strategies to help you prepare for birth. It's centered around hypnobirthing techniques, and it includes her very popular oxytocin bubble birth tracks. And one Great Birth Rebellion listener has given some feedback to Poppy about the use of the oxytocin bubble and of the birth box. And she says, I just wanted to thank you for your birth tracks. I'm in Australia and I found you through the Great Birth Rebellion podcast. I had a successful home VBAC on Saturday at exactly 37 weeks and I was able to breathe my baby out with minimal damage thanks to your breath work. I listened to the oxytocin bubble loop tracks all throughout the hours of early labor until transition. It was so reassuring because I'd become familiar with the tracks. If you're interested in learning more about the birth box and the oxytocin bubble loop tracks, click the link below in the show notes and Poppy is offering Great
[1:36] Birth Rebellion listeners 25% off.
[1:40] Welcome to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson, and I've been a midwife for over 18 years, attending birth that whole time, predominantly for women who are choosing home birth, but I still encounter the situation of women getting a swollen cervix in labor. And that is the topic of what I'm talking about today. Swollen cervix in labor, or the clinical term is cervical oedema.
[2:07] During labor. So this is something that the medical community has not been able to solve except with the two extreme options of administering an epidural or offering women a cesarean section if their cervix is swollen. So this could happen to you if you're in labor and your cervix swells up. It is possible that you'll either be offered an epidural or a cesarean section. But today I want to talk about all the other possible strategies that you could use to reduce the swelling of your cervix if you want to avoid the use of an epidural or a cesarean section for that reason. But I will say in preparation for this episode, as I always do, I went on a mission to find all of the academic research around this topic and there is none.
[2:59] Not a single research paper written about the management of a swollen cervix in labor. There is not a single scientific research project that has been dedicated to this topic. The only thing that you will find is a series of published case studies from other clinicians who have published what they did in the circumstance of swollen cervix. And I know in my work as a midwife, we often reach out to our peers and colleagues to gather strategies for what we could do in various situations. And a swollen cervix is one of those. There is a lot of midwifery knowledge and practical clinical knowledge around what to do if a woman has a swollen cervix, but none of it is based in actual research where they've tested individual treatment strategies to see which ones are most effective and which ones are not.
[3:57] And so today, my big disclaimer is, is there's no research. So every time I'm telling you about a possible option, it literally is just something that someone has tried and perhaps found it effective. So this is all kind of historical knowledge and wisdom that's been passed down from clinicians and practitioners and from women to say, hey, I had a swollen cervix. We tried this and that's what worked. So that's what I'm going to be presenting today. And I cannot tell you that all of this or any of this is actually rooted in any kind of evidence because there's zero research papers. Now, let's just be clear. If anyone is telling you about the treatment for swollen cervix, none of it is based in any kind of sound academic literature.
[4:47] We've got that out of the way. Now, I will say many of you will not listen to this episode unless you're actually in the situation of having a swollen cervix in this moment, or maybe you had one. If you are literally in that situation right now and you're looking for a quick fix or some very quick advice and you don't have time to listen to this podcast episode, I have created a cheat sheet, a quick checklist of things that you could do right now to see if you can change your circumstance. It's a very rudimentary summary of what I'm about to talk about in this episode and just a literal tick list to see if you can work your way through those things to help you in the current situation. Obviously, I'm assuming that you are with a maternity care provider who can help you with this decision-making. But certainly, if you're in a situation where you are trying to avoid an epidural or a cesarean section, and there's no other things that are concerning to your care provider, then you've got time to try a few of the strategies that are in the cheat sheet. So just scroll down to the show notes, click the link, and it'll come up as a PDF.
[5:51] Okay, let's get straight into this. So I'm just going to talk through each of the management strategies that you can try if your clinician is telling you that your cervix is swollen during labor. And I will say again, here, this is what we call anecdotal evidence. For all of these things, there's no direct research that suggests that any of this will work. In fact, there's not even any research that'll tell you an epidural will work or that a cesarean section is a safer or better option in this circumstance. This is only a list of possible options. None of them have been tested against each other. And what you also do need to know as we go through this podcast episode is that some medical care providers and midwives don't know that there are any other options for a swollen cervix. And because they don't know any better, they may make the very extreme suggestion to offer you either an epidural or a cesarean section without trying anything else to solve it. And we actually don't even know if a swollen cervix is even a problem in the first place. For all we know, your cervix could keep dilating and your baby could be born through the scenario of a swollen cervix. We just don't have the data. We don't even know how often this happens.
[7:10] Nonetheless, the medical establishment or midwives who have not looked into other options may not realize that there is any other way to deal with a swollen cervix. We actually don't know why it happens or what the outcomes are. We've got some vague ideas of maybe the baby is in an abnormal position, which is causing that. But we have no idea outside of our own clinical experience and what we've garnered from other care providers as to what we could do to help you. So here we go. I have collected as much of that information as possible over the 18 years from colleagues, from a big, super big search on the internet and the currently existing academic case studies that have been written up. And it's quite possible that this podcast episode is as much as you will ever be able to gather about the management of an oedematous cervix or a swollen cervix. So this could be the most high quality and comprehensive resource on the planet regarding swollen cervix. I'm not going to say for sure, but it feels very much like that.
[8:21] So here we go. So swollen cervix, clinically called an odematous cervix, is when your cervix swells up during labour. And it's usually noticed because, particularly if you're giving birth in a hospital, your midwives are usually doing four-hourly vaginal exams during labour. And so they feel the change from one examination to the next. And usually it's not your whole cervix that becomes swollen. It's just likely to be one part. And it seems as though the most likely part that will get swollen is the anterior part, the front part of your cervix that's on your belly side, not the backside of your cervix, which is on your back. So your cervix in labour does dilate in a bit of an oval shape from front to back. It doesn't dilate symmetrically like a circle all the way around. And generally the front part of your cervix that's on your belly side is the last part to move over the baby's head. And this seems to be the part that is most prone to swelling, but it can be anywhere. I felt swollen cervix on other sides before during assessment and we've discovered the cause way later.
[9:33] So now I'm going to list out your management options. I'm going to try and list them from the least invasive to the most invasive. So if you have time and you and your baby are well, you can start with the least invasive options because you've got time, there's no rush. And if you're in a hurry though, and there are actually medical concerns for yourself or your baby, you might need to consider more invasive, quicker options. But I will start from least invasive to most invasive, which generally relate to least medical to most medical.
[10:08] So the first thing, this is step number one, it seems as though from the case studies and stories that I've heard and experiences that I've had is that the most likely reason you'll have swollen cervix is that your labor has been delayed or complicated by the malpositioning of the baby's head. The baby's head might be either tilted to the right or left, front or back. The ideal position for your baby's head is that the chin is pressed up close to the baby's chest. That's what we call a flexed position. Whereas if your baby's head is deflexed, it means your baby's actually looking up. And the part that is trying to come out of the cervix is more like their forehead, which is not the most ideal position for a baby. The ideal position is that the back of the baby's head will be applied to the cervix. And that's the least likely chance that you're going to have something like an obstructed labor or a slower labor because of the malposition of the baby's head. But malposition seems to be what causes delay in progress, but also possibly the swelling of your cervix. Because the way that the baby's head is positioned changes the way that the baby's head is applied to the cervix, but also how it's coming through your pelvis.
[11:29] It comes through your pelvis most efficiently if the baby's head is flexed forward where the chin is on its chest. So anything other than that position can cause a delay or complication in your labor.
[11:41] So that means the first steps that you're going to take when managing a swollen cervix is to try and reposition the baby's head. So the first position and the one that is my go-to for any malpositioned baby.
[11:57] Is a head down, bum up position where your bum is higher than your head. You can do this anywhere, on the floor, over a beanbag, on the bed. You should put some pillows under your knees to kind of raise your bum up a little bit higher. The idea is that you're creating a downward slope so the baby's head actually shuffles out of your pelvis as much as possible and off the cervix. It's kind of like disimpacting the baby, pushing it back up out of the pelvis or letting it slide down out of the pelvis by this head down bum up position and this is the first step in repositioning. So when your head down bum up during each contraction or in between you can also be shuffling your hips in kind of a figure eight position and getting some movement in your pelvis to kind of shuffle the baby out and down. Paired with this your midwife or your support people somebody who's with you to provide hands on support and you are going to need a lot of hands on support. If you're working through labor, working through the pain of contractions and just doing that, that's a big enough job. But now you're doing the job of repositioning your baby.
[13:12] Which requires a little bit more energy and attention and a lot of mental capacity. So you're really going to need a tapped in care team who's going to be able to help you. So the other thing that can be done while you head down, bum up, and you're doing some movements is if your care provider or your partner support people can grab your bum back, lower your body and really give it a good jiggle. The idea is to soften up the muscles and there's a sort of a mesh layer that surrounds your muscles and inner organs called fascia. And softening up the fascia can soften up your inner organs and potentially allow for relaxation of the uterine supporting muscles and fascia and potentially impact upon the activity of your cervix. These are things that you could do, not invasive, they're not risky, they're easy, easy to apply.
[14:14] So the first strategy is changing your position in an attempt to change the baby's position and move the baby off your cervix to reduce the pressure on your cervix and so the baby has room to move into a better position. This will also mean that your cervix has a chance to reduce the swelling. So head down, bum up and one of the papers that I looked at for as I was researching this topic talks about a knee to chest position. So you're in a kind of exaggerated squat, but on your hands and knees and your knees are coming up towards your nipples.
[14:51] Now, while we're here in a hands and knees position, you can double up and use a few other strategies that could help reposition the baby and bring it up into a better position to rotate and change the position of its head. So if your clinician is skilled in rebozo, you could add that to this process while you're on your hands and knees. It's a repositioning technique that your clinician could use. And many midwives are skilled in acupuncture, well, acuneedling or acupressure, or you can get an acupuncturist in. And you can try some acupressure, acupuncture or acuneedling points that are designed to reposition the baby and dilate the cervix, you can do all of this while you're in the hands and knees position. And I would be layering possible options on each other to reduce the amount of time that you need to try these strategies so that the cervix has a chance quicker to reduce the swelling. Because as we all know in hospitals, if you're in a hospital giving birth, time is of the essence. They want to see progress. So if you can add as many strategies as possible to get as much positive result as possible, you'll be doing yourself a favor.
[16:10] Now, I'm not saying this is going to be easy. I know I'm saying this really practically, like just do this, this, and this, but it is not going to be easy. And clinicians, if you're listening, you have to be fully present with the woman and she has to have all these support people who are on board because it's a mental commitment and a physical one. They'll be spending at least, I ask women to just spend at least 10 contractions in this head down, bum up position. So it translates to roughly 30 to 50 minutes, depending on how frequent their contractions are, that they're in this head down, bum up position and doing these hip movements. It can be quite physically exhausting, but also mentally exhausting because they're already possibly dealing with the ramifications of a long, slow labor. They're also dealing with the contraction pain that they're trying to work through. And now they're remedying this issue of a swollen cervix. So when you're in this head down, bum up position, see if you can also try and breathe through the contractions and don't push or bear down.
[17:20] If you are feeling the need to push your baby out, it's quite possible that you could push your baby out through a swollen cervix. I'm not saying that's not possible. Nobody even knows if that's possible but if you do have pressure and your cervix isn't fully dilated and quite swollen try and breathe through each contraction instead of bearing down through the contractions. So you want to reduce the downward pressure of the baby on your cervix and this is going to take using some of the pain management strategies that you've adopted hopefully that you've prepared for. So while you're doing these position changes you are working through the pain of each contraction and applying pain management strategies all of the energy and mental toughness.
[18:08] And in any labor, I would suggest being super prepared for managing the pain of contractions yourself and preparing your partner and support people to help you through each contraction. It becomes even more important when you're working with a swollen cervix. And obviously in this episode, I can't go through every pain management strategy, but I do have an all facts, no fluff guide to giving birth without pain medication. And it contains all of the pain management strategies that I would normally suggest to you and I've got a link in the show notes it's super easy you just click and get that for yourself it's an online course there's a section for you and a section also for your partner or support people so that at the very least you know how to navigate the pain of contractions everybody's on top of that you're going to continue doing that while also adding the swollen cervix strategies so step one is to be prepared for the contraction pain and what you can do for and with that and that is all in the guide to giving birth without pain medication all of that is still going to be being applied while you're doing this head down bum up situation someone's giving you a jiggle you're rotating and moving your hips to try and shuffle the baby off your cervix and maybe there's also someone working with some acupressure or acuneedling points and or a rebozo if anyone's got that skill.
[19:32] So already, these are two or more particular strategies, head down, bum up, and still managing the pain of labour effectively.
[19:42] Okay, now the next thing, at the same time as doing that head down, bum up thing and whatever else you've been able to add to it, there is some remedies, homeopathic remedies. So now, before I was a midwife, I studied to be a naturopath and I worked as a naturopath for a few years. And part of that training included training in homeopathic medicine. And you can buy homeopathy remedies in health food stores, chemists. They're really easy to come by these days. And I would have these in your birth kit anyway. If you're a clinician or doula, midwife, these are some remedies, basic remedies that you can have in your birth kit. They're really shelf stable, super easy to transport, really cheap. And certainly if you're a woman and you're worried about your cervix, what your cervix might do in labor and birth, there's three remedies that I'm going to recommend here. And I've tried at least one of these in a clinical situation and found them to be really successful. So the one that I would definitely not go past and have in your birth kit and it's got value for lots of different things is homeopathic arnica pills. You can get these things in creams but don't get the pills that you, the women just dissolve them under their tongue and that's homeopathic arnica.
[21:05] This has value postpartum as well the remedy is specifically for swelling bruising tenderness and injury so really good post-birth but during labor and birth this remedy I've seen work for swollen cervix so I would say if you're going to administer arnica every 15 minutes until the swelling starts to go down, And I have mentioned homeopathy on this podcast before, and there've been a number of people who've come back and said, oh, Mel, I thought you were evidence-based. I didn't realize that you would engage in like woo-woo homeopathy. There's no current research for that. There is actually a stack of research. Obviously, I'm not going to go through that today. But what I will say in this scenario, if the argument is, hey, there's no research for homeopathy, I just need to tell you there is zero research on anything that is offered to you for swollen cervix. Homeopathy is really safe, highly unlikely, very, very rare circumstances are there. Even a side effect to using homeopathy, if you're using the dosage correctly, usually the side effects are put by poor dosage and overdosing.
[22:14] If we're trying everything, homeopathy can be part of the mix, even if you don't believe that there's actually any science behind it, because there is no science behind anything that we do for swollen cervix. Why not give it a try it's easy you can administer it yourself there's almost I mean there's no side effects if you use it properly and homeopathy is definitely a lesser evil if we're thinking about side effects and risks a lesser evil to epidural or cesarean section to to mediate the the problem of a swollen cervix, Epidurals and cesareans carry massive risk to the woman and the baby if you compare it to the use of some homeopathic pills. Why not try it? You're already in a head down, bum up position. Your only other option might be epidural and cesarean section. So the remedies that I would suggest having would be Arnica. And I do have three remedies I'm going to tell you first.
[23:19] Arnica, belladonna, and aconite are your three homeopathic remedies. I will put that in the PDF for anybody going, oh my gosh, I didn't have time to write those down. Arnica, belladonna, and aconite are the three homeopathic remedies that could be used to remedy a swollen cervix. There's also, if you're interested in homeopathy, a great book called Homeopathy for Midwives. It tells you all the different remedies to use for all the different issues that might arise.
[23:48] And I did have a client, my very, very first client in private practice. She hired me to help her have a VBAC in hospital. She'd actually already hired a private obstetrician and I was there probably more like in the role of a doula to come with her to hospital and help her achieve this goal of VBAC. She'd actually hired a really good obstetrician who was on board with the idea of VBAC. And we got to hospital, everything was going great. And he did a vaginal examination, the second one, and said, oh, look, your cervix is swollen now. And I think you just need to have another cesarean section, which was massive news to her because her whole intention for this birth was to have a vaginal birth. She hired him and me with the intention of achieving a vaginal birth, so to suddenly hear that that whole thing was derailed by the presence of a swollen cervix was devastating.
[24:49] So in that circumstance, she actually was interested in an epidural and I let the obstetrician know she's not interested in a cesarean section now. She would first rather try an epidural and then I figured I've got nothing to lose. She's having an epidural anyway. And I offered her the use of homeopathic arnica in conjunction with her plan for an epidural. She agreed. I thought that was fine. You know, why not try it? And then we did side-lying positions left and right, and I'll talk about that. At that time, I used, I stacked up lots of pillows to flip her side to side. There wasn't really peanut balls, which we use today.
[25:32] And about 45 minutes later, after the epidural was effective, the doctor wanted to come in and do another vaginal examination to see if the swelling had gone down. I was really nervous about this because I thought that's really not long enough to have allowed for much change in her body. So I was a little bit nervous. And in my head, I thought, gosh, if it's still swollen, I'm going to suggest to her, hey, baby, we wait another hour or two. If we can, if the baby's well and you're well, let's wait another hour to see what happens then before making any major decisions. But as it turned out, he did a vaginal examination 45 minutes after the sighting of the epidural.
[26:13] And he said, oh, the swelling's all gone down. We'll just wait for you to be fully dilated now. She did get to fully dilated. And then the decision was made as a team, as a group. Obviously, the woman was very interested in her vaginal birth. She also was happy to turn the epidural down and then off and push out her baby. So we did all that. She pushed out her baby and she had a VBAC.
[26:42] And I couldn't help but think if she'd gone with the advice of the obstetrician in that moment to just have another cesarean section her v-back wouldn't have happened so that's my very first experience with the use of arnica homeopathic arnica for the management of swollen cervix and I know some of you out there we say well maybe it was the epidural maybe it was but honestly we'll never know because no individual remedy or strategy has ever been tested for cervical swelling so I'm just going to suggest layering upon layer of any of the remedies that I'm talking about to see if you can get some effect. It really doesn't matter which one worked. Just try whatever you've got access to in conjunction with each other if it's safe to do so. So already we know that we need to really navigate the baby's position. So if the head is asynclitic, what midwives call asynclitic, or if it's tilted to the side or deflexed, if the baby's head is malpositioned, first trick is to try and reposition the baby. And there's lots of other strategies for this. Like if you're spinning babies trained or if you've got some skills in changing the baby's position with optimal maternal positioning or whatever technique you've learnt, then try those things.
[28:06] But that's the principle, repositioning the baby at first. And if you're really unable to get into this head down, bum up position for whatever reason, maybe you've already got an epidural, maybe you're really tired and you can't really move enough to make that head down, bum up position viable, why don't you try to a left side-lying position and then after 15 or 20 minutes or so, go right side-lying and you can position a pile of pillows in between your legs or a peanut ball between your legs, still using all the pain management strategies that you might've got from the guide to giving birth without pain medication. You can still use your homeopathic remedies. You can still use your acupressure points and acupuncture points. There's still use your TENS machine, whatever you're using, sideline position. And then if you're flipping side to side, that can help change the baby's position. And one of the papers that I read, the midwives in that paper used, if you're aware of spinning babies techniques, it's called a side-lying release. They used a side-lying release to help with changing the baby's position.
[29:21] So that's another strategy is side-lying instead of head-down bum-up. Or you can do them simultaneously, both, just moving, trying, anything. So next, again, regardless of which position you're in, if you're bum up or sidelined, someone can be offering you the acupressure or acupuncture or acuneedling. And actually, if you go to the resource folder for this episode, episode 203, for those of you who are new to the podcast each episode has a resource folder attached to it and you can get access to this big global podcast resource folder it's got resources for every single episode including this one but in that folder I've put a cheat sheet for which points you can use to help rotate and change the position of a baby and also which points help with cervical dilation and change so if you go into the resource folder for episode two or three that's a printable pdf.
[30:25] If you're not, if you don't have access to that yet, just scroll down to the show notes of this podcast and join the podcast mailing list. So anyone who's on the mailing list gets that link to the folder, the resource folder, and you can find all of the research and resources for every single episode, including this one. So I would suggest scrolling in there now, even if you're in labor, you can get that PDF and try some of those points. You've got nothing to lose because your other option could be an epidural or cesarean section. It's worth trying.
[30:59] All right. The next thing I'm going to suggest could sound a bit outlandish and a bit wild, but of any of the other techniques that I've talked about, this one, midwives have commented that they've tried it and that it works. And this is where you actually directly apply ice to the cervix. So if you're familiar with anatomy, your cervix is inside of your vagina attached to your uterus. It needs, you know, during labor and birth and probably at this point, it's quite, it's at the fingertips of the clinician who's doing the vaginal examination.
[31:40] That's as far in as your cervix will be. And so you apply ice directly to the cervix. Now, I'm going to read from a paper that I found online, and this, unfortunately, is not available in full text access to the public, unfortunately. I've put a summary in the resource folder, but I will read to you the case study of how they used ice. and this is the ways that I've seen it used as well. So it's in the context of a case study. So this paper was released in 2022 and it's called, and I apologise for the title, unfortunately this whole entire paper didn't mention the word woman at all. They gave this woman completely different titles and I don't understand why. But midwifery management of a birthing person with cervical edema during labor. And they provide a case summary of a 30-year-old woman who's having her fourth baby. And I'll skip over to where they start talking about what they did for her.
[32:54] So at this time, the midwife discussed the findings of the vaginal examination where she found persistent cervical edema. This discussion included the possibility for a cesarean birth if the cervix was unable to progress to complete dilation. The midwife provided information on interventions that might reduce the cervical edema. These interventions included IV intravenous diphenhydramine, which is known as Benadryl. It's an antihistamine. We'll talk about that later.
[33:30] Ice to the cervix, a side-lying release, which is that spinning baby's technique, a continued side-lying position with changes with the peanut ball, so that flipping from left to right. All of the risks and benefits and alternatives to each intervention were discussed. Using a shared decision-making approach, the midwife and the woman decided to proceed with IV diphenylhydramine, which is the Benadryl, ice to the cervix, and the side-lying release procedure. Orders were placed, the IV medication, which was 50 milligrams of the Benadryl, was administered by the nurse. Now, by the way, we will talk about this Benadryl. I looked up this procedure. There's no research behind it. There is a study that's currently ongoing that they're recruiting for to see if this is useful. So this is kind of an untested strategy that they were applying here. And online, as I looked into some recommendations, the medical community generally doesn't recommend this because it hasn't been tested, but they used it anyway, nonetheless, in this case study.
[34:42] Then they applied ice directly to the woman's cervix in a sterile manner. The ice was held in place by the midwives examining fingers for five minutes. And this is what I've heard other midwives talk about. The time is roughly five minutes. But other papers that I read in the process of this suggested that there's no real limit to how long you can hold it on. It's more just about how well you as the woman and the clinician can tolerate that discomfort because obviously you'll have somebody's fingers inside you holding the ice on. It could be two fingers. Or if the midwife's really good, maybe she could have gotten it in there and left it in place. But it's really got to be directly on the cervix. So it could feel uncomfortable. and then the midwife obviously also has to tolerate the ice on her own or his own fingers as well. But they held the ice on for five minutes and approximately 40 minutes after these interventions were initiated.
[35:50] The woman was almost fully dilated and the anterior part of the cervix was soft and stretchy and no longer swollen, The midwife asked the woman to push with her next contraction while she was putting pressure on that front anterior part of the cervix. That's beside the point.
[36:10] And within 12 minutes from starting to push, her baby was born. Quite a good size baby, about four and a half kilos. The baby was in an OP position. So instead of coming out facing down towards its mom's bottom, it came out facing up towards it's mum's pubic hair which is seems to be a classic reason for why the cervix would swell is is a malposition of the baby and this same case study goes on to talk about the application of ice to the cervix and because this is not available in full text for the general public I'm going to read what it says about the application of ice to the cervix so you can understand the technique so if you're a midwife listening wondering how do you get ice onto the cervix. Here you go. This is as good an explanation as I've ever heard on how to do it. So direct application of ice to the swollen aspect of the cervix is a management option in the setting of cervical oedema. The mechanism of action is assumed to be that cryotherapy, which is just a fancy word for putting ice on something, cryotherapy reduces cervical oedema by constricting blood vessels. Scientific evidence is lacking for the application of ice to the cervix. However, this technique has been reportedly applied.
[37:30] Has been reported informally in midwifery blogs as a trick of the trade. So from these publications midwives have reported that applying ice directly to the area of cervical swelling can reduce the cervical edema and recommend repeat application if the ice melts or if the swelling persists. So you can just keep trying it if you and the woman can tolerate that treatment.
[37:55] In the absence of rupture of membrane, so if your waters aren't broken, considering a brief course of ice to the swollen area of the cervix is an option. It still is an option if your waters are broken, but you just have to be really sterile about it. Sterile gloves try and introduce no extra bacteria to the area. So using sterile technique, a small amount of ice is added to one or two fingers of a sterile glove. The glove is then tied closed and gently inserted into the vagina and placed against the edematous area of the cervix. Lubricant can be applied to the outside of the glove to minimize discomfort during insertion. So the eye should be left in place for a minimum of two minutes, but of course, remove it sooner. If the woman's uncomfortable, don't keep it in there. And there seems to be no maximum recommended amount of time for application of eyes to the cervix. In the setting of ruptured membrane, so if your waters are broken or when more precision of the ice application is desired, another option is to place smaller bits of ice into the index and middle fingers of a sterile glove. And then the midwife puts a second pair of gloves on and inserts their hand into the ice glove and then inserts their hand fully into the woman's vagina, the two ice fingers.
[39:21] And then you can more efficiently press the ice firmly with the tips of your fingers to the swollen part of the woman's cervix. So during a sterile vaginal examination, the ice is held against the cervix with the midwife's examining fingers. An advantage to this approach is that the ice is placed exactly where it's needed and the midwife can better appreciate if it's working. So the technique is limited by how long the midwife can tolerate the ice on her fingers as well as by how long the woman can tolerate the examination.
[39:55] So quite invasive through the vagina. However, of all the things that I've heard that work for a swollen cervix, midwives have spoken about this the most. Possibly they don't have the homeopathic remedies that I spoke about. But you could, again, do all this in combination. If there's ice on the cervix, you could do that in a side-lying position with the peanut ball. You could also be doing the acupressure or acuneedling points. You could also be taking the homeopathy. There's all of these things that you can use in conjunction to see if you can get things going. Not to mention, if you're doing all of those things, these things can also be done if you've got an epidural, if you actually have effective pain relief on board and you can't feel anything, it kind of makes it easier for this ice on the cervix. I wouldn't recommend getting an epidural in order to just tolerate the ice, but I'm just saying this all still can be done if you have an epidural. So that is the ice on the cervix trick.
[40:55] Now, if all of this is not working and perhaps the baby's still malpositioned, you could consider just feeling a big birth pool if you're at a place that has a nice big bath and floating around in there for a little while. So Michelle O'Donnell, he's now passed away, but he recommended the use of baths. And I mean, midwives talk about it all the time.
[41:20] Purely for relaxation if the woman needs it or if she's in a state of exhaustion you can use the bath for a rest but also this really takes the pressure off your pelvis and allows you to move into positions that can help the baby reposition and take this the pressure off your cervix so you could use that pool as a bit of a respite and a bit of a rest to elicit some relaxation and maybe that will help your body function in a way that is efficient and going to dilate your cervix.
[41:54] Now, the other thing I'll mention here is that if you're in the process of an induction with IV oxytocin, if you're in America, it's called Pitocin. If you're here, it's called Syntocin, if you're here in Australia or in the UK. But IV oxytocin is often administered with IV fluids and potentially you're overhydrated and actually your whole body is odematous, including your cervix but IV oxytocin is quite a pressure and stress on your body and on your uterus consider if you've got a swollen cervix you could turn off all of these fluids especially if you're just having some kind of routine prophylactic induction that's not for any actual problem it's just kind of prophylactic preventative one why not try and turn off the oxytocin give the woman a break from contractions and a break from labor give everyone a chance to recover the cervix to reduce in swelling and then potentially she's been over hydrated and she's edematous everywhere including her cervix and of course it might not work we don't really have.
[43:04] Evidence to suggest that it will work but it's an option and something you could really try before choosing the option of cesarean section which is quite a more significant risky surgery for such a potentially minor circumstance that could be fixed with a simple solution like giving the woman a rest from the oxytocin. All right so again these those are kind of the least invasive options and this next strategy is by no means tested or recommended by anyone at the moment that I can see online. And in fact, there were some medical documents saying don't use it. It's not been tested for this. However, I have heard stories, including in this case study that I just read from, that IV Benadryl, which is an antihistamine.
[43:56] Is has been used for reduction of swelling on the cervix as I've heard that the two stories that I've heard it was effective however the you'll have to talk about that the risks and benefits of that with your treating clinician and they may not even be aware of this protocol or how to do it it certainly was only something I came across as I started looking more deeply into possible strategies and the next thing so that's one thing the next thing again is you could accept the epidural that will probably be offered to you if you've got a swollen cervix and just wait and do all the other things too the ice the position changes the homeopathy the acupressure use it all in combination and see what happens because the aim here is to avoid an unnecessary cesarean section. If you have a caesarean section just because your cervix is swollen, then it's kind of like killing a fly with an atomic bomb when potentially there's a lot of other solutions that could have been effective before resorting to major surgery. So why not try everything you possibly can, including the epidural if that's what you want. And then once you've tried all of those things.
[45:17] There could be a combination of reasons why a cesarean section might be indicated for you. A swollen cervix might be one little symptom of a bigger symptom picture that's showing disorder in your labor and birth. So obviously, if there's other things, you and your baby are actually unwell, if there's a clear medical danger to you and your baby, a cesarean section might be warranted. But if it is just for a swollen cervix and you and your baby are well, then you've got time to try all of these other strategies that are less risky, less invasive before you revert to a cesarean section. Now remember, the maternity care system likes to hurry through things. So the other thing that's going to be really on your side is doing anything you can to buy yourself some more time.
[46:10] So if you and your baby are well and there's no medical risk or danger other than it's taking a while and your cervix is swollen, just tell them, I need, I want more time to see if I can reduce the swelling in my cervix. I don't want a cesarean right now unless there's a clear medical need. I want more time to see if I can reduce the swelling in the cervix. You will need to advocate for yourself in this because there will be a collection of care providers who have no idea that there's anything else that can be done other than an epidural or a cesarean section. So you may need to educate them on that and also be prepared with some of these
[46:50] strategies for yourself. So let's summarize those strategies. So you want to correct any malposition of the baby with position change, spinning baby's techniques, and these included the head down bum up position, some jiggles.
[47:06] A side lying position with a peanut ball and a side lying release. And the thing I'll add to this is once the baby's out of your pelvis, then it's time to get up and moving. You could get into the pool or in a more upright position to bring the baby back down and into your pelvis in hopefully a correct position. You could also add the homeopathic remedies, Arnica, Belladonna or Aconite every 15 minutes until change happens. You can use the acupressure and acupuncture techniques that are in the PDF file in the resource folder for the podcast and all of that, all the links for these things are in the show notes below.
[47:47] All the pain, you still will need the pain management strategies that I explain in the guide to giving birth without pain medication. So be prepared for what you are going to do for the management of labor pains because managing a swollen cervix is going to be on top of that. So hopefully you're prepared with the basics and then on top of that you've got the energy to manage the issue of the swollen cervix. You could hop in a bath and have a float around for relaxation and take the pressure off. There's the ice applied to the cervix trick. You could stop the oxytocin drip until there's some change in your cervix.
[48:25] Explore the idea of the IV diaphenylhydramine, which is the Benadryl. But again, I can't recommend this because there's zero research about it. It's definitely something that you'll have to explore with your clinician if they're comfortable to provide a medication like this that hasn't been tested in this circumstance. You could try an epidural in conjunction with all of the things above and make sure that you give yourself some time. There's no rush if everything is fine and of course if you don't want to do any of that you could accept the offer of a cesarean section. However if your baby's not in danger and there's no medical indication there's no harm to trying all the previous things that I spoke about. That is today's episode of the Great Birth Rebellion podcast dealing with the swollen cervix. I would suggest getting access to the resource folder so that you can see all of those acupressure and acupuncture points and grab the guide to giving birth without pain medication because it is a basic for going into labor because you're going to need your mental energy, your physical seminar and your robust support team to help you if you also have a swollen cervix. I'm Dr. Melanie Jackson, and I will see you in the next episode of The Great Birth Rebellion podcast.
[49:44] To get access to the resources for each podcast episode, join the mailing list at melaniethemidwife.com. And to support the work of this podcast, wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com. Follow me, Mel, @MelanietheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
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