The Posterior Cervix: Distraction or Spasmed Ligament?

When people are concerned about a posterior cervix, the first question that comes to mind is, “Where is the baby in the pelvis?”  The cervix is possibly posterior because the baby is high and not even engaged.  Some may believe that the head is low, but if it is low in the anterior part of the pelvis, is it due to a shallow pelvis and a posterior baby’s head dipping down into it?  Is the baby even engaged to put pressure on the cervix?  Or is the head high and going through normal descent rounding the sacral promontory where the cervix isn’t involved in the least?   Yet the question becomes, why are we focusing on the cervix at all?

Now don’t get me wrong, cervical-centric care can have its moments.  Is there scar tissue on the cervix itself preventing it from opening?  Various cervical procedures, surgeries, or even abuse can leave scar tissue that can interfere with the continuance of cervical dilation even once the baby is in the mid-pelvis.  Also, the cervix is suspended by soft tissues like cervical ligaments and the uterus is suspended by the utero-sacral ligaments.  When these ligaments are in spasm, they can result in a tipped uterus or a persistent posterior cervix.  Sometimes this can be addressed in pregnancy with bodywork including balancing with the use of the Forward-Leaning Inversion (FLI).  One can use gravity with an FLI to assist in lengthening these ligaments for a short period of time.  This lengthening can help with balance allowing the baby to be able to move into a greater space available once they are released.  

However, as we look to a normal birthing process, it is normal for a cervix to be more posterior before the baby engages into the pelvis.  As the baby comes lower, the head applies and the pressure changes the angle for the cervix to become more anterior.  To focus on a cervix when the baby is above the brim of the pelvis is just a distraction.   

In fact, may we not forget our skills of observation of the bigger picture of what is happening.  Is there even a reason to do that vaginal exam that caused the worry of the posterior cervix in the first place?  Whether it be the generalized initial assessment or an answer to an irregular labor pattern with contractions one on top of another, we may just be responding to a call for help that includes balance before force and solution focused rotational positions.