Posterior Cervix in Pregnancy- Should You Be Worried?

By - Ramiza Zaman

Has your doctor told you that your cervix is in the posterior position? You must be feeling extreme pain with the baby inside. It may feel like a creature is dragging the pain inside. 

Although it can be difficult, it occurs to many women and you are not alone in this battle. 

So, what does it really mean to have a posterior cervix?

In short, your cervix is situated and tilting to the back of the body or towards your bottom. The cervix being at the back is normal and has no repercussions in conception. But sometimes, it can lead to a complicated delivery. Several women have a posterior position which usually switches to anterior route before birth.

Now you need to have a better idea than this information to be clear and feel reassured. There are possible answers to you being among the general population with a posterior cervix. So without any delay, give a read and see the light to it. 

What Is a Posterior Cervix?

Mainly in medical terms, anything posterior in the body means it is located at our back. The cervix is integral during the time of conceiving, management of pregnancy and for a punctual delivery. It’s a tube joining the uterus and vagina. 

Although it is usually angled forward, the cervix can sometimes be positioned at the back in a posterior way. 

This occurs regularly throughout pregnancy, where the cervix switches from anterior (front) to posterior. So, the position of the cervix aids doctors to monitor the progress of childbirth and due date.

How Common Is a Posterior Cervix?

This occurrence and position happens in 20% of most pregnancies. You should not worry about this, as the cervix usually changes while you are in labour. 

In fact, around 90% of pregnant women have a low chance of having a posterior cervix in their 3nd trimester after completing the 2nd trimester. All this varies based on how close women are to their delivery date. 

With labour initiating, about 34% women have babies in the posterior position, but it turns to only 5 to 8% at birth.  

So, it is very much possible for you to deliver normally, with appropriate guidance and assistance from your doctor. 

How Does a Posterior Cervix Occur?

As we have said earlier, a posterior cervix in women is more common than you think and it can occur naturally. It even changes positions before you give birth to your child, so its occurrence is not abnormal.

But in some cases, endometriosis can also cause an unusual tilting of the cervix to the back. It is a uterine disorder, where the tissues lining the uterus, or endometrium, join to external areas of the uterus. This can create lesions too, leading to extreme pain and even fertility issues. 

How Is the Posterior Cervix Diagnosed?

Usually this position change cannot be detected without a vaginal examination. Your doctor will conduct a manual examination during your second stage in labour. That is, when the cervix is fully dilated. 

This is also best confirmed by an ultrasound.

What Does a Posterior Cervix in Pregnancy Mean?

We know the cervix is the lowermost area of the uterus, and is usually angled at the front part of the body. When you get pregnant, it switches to face the back of your body. At that time, the cervix is even more firm and has lower elasticity.

During the most part of your pregnancy, your cervix is supposed to tilt posteriorly. This is usually behind the baby’s head. 

But as your date of delivery arrives and your body gets ready for the arrival of your new addition, the cervix starts to adjust its way to the anterior direction. This occurs during week 37 to week 38.

You’ll figure it out without your natural womanly instincts that some progress is definitely happening in your cervix. This serves as a soft signal to let you know that the cervix is changing positions to the back. 

Now, as the D-day approaches, your physician starts searching for any sign that your cervix is actually on the move to the front face.They’ll understand if it is anterior then and faces the birth canal. You usually cannot determine this change without a vaginal exam. 

Posterior Cervix During Labor Pain

Predominantly, your cervix tends to tilt by itself while progressing towards labour, and starts softening up to allow the exit of the baby. This occurs when you are at week 38. 

Usually doctors perform a vaginal examination when you are in labour. They keep checking where the cervix is angled, since your baby is almost at full time. 

It also shows how far into labour you are, as I mentioned earlier. So,at times your cervix can get arranged in a comparatively posterior direction rather than changing to an anterior position. It indicates that you are still at the launch or starting point of labour. 

Your headstrong baby and posterior cervix usually should change to an anterior position, but if it doesn’t, there is no need to panic whatsoever. Just relax and stay as calm as Harry Styles’s low voice. 

Then, operations like a Caesarian section need to be generally conducted. 

So, this will be determined by your physician when it is required.

Test to Check for Labor

A posterior cervix is quite uncomfortable for women, but it can also be a little difficult to check it for dilation. This is solely since it is hard to reach all the way at the back. 

So, often doctors use a test called a Bishop score to analyse how soon your delivery is and if you are ready for labour.

The main constituents of Bishop score include: 

In these categories, they are given a score of 0 to 3. These are added up and the total score indicates the success and procedure for inducing your further delivery. 

So, if you have a posterior cervix, you are likely to receive a lower Bishop score.

This is not something to fret over. Many pregnant women usually check their cervix in prenatal doctor appointments. During this period, you’ll hear whether your cervix is ripe or unripe. In other words, is the cervix in the posterior position or anterior and ready for labour? 

There have been many women who have gone to labour in 2-3 days with an unripe cervix. Likewise, women even with a ripe cervix cannot go into labour and have to wait for many weeks for it. 

Hence, this score doesn’t mean much. It just shows your body is not ready for labour compared to a woman with a cervix in the anterior direction. 

Is It Possible to Move The Posterior Cervix Position?

Preferably, your body automatically prepares for labour which leads to changes in the cervix. It will start to switch to the anterior position way before labour. 

Then your cervix is ready to dilate and open in order to keep the baby. So, your doctor or a midwife usually can manually change and move the cervix anteriorly. Usually the cervix does this God’s work on its own so this situation is often avoidable. 

But sometimes when your cervix is persisting in the posterior position there can be some arising complications. Let’s take a look at these next.

Complications Related To Posterior Cervix

In some cases, even before some women become pregnant, they have a naturally posterior cervix. It used to be a worrisome issue among medical experts before, as it can affect fertility, but not anymore. 

But in rare cases, there can be some problems that can arise due to this unusual position. 

Bleeding

Sometimes the stubborn cervix may be an occasional medical cause of bleeding. This can happen in your third trimester. It usually is bright red but causes no pain.  

Cramping

Along with bleeding, cramping is another issue when contractions feel the worst amongst any agony. But this also happens in unusual cases and is not a matter of worry.

Longer Pushing Period

Since this kind of cervix is hard to reach, doctors usually have to take early precautions for tending to the patient. Women have a hard time pushing the baby if the birth canal is blocked due to the posterior position. 

Hence, they go through the long pain of pushing for more time than usual. 

Pitocin Requirement For Contractions

Pitocin is an artificial form of the oxytocin hormone, used to strengthen and induce contractions of the uterus. Normally, oxytocin is produced naturally in high levels to help with contractions. This helps deliver the baby easily. 

But when you have a posterior cervix which does not change positions, it cannot induce any contractions to let the baby out. At this time, pitocin is prescribed. The less it is used, the better for the mother. 

This is due to its several associated risks. These include getting contractions which come one after another without intervals in between. So, it doesn’t provide the uterus any chance to recover and ease up. 

Hence, it can end up harming the baby due to fetal distress as well. Pregnant women are likely to suffer from pulmonary edema, irregular sodium levels and water intoxication. 

Increased Possibility Of C- section Or Assisted Vaginal Delivery

As pregnancy progresses, your cervix changes which is usually referred to as ‘cervical ripening’. Your doctor assesses the position, cervical opening and softness. From this, they conclude which induction method to use. 

So, if the cervix has a posterior position, it tends to stay more firm, and be less responsive to induction. Hence, it leads the doctors to undergo a Caesarean or C section. 

Although C-section and its lingering pain are not of high risk, some dangers such as blood clots and secondary infections may arise. Also, pregnancy-related hysterectomy may be associated which means you cannot get pregnant after this hysterectomy surgery. 

Uterine rupture and abnormal placentations are also one of the risks involved with such deliveries. This is not something to get frightened over, because with modern technology and proper planning before birth, these situations can be avoided. 

Episiotomy and Perineal Tears 

If your cervix is posterior during childbirth, the baby is in an unfavourable position, compared to babies facing down comfortably. At this time, you may require an episiotomy or a surgical cut. This cut is in the skin between the vagina and anus, or the perineum area. 

As your vaginal opening needs to be enlarged to first deliver the baby’s head, doctors use this procedure. 

But this shouldn’t be conducted routinely as it can cause many complications such as: 

Postpartum Hemorrhage

Postpartum hemorrhage or PPH refers to excess bleeding with the loss of over 500 ml of blood, just 24 hours after giving birth. Due to excessive stretching of the uterus with the posterior cervix, it leads to prolonged labour. This is one of the common causes of PPH after delivery.

So, this condition leads to sudden loss of pressure and causes sepsis in some women. Even additional complications such as uterine perforation, urinary tract and vascular injury, and pelvic hematoma can occur. 

This happens within 1 day to 12 weeks of delivery, but it occurs in 1 out of 500 women, so the chances are rare. So, you need to just relax during your time with the baby and stay as stress-free as possible.

When Are You at Risk of Posterior Cervix?

After knowing the complications, it’s good to keep in mind the risk factors connected with posterior cervixes. You could be at high risk of developing this cervix if you fall under the following criteria:

How Does a Delivery in Posterior Position Affect the Baby? 

If you deliver your baby with the posterior cervix, there are slight chances of short-term risks like increased likelihood of having to be admitted in the neonatal intensive care unit or NICU, longer stay in hospitals, and low 5-minute Apgar scores. 

Is There any Treatment?

Having this type of cervix is quite natural and there is no treatment except for a manual rotation by your doctor. Once you reach full dilation, they put their hand on the baby’s head and attempt to rotate it. This diminishes the need for a C-section and reduces perineal tears.

Also, medications like prostaglandins have thrived at cervical ripening. These are placed in the vagina to aid in a successful induction.  But even these medications can have side effects, hence it is not always recommended.

However some tips can help you in the long run too.

FAQs

Is it normal to have a posterior cervix if you’re not pregnant?

Yes, this is normal. There is no actual concern over this and it doesn’t mean much. But issues like performing a pap smear test or inserting an intrauterine device (IUD) prove to be challenging. 

Can I reduce the likelihood of my baby being delivered through a posterior cervix? 

No, not really. Even being on your knees and hands does not rotate your baby. But if you have a backache in pregnancy, this position may help you.

Will a high cervix make it hard for giving birth?

No, but it will be difficult to conduct pelvic exams. High cervixes indicate the uterus being placed high at the pelvic cavity. But it won’t impact you in becoming pregnant.

Parting Words

Your time with your child is the best time, so enjoy it as much as possible! Just think of the position of the cervix like being left or right-handed. It won’t affect you greatly. But if you have any attached fears, consult your midwife or doctor.

Just let your body flow and do the work on its own! Hope this article fed to all your concerns and gave you a clear mind. Let’s break all doubts and never fear a posterior cervix!