LEEP or cervical procedures? You MUST read this!

November 18, 2010 in Birth, Childbirth Education

I ask my doula clients if they have ever had any procedures on their cervix.  Something as simple as LEEP can cause scar tissue that can affect their dilation. It seems to be an issue that some care providers don’t know how to deal with, leading to a label of failure to progress and cesarean.

How do I know to ask this?

I had a doula partner call and ask me about cervical scarring during one of her clients birth.  Her client was “stuck at 3cm after hours and hours of strong, consistent pressure waves.  She had a procedure done to her cervix years before.  Could this be leading to the issue?

Reading Blogs had Taught Me.

Since I had read quite a few good blog posts about this, I knew the answer.

1.  Cervical Scar Tissue:  A big issue no one is talking about. This is a great post with so much information that really helps explain the issue and gives some good ideas of how to deal with it, before birth begins to during birth.

The midwife proceeds to explain to my sister that she is going to try and massage the cervix and break the scar up. With some discomfort for my sister, she went from a finger tip dilated to 3 cms in a matter of minutes. An hour later she was 4 cms and an hour after that my nephew was born. Once the scar tissue had completely released, she flew to 10 cms.

As you can imagine, I asked that Midwife a ton of questions. I wanted to know all I could about this scar tissue stuff. Besides “massaging”, what can you do before hand? She shared her knowledge with me. Told me that HPV is so very common and more and more women are having these standard procedures done, but are never informed that it most likely will leave scar tissue. Although less common, this includes women who have ever had a D & C after a miscarriage or abortion.

Once I was armed with the knowledge, my successful VBAC rate shot up as did my vaginal birth rate in general. I would ask the question and if the answer was yes, I would tell them what I knew.”

2.  I remembered reading about Jenny’s doula client who had scar tissue on her cervix and how after 3 trips to the hospital a midwife massaging it helped her finally dilate.

…at 1:30 am, with contractions that had been consistently every 3 minutes, we went back to the hospital… same deja vu… same parking, elevator, nurses, nothing… she was still 1 cm.  This time a midwife checked her cervix, and remarked that there might be some scar tissue on her cervix that was making dilation difficult.  Scar tissue? a knot of scar tissue? Scar tissue on her cervix? How come no-one had mentioned this before?  Mom was sad, upset, increasingly despondent, and asked for the epidural, her husband was surprised and puzzled, scar tissue?.  She said she needed a break, she needed to rest.  We agreed.  After the epidural was placed, the midwife massaged her cervix.  This massaging did in fact help break up the scar tissue, and about an hour later, the mom’s water broke, and she dilated from 1 cm to 9 cm in a matter of minutes…. A few hours later, she delivered a healthy baby boy!

… Every time I support a woman in labor, I come away with more knowledge and more information.  I researched cervical scar tissue, and found out that some routine interventions do cause scarring on the cervix that can slow down cervical dilation during labor.  Massaging the cervix does help to break up the scar tissue and helps the cervix dilate.

3.  On the Birth Faith blog I read more about this issue and  how her midwife explained how it is a more common issue she is seeing and what she does for it.

Mary, my midwife, explained that the scar tissue from D&C’s is usually minimal. It’s the LEEP procedure which typically creates the most troublesome scar tissue. When one of my midwives’ clients has cervical scar tissue, they explain to them ahead of time that they will need to have more frequent cervical checks throughout labor so that they can massage the scar tissue. If the cervix is left alone, these women can end up laboring “for days” with little to no progress. They also explained that once the scar tissue has been broken-up, subsequent births are usually much quicker and smoother.  Unfortunately, doctors aren’t usually around while their patients labor, so massaging the scar tissue rarely happens. Instead those women far too often get stamped with “failure to progress” after a long, exhausting labor, and sent to the operating room.  Many spend the rest of their lives believing they’re incapable of giving birth vaginally.

This is why I knew the answer!

I said “Yes!  Mom may have scar tissue preventing dilation.  It can be manually broken up and then moms cervix can open.”

Sadly, her OB insisted there was no such thing and refused to try to massage her cervix.  The mom ended up with a cesarean.

OBs and Midwives need to know.

Doulas and CBE’s too!

I think this is something important that OBs and Midwives know how to deal with this issue.  How much of the rise in cesarean rate is due to failure to progress due to cervical scar tissue?

Can you do something before birth starts?

Is there anything you can do to help soften the scar tissue?  I have read that inserting Evening Primrose Oil vaginally a few weeks before you due date can help to soften this scar tissue and help prevent dilation issues.  Google it to do more research.

What experiences have you had with cervical scarring?

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