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?
I had a procedure done a couple months ago and my GYN said there would be no problem whatsoever with a birth, as they used new techniques that are apparently less brutal. It was only a small thing, about the size of a cue tip, but it still worries me, as I keep reading things like this…
I guess that your best bet would be to research EPO and it may be worth using. Hopefully there is no scarring, but it may be better to use it in case there is.
This is so interesting!
I am a midwife and this is something I have seen many times. I also experienced it myself with my first birth, opening from fingertip to 4 cm in moments with my midwife’s assistance. I had undergone cryosurgery about 14 years earlier, a much less invasive procedure than LEEP – but apparently still enough to cause this scarring. Great work to spread the information.
I had a LEEP done in ’06 and was really well informed of the possible complications, from scar tissue to a weakened cervix that might require stitches to keep me ‘closed’ during pregnancy…. I made sure to tell my OB about it from the beginning of my pregnancy and sure enough, when my water broke, I had trouble dilating. The nurse actually broke up the scar tissue, and it helped me dilate much faster (hurt like a son of a gun though!!). I hope that this becomes more common knowledge–I will make sure to share it with my doula and midwife so that hopefully they can help other moms dealing with it!
I’ve had two LEEPs and several biopsies. I was informed that I could end up with scarring that could cause problems dilating, or that it could cause problems with an incompetent cervix. After the second LEEP, I experienced severe cramping during my period and the doctor used a catheter to stretch my cervix just enough to stop that problem. I’m now pregnant and due in April. After the problem I had with my period, I am planning to start EPO at week 36 because I fully expect to have trouble with dilating.
Thank you for this article. I am shocked at how many women have these procedures done and are not warned of the possible future consequences and how to overcome them.
Hopefully with the EPO you will dilate easily! 🙂 And you know about the potential issue, so if there are problems your care provider can massage the cervix for you.
Interesting it caused issues with your period.
Thank you! If I still have trouble, I plan to insist on massage, even if I have to do it myself or have hubby do it for me.
I thought it was interesting, too. I’ve been fortunate in that I’ve never had more than minor cramping before, but after that second procedure until I went back to my doctor, it was awful. She said the scarring was interfering with the blood flow, so my body was having to work harder. She used a catheter to stretch it back out a bit, and I’ve been fine ever since.
I am 38 weeks, and at 39 weeks, my OB plans to do cervical massage to break up the scar tissue from a LEEP I had about 8 years ago (so before labor begins).
I am not sure whether this is likely to trigger labor to begin or not, but I think probably not.
I don’t know. I guess it potentially could, but as long as you are full term that would be OK.
I had a LEEP, and my midwife was very proactive about this issue. She had me taking evening primrose capsules orally for at least a month leading up to birth, and both orally and vaginally in the last few weeks. It was amazing…no cervical massage required. I had a fast labor – 9 hours of first stage (during which I was really not even convinced I was in labor), and delivered 3 hours after my water broke.
interestingly, I had a LEEP done in 1997 and had babies in 01, 03 and 06 with precipitous labors for the last 2. I remember mentioning the LEEP to my care providers but was never told that it could stall dilation. In fact, after my third birth with a labor of just over one hour, I was told that my cervix “melts like butter” by my midwife.
That is great. I doesn’t effect every woman this way, but enough that it should be something care providers are aware of and have tools to help a mom achieve a vaginal birth!
I miscarried and had a D&C. Now my cervix OS is large, my fertile cervical mucus is not of the same quality and I feel something on the surface of my cervix. The doctor said she didn’t have to dilate my cervix, but obviously she caused me damage!
I want to know if there is anything I can to do to heal my cervix? It has been 7 months since the D&C.
I had a LEEP procedure years ago and with my 2nd pregnancy I had issues with scarring (my first was a c-section due to breech baby). I had a 39hr labor with nurses manually breaking scar tissue every couple of cm’s. ( i did take EPO orally and vaginally the last month or so) Thank God they even tried because I’d never even heard of such a thing… Even after specifically asking what effect it could have… I wonder if subsequent pregnancies will be effected.
It is my understanding that once the scar tissue is broken, it shouldn’t be an issue for the next birth. I am glad your nurses were proactive with this issue!
I had a LEEP done a few years back and I am now pregnant and want to have a natural birth at a birth center with a midwive, but I was afraid that I would not be able to because of the LEEP. After reading this i guess I can still have a natural birth, which eases my mind. I am only 12wks and haven’t discussed it with the midwive or OB yet.
You should be able to, but definitely talk to your midwife about it and ask what she suggests for softening any scar tissue (if there is any.)
Aloha~
I am a doula serving in Hawaii. I am wondering… I am working with a mama who has had cervical cancer and so part of cervix has actually been removed. Have you heard of or worked with any women with this particular situation? Any suggestions on how to support vaginal birth?? She is planning a vaginal birth but it would be nice to give her some support other then your standard dr. At the hospital…
Thank you for writin up on this!
Ashley
Wow! I stumbled upon this by accident , and I’m so glad I did!
I am 35 weeks with number 3 and going for a vbac this time, but this has really helped me to understand what possibly happened during my first pregnancy. My water broke, I was in full blown labour, but was not dilating past a 4. I ended up with an emergency c- section. I am going to talk to my ob and get some EP asap!
So thankful for this write up!
Wish me luck!
Natasha
My second was a c section because the dr and hospital didn’t allow v bacs.
I
Women can also visit a pelvic floor physiotherapist before or during pregnancy to have the scar tissue released.