Cervical scar tissue and cesareans

September 12, 2011 at 9:13 pm

One of my most popular blog posts is one I wrote just over a year ago called “Cervical scar tissue.”  In that post, I shared important information about how scar tissue from various procedures (LEEP, D & C, etc.) can potentially impact future birth experiences, causing labor to stall for hours or days if the scar tissue isn’t massaged by a caregiver to help it release and allow the cervix to dilate completely.  I also said:

I have a hunch that cervical scar tissue is likely contributing greatly to the rising cesarean rate. . . . 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. (Cervical scar tissue)

And now I’m even more convinced than ever that a large percentage of today’s cesareans and “failed” VBACs are happening as a result of cervical scar tissue. A comment from Lauren on my post has alerted me to something alarming:

I had no idea I had scar tissue on my cervix, as I’ve never had any procedures that could cause it. When I stalled for DAYS during my home VBAC labor (was at 5 for over 24 hours), I finally gave up and went to the hospital hoping for answers. They found it, massaged it out and I was able to birth my child! :D But I needed answers. A couple months later I went back to the same OB who assisted me during my VBAC and massaged the scar tissue (she’d been trained by midwives heh heh). I told her everything I’d read about cervical scarring, and that the ONLY possible cause for mine was my C-section. She then admitted it’s not uncommon for sectioned women to be manually dilated to allow them to bleed vaginally afterwards. I felt so violated. THIS is another cause of the scar tissue that women need to know about!

Since receiving this comment, I’ve also had other women tell me that their cervixes were manually dilated following their cesareans for similar reasons (lochia, placenta fragments, etc.). Jennifer said:

During my son’s unnecessarean my cervix was manually dilated from a 4 to a 10 to allow for locchia to flow. I didn’t realize that this could cause scarring that would prevent future dilation till after my failed VBAC attempt with my daughter where I labored for days and didn’t dilate at all! 

Before I say anything else, I want to thank Lauren and Jennifer for sharing their experiences.  I feel quite certain that their doing so will prevent hundreds (I can hope, right?) of future unnecessary cesareans.

If you know you have had a procedure which impacted your cervix either through removing abnormal cells or manually being dilated, be sure you talk with your doctor or midwife about the possibility of scar tissue before you go into labor.  Find out whether they will be willing to massage the tissue to keep your labor progressing smoothly.

If you have had a cesarean and are hoping for a VBAC next time, there’s a possibility that you also have scar tissue from a manual dilation following your cesarean.  Find a care provider to assist you with your VBAC who is comfortable helping to loosen-up any scar tissue that may impede your labor progress.

I would love to see a day when every woman, doctor, midwife, nurse, and resident is familiar with the impact of cervical scar tissue on labor and is trained to handle it (as gently as possible).  Think of all the hours/days of unproductive labor that would be eliminated! All those unnecessary surgeries that would be avoided?! Maybe then “failure to progress” would be put back into its rightful place as a rare and unusual diagnosis?  How awesome would that be?

It scares me to think of how many women may be having manual dilations without their knowledge/consent following cesarean births.

Spread the word far and wide, friends!  And if you’ve had experiences laboring with cervical scar tissue or stalled labors, please share them in a comment so other women and care providers can benefit!