Last Friday I saw my midwives, Mary and Nedra. We finished the whole urine, weight, blood pressure, fundal height, heart tones routine in about fifteen minutes, and I asked a couple of questions about vitamin K and ultrasounds, and then we just got chatting. Quite a bit of time passed, and their next client didn’t show up, so we just kept on chatting. I could have stayed all day, I think. It was so great to have extra time with them.
I don’t remember how we got on the subject, but Mary started talking about the cervixes of women who have had a LEEP procedure. I didn’t know what LEEP was, so she explained that it’s when they go in and cut away abnormal cells from the cervix. Then bells and whistles started going off in my head because I remembered reading several months ago about how having procedures done on your cervix can create scar tissue that often proves troublesome during childbirth. My midwives said they’re seeing more and more women with cervical scar tissue.
When I first learned about cervical scar tissue’s impact on labor, I thought: women need to know this! I did share a link on facebook and in the sidebar of my blog, but then I let it slip to the back of my mind. After the chat with my midwives on Friday, I felt driven, again, to spread the word. With more and more women approaching childbirth with scarred cervixes, this information is more important than ever. In fact, I have a hunch that cervical scar tissue is likely contributing greatly to the rising cesarean rate.
Why does cervical scar tissue matter?
When a cervix has scar tissue, dilation can occur slowly, sporadically, or not at all. Let me illustrate with an excerpt from the post that first introduced me to this important subject, “Cervical Scar Tissue – A Big Issue That No One Is Talking About,” from the San Diego Birth Network’s blog. The author of the post, doula Dawn Thompson, describes how her sister had spent over a week contracting off and on when her water broke:
She has mild labor, 7 minutes apart for 16 hours. Nothing is changing. I suggest we head in. Something is just not right. We get to the hospital and a different midwife she has never met comes to check her. 100% effaced but only a finger tip dilated. What?! Are you kidding me?! Then the words that changed my life. “Have you ever had any procedures done to your cervix?” My sister says “yes, I had cryo surgery done a couple of years ago to remove pre cancer cells.” Midwife “ok well that makes sense, you have scar tissue on your cervix, and I can feel it.” Huh? Scar tissue on the cervix? Why had I never heard of this? . . . 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.
Dawn later drilled the midwife with questions. The midwife told her “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.”
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.
Thanks to those spreading the word like Dawn Thompson, some women are being spared that outcome. She says:
Since this very important day 3 1/2 years ago [her sister's birth], I know I have prevented c-sections. Several times in the hospital I have asked the doctor to please, when he is checking mama to feel for scar tissue. Almost every time the doctor has said “oh yeah, I feel some sort of knot here” or some other variation of that statement. This then leads to a question of; can you try and rub it out?
Why Doctors aren’t talking about this is beyond me. I honestly think they don’t know that it is an issue. I don’t believe it is something they are being taught in medical school. We all need to start talking about it because unless women are being asked the question, they just don’t know. (Source)
Some women are talking about cervical scar tissue. You can read multiple discussions at the Mothering.com forum. In one of the threads, a women talks about discussing her cervical scar tissue with a nurse practitioner. She had been concerned that her excessive cervical scar tissue might prevent her from conceiving again. The nurse said that “it’s usually more of an issue during a pregnancy (when it can cause pre-dilation and may require cerclage) or during labor. . . . She said most OBs then recommend C-section.” So cervical scar tissue can cause early dilation too? And look at the possible risks associated with cerclage and other treatments for “incompetent cervix”:
- Premature rupture of membranes (1-9%)
- Chorioamnionitis (Infection of the amniotic sac, 1-7%) (This risk increases as the pregnancy progresses and is at 30% for a cervix that is dilated more than 3 cms.)
- Preterm Labor
- Cervical laceration or amputation (This can be at the procedure or at the delivery, from scar tissue that forms on the cervix.)
- Bladder Injury (rare)
- Maternal hemorrhage
- Cervical dystocia [failure to progress]
- Uterine rupture
As I talked with my midwives last Friday and our discussion of cervical scar tissue came to a close, I said:
“So, if you want to have better births, protect your cervix?”
They both said, “Yes!” You better believe I’ll be talking about cervixes and the implications of HPV, abnormal cervical cells, LEEP, cervical scar tissue, and impaired dilation with my girls long before they have a chance to put their cervixes in any danger.
Has cervical scar tissue impacted your births or the births of your clients? Please share your stories in a comment. And please spread the word. Women need to know.
UPDATE: Be sure to check out my follow-up post about cervical scar tissue from cesarean births: “Cervical scar tissue and cesareans.”