Previously written and posted on April 28th, 2016, I am updating it now in July 2019 in hopes to reach and help more women effected by cervical scar tissue and its potential effects to their birthing time.
Cervical scar tissue. Have you heard about this? What do you know about it? More importantly, what does your provider know about it? When I was an apprentice midwife several years ago, I noticed a trend of first time moms transferring to the hospital at 2cm or 4cm, with transition like contractions but the cervix wouldn’t budge. Through seeing this scenario play out time after time, I began looking deeper. The only information I could find to correlate with a cause for cervical scaring was a LEEP procedure. None of these clients had a LEEP procedure in their history, but they had many other things. Other things that could cause scaring on the cervix. With looking deeper, I began to notice a pattern. So what is it? Scaring on the cervix can cause issues with dilation of the cervix. It causes a very tight, rubber band to form on the outer os, with a ridge of scar tissue often felt on the lower left portion of the cervical os. It often takes a significant period of hard contractions to allow the scar tissue to gibe and help the cervix to open. Many things can cause scaring on the cervix. Here is a list of things that I find can cause issues with scaring:
- An abnormal pap smear where a follow up procedure was done on the cervix (for example, a Colpo, Cryo, LEEP, etc.)
- Long term hormonal birth control usage of a year or more
- Miscarriages where a D&C or D&E procedure was needed
- Any form of a termination
- History of having an IUD
- Previous surgical birth with or without labor
- Previous use of Plan B, even once
- Previous vaginal delivery that resulted in a cervical laceration
- Sexual abuse history
What does labor look like with cervical scaring? I can give many examples of what a scar tissue labor looks like. Once I got a call from a husband in the middle of the night. His wife was a few days past her due date and had been having very painful contractions for 3-4 hours, coming every 3 minutes and over 90 seconds long. I headed to their home. when I arrived, I found her with contractions that resembled transition. She was rocking on her birth ball, moaning with contractions, her doula providing counter pressure to her back. I did an exam and found her to be 1cm dilated. I discussed with her allowing me to work out the scar tissue and she agreed. I massaged on it and it opened to 4cm. Hours down the road, the decision was made to transport. About four hours after having an epidural, this patient went from 4cm to 10cm and pushed out her baby vaginally. Her body had to work very hard, for a very long time in order for the scar tissue to finally release. What I consider the standard symptoms of a “scar tissue” labor include:
- Prodromal labor
- Transition like labor
- High effacement/low dilation
- Water breaks earlier in the labor journey
- Early urge to push
- Stall in dilation
One thing that often can be seen with scaring, is that when the scar tissue releases, labor often moves along very quickly. I had a patient once who was 4cm for around 19 hours. She received a dose of IV pain medication, which allowed everything to relax just enough that she was holding her baby 20 minutes later. Things often move along fast and furious once the cervix loosens and opens up. So what can you do?
- Figure out if you possibly could have scaring on your cervix. Do you fit any of the criteria? Did you have a previous delivery with a surgical birth for failure to progress? A long, hard vaginal birth with a stall and then rapid dilation?
- Find a provider who is knowledgeable about scaring on the cervix. Here is the unfortunate thing I find. If a provider believes in cervical scaring, the main direction they give is LEEP procedures. If there is no history of LEEP procedures, cervical scaring is completely discredited. This is a huge problem for the patient who doesn’t get the proper diagnosis or help, which could have less than ideal birth outcomes that go against what the patient desired.
- Consider recommendations that are known for softening the cervix. This includes anything in the prostaglandin family: semen, evening primrose oil, borage oil to name a few. Placing any of these items on the cervix once term can help soften up the scar tissue ahead of time. (Update: Do to current research associating evening primrose oil with premature rupture of membranes, I no longer recommend using it.)
- Castor oil tampons have been amazing for my clients since I started utilizing them in my practice. My apprentice a few years ago took a training, and came back with this take away to use castor oil tampons to break away cervical adhesion’s, and let me tell you, they have been incredible. To follow this is very simple: purchase OB tampons and castor oil. Once term, soak a tampon in castor oil every evening for 10 minutes, and apply vaginally near the cervix for 40 mins and remove. Repeat daily until labor.
With my patients, I review potential risks for scaring at the first appointment. If the patient is open to it, we do an exam around 38-39 weeks and assess the cervix for any potential scaring. If I feel scar tissue on the outer os, we discuss me working on the scar tissue at every appointment and during labor, as needed. Nothing is 100%, but this often helps encourage the cervix to loosen and soften. Does this fit you? Do you feel like you have been or are at risk for cervical scaring and potential issues with dilating during labor? Let’s get the conversation going! #sacredjourneymidwifery
Updated July 4th, 2019