Previously written and posted on April 28th, 2016, I am updating it now in August 2019 in hopes to reach and help more women effected by cervical scar tissue and its potential effects to their birthing time.
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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 a few years ago. My apprentice at the time, Rowan TwoSisters, took a Scar Tissue Remediation Course, 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
Addendum: Added to say, I will not give advice for a particular case via email or my post. Should you want a virtual consult, you can email me to schedule this. You can also take this great DIY course written by Rowan Twosisters, LM CPM which gives you more skills to work on your scar healing yourself.
Updated August 7th, 2019
Hello, thank you for the information. This is really good to know – and I have a question. My cervical scar tissue makes my periods really difficult. I’m wondering if inserting Evening Primrose Oil would be helpful. And if it would help to heal the scar tissue over time, or do you know anything that does?
I realize you deal with birthing but if you had any information at offer, I would really appreciate it 🙂 Thank you!
April 15, 2019 at 6:50 pmI had the Mirena IUD and was having issues with it so I pulled it out myself and it felt like a huge relief with no pain but there was a scar tissue capsule surrounding the IUD and it felt like I just pulled it out of my cervix and not my uterus. I think it could have been in my cervix for a year and I’m worried there’s scar tissue in my cervix that might give me birthing issues. How do they diagnose cervical scar tissue and will I know ahead of time if I can deliver vaginally?
May 18, 2019 at 11:02 amTHANK YOU. My home birth was a living hell because of cervical scar tissue. The doctor who performed the LEEP promised it wouldn’t interfere with childbirth. What a joke. Contractions that felt like being stabbed in the cervix for 10 hours, the pain often continuing between contractions. I wanted to run away from my body. At one point my midwife stuck her hand inside and must have massaged some, and it was such a relief.
I’m looking at doing pelvic floor therapy to have any remaining scar tissue worked out, as I am pregnant again and still want to birth at home.
This is one of the few resources I’ve found, so thank you very much for writing about it.
June 27, 2019 at 12:38 pmI am so sorry what you went through! I am about to post this with some updated info. I hope you have a healing birth, and a provider team that is experienced with cervical scar tissue.
July 4, 2019 at 8:13 pmHello,
I had cervical conization, similar to LEEP one year ago. I know this is a blog for pregnant women, however, I have some issues with my cervix. I believe my menstruation is blocked by cervical scarring. When I climax during intercourse, I bleed old blood. It’s not BV. It’s not an STI. Is this possible that my cervix can’t open as much during menstruation now because of scarring? Can I use primrose oil preemptively before I have problems later when I decide to have children? Help!
I don’t have health insurance, so I rely on blogs and of course planned Parenthood too.
July 26, 2019 at 11:37 amFellow Leep patient here. Yes, it’s totally possible. It’s one of the possible side effects involved with the leep. The same issue can also make it difficult for you to get pregnant and can cause other issues. There are treatments available to help, but you are going to have to go back to the OB for that.
December 12, 2019 at 11:31 amHello,
Can an ECC (endocervical curettage) be cause for scarring as well?
I had one done July 2019. Since then I’ve had low sex drive, little to none cervical mucus, having troubles “relieving” myself during sex.
Thanks!
August 27, 2019 at 9:38 amI’m so glad I found this post-I feel so validated now! My birth was a nightmare because of this. I was induced and was in horrific, unrelenting pain for hours. I knew something wasn’t right, and after hours of begging for help (and the nurses being really mean) the Dr. finally came and checked me. He asked if I had ever had a surgical procedure on my cervix, which I had told them MANY times I had a LEEP. He then manually broke up the scar tissue and I dilated rapidly. I ended up with a C-section immediately though because she had flipped breech and was in distress. Nobody ever explained to me what happened and I felt so traumatized by the whole event. Thank you for writing this!
October 21, 2019 at 11:23 amI am so sorry your birth was traumatic. I hope this information will help you have a healing, empowering birth if you should have another baby.
December 30, 2019 at 3:40 pmWhen I went into labor with my youngest child (13 yrs ago) we went to the hospital with the standard 5-minutes apart contractions. -They sent me home because I was barely dialated. A short time later we went back with contractions that seemed to be on top of each other. – They kept me, because I basically insisted, but didn’t call the doctor, because again, no dialated. That night was hell….I cried with contraction after contraction (they wouldn’t give me the epidural until I was “close to pushing” which of course was a long way off, since I wasn’t dialating) The next morning when the doctor came in, she checked my cervix, found that it wasn’t dialated, but then poked at it for a minute. They couldn’t get us into a delivery room fast enough. When she realized there was scar tissue (I’ve had to have cervical cerclages with every pregnancy to prevent preterm labor) my cervix essentially popped open and they had to prepare to catch a baby who had been trying to get out for ours. It turned out ok, but could have been so dangerous.
I have only recently made the connection with the fact that my period is often late, but arrives in full, painful, force the morning after sex with my husband. Due to the location of my cervix, it is often bumped against during sex. I’m wondering if this is having the same effect as the cervical massage, resulting in the flow of my period.
Being a military veteran, and now military spouse, much of my medical history is scattered among various gynocologists. I often have to figure things out and advocate for myself. Thank you for posting this information. It helps to have some insight that makes sense.
December 29, 2019 at 8:30 am