Revision, 2/14/2013

My nephew just had his sixth birthday in February. Who knew his birth would mean so much to my career as a birth professional?  It was the day I first heard the words “Cervical snuggle with MomScar Tissue.” How is it that I had been a doula for four years and had never heard this before? Those words changed my life.

I sat down just days later and wrote a blog post. Cervical Scar Tissue – A Big Issue That No One Is Talking About. In the past six years, that article has circled the globe and has been read more than 50,000 times–significantly more if you consider how many other people have gone on to write and quote my story. People are now indeed “Talking” about it. The emails and comments I have received have been staggering: most of them, women having an Oprah Aha! Moment; many of them feeling a sense of relief, to have an answer to “why” it happened to them. I have even had women find the blog during early labor, looking for a reason why their labor wasn’t progressing after days and days of surges.

At the time of writing that blog of sorts, I didn’t know much. Since that time I have dedicated most of my doula career to learning more about cervical scar tissue and, specifically, helping families who experienced a c-section with their first birth. I started working very closely with a local ObGyn who was very aware of cervical scar tissue. We started referring each other all of our VBAC (vaginal birth after c-section) clients. I kept track of the clients’ previous birth experiences, what kinds of procedures they might have had, and then what happened in their subsequent births.

The results were very clear. Out of 21 mothers, three of them had c-sections because of breech presentation and 18 were listed as “Failure to Progress” during their first birth. Seventeen of the 21 had an obvious long, prodromal labor pattern. They also “seemed” to be having transition-like labor, but were only 4-6 cm dilated when arriving at the hospital. In all seventeen women, the doctor observed obvious scar tissue during their subsequent births. The majority of these women also went on to deliver anywhere from just a few minutes after the scar tissue was resolved by the doctor to two hours after. In all cases, the labor progressed quickly.

The most interesting part of this observation is that not all of these women had had the typical cervical procedures associated with scar tissue like LEEP, Cone, or Cryo. The scar tissue also presented differently in some of these women. The women who had the procedures previously mentioned had tight rubber band type scarring on the interior of the cervix. Others though had more granular-type scarring. I have since heard it described as feeling like a piece of uncooked rice on the outer part of the cervix. That leads to the question, do other procedures cause scarring?

After interviewing several Midwives and ObGyn’s, I believe the answer is “Yes.” I found that the other women in our small group all had had procedures like a D&C or an IUD placed. For both of these procedures, in many cases, a cervical stabilizer (Tenaculum) is used. This instrument pierces the cervix while it is being manually dilated. This seems to be what causes the granular type scarring. Not all women seem to be affected by this type of scarring or maybe some of them don’t get much scarring naturally anyway. I have heard a few people share the theory that if a mother gets significant stretch marks, than she has a higher likelihood of scarring. Some people naturally produce more Keloids. Keloids are the excess growth of scar tissue at the site of a healed injury. This would make sense as to why some people would be affected and others would not.

Signs of CST

•           Prodromal labor

•           Release of waters after much Prodromal labor

•           Dilation Stall

•           High Effacement/Low Dilation

•           Mom describes surges, but gets checked with no dilation

•           Mom appears to be in transition but has early labor dilation

•           Overwhelming urge to push, but low dilation

The next question of course is – can it be removed and is it something that can be checked before labor? In most cases, it can be resolved. Unfortunately it can’t be detected before labor begins as a significant amount of effacement of the cervix is required. Some care providers recommend using either Borage Oil or Evening Primrose Oil vaginally after 36 weeks to help soften any scar tissue on the cervix. It’s not clear if this actually works and has never been studied for possible negative side affects. This would always be something to discuss with your care providers.

Once in labor, your care provider can do a vaginal exam and “massage” the cervix and help the scar tissue release. The word massage can be misleading – this is an uncomfortable procedure, but not unbearable.  When the scar tissue is less severe, movement and time is often what is needed. Another option used is a Foley Bulb Insertion, where the tip of a foley blub is inserted into the cervix and then inflated gently. All of these things would require having a provider that is present during your labor (often ObGyns aren’t present until much later in a labor), is familiar with cervical scar tissue and knows to look for it.

Since this small group four years ago, I have gone on to help many more women and experience their joy and relief when their scar tissue was recognized and resolved–all of them climbing that amazing mountain, to reach the top with a roar, holding their beautiful new gift. Thankfully, though, many of them were first-time moms that might have otherwise been recovering from a preventable c-section.

Dawn Thompson is the president and founder of Improving Birth.org. She has been in the birth industry since 2003, supporting hundreds of families as a Labor & Postpartum Doula, with a background in public relations and marketing. Because of her own personal struggle through three preventable surgical births and, finally, a triumphant vaginal birth, her passion and desire to empower people through education has become her mission.

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  1. Al R says:

    Evening primrose oil has been shown to increase the risk of hemorrhage… Especially in VBACs.

  2. LLR says:

    I have just learned about clary sage or sclaressence essential oil being rubbed onto cervix during labor used for this exact problem. I plan to use it in practice.

  3. SBaker says:

    Thank you for posting this information. Does anyone know of any published clinical evidence regarding inadequate cervical dilation and history of cervical treatment such as LEEP, Cryo, etc.? I have performed a quick search and am finding a few articles that suggest no difference in conception and one article that claims no difference in type of delivery between women with and without this history.

    I am interested in length of gestation, birth weight, length of labor, complications, and degree of perineal laceration and episiotomy.

  4. Tasha says:

    This was a good read helped me figure out a bit more about my situation in 2009 I had cin 4 they removed almost all my cervix by leep procedure well it ended up healing at the top part with a lot of scar tissue in 2010 I ended up getting pregnant my obgyn told me I was lucky to even have gotten pregnent due to my cervix being almost completely heal shut she said it was open a needle point well I had to have a emergency c-section in 2011 because my scar tissue was so severe they couldn’t break through it but now I seem to have extreme cramps that criple me during that time of the month since my cervix is so closed up it also causes me not to bleed which I think is why its so painful has anyone else had this problem and what did you do

  5. Yolanda says:

    Hi – I know this article was written some time ago – I recently had a C-section because of excessive scar tissue that my car provider could not break up.
    I am curious as to if there are any treatments that could help before I become pregnant with our next baby?
    Thank you!
    Yolanda

  6. Tessy says:

    Wow!!!! this is very informative. I had my first baby through c-section. I was not dilating at all and I was induced still no progress. this resulted to the c-section. when I was 37 weeks, I was made to do a pelvic exams, whose result shows that my pelvic was inadequate. My problem right now is that I got pregnant again just after 8 months and the doctor is saying that i’ll have to go through c-section in all my subsequent pregnancies including this very one and I’m not comfortable with it at all. I want to ask is it true that because a woman’s pelvic is inadequate she has to deliver all her children through c-section? please I really need a reply from you. Thanks, nice article.

  7. Heather Hegland says:

    I always guessed that having an IUD placed before I had ever given birth was the cause to my cervical scar tissue but no dr or midwife agreed. In the third trimester with my first baby ever nurse, dr, or midwife that checked me asked me if I had ever had a surgery on my cervix, then when I went into labor my water broke at home and I headed to the hospital after 12 hours and contractions 1.5 mins apart they decided to give me piticin after 20 hours I still was barely dilated to 1cm and had an emergency c section. I wanted vbac with baby number two but again I got to the hospital with back labor and contractions 1.5 mins apart and they said I wasn’t dilated at all. I’m currently pregnant with number 4 and they won’t give me the option to do a vbac now.

  8. Heidi says:

    I am disheartened by how little seems to be researched regarding childbirth.
    I suffered terribly during the birth of my daughter. I had. LEEP done a few years before becoming pregnant. (It took nearly two years to become pregnant as well.)
    I was two weeks late when my Dr. Determined during an ultrasound that my amniotic fluid was low and she admitted me to the hospital in Seattle to induce labor with pitosin. I was immediately in excruciating pain but was told to go home after several hours because I was not dilating. I was in so much pain that I could barely walk, relief maybe lasted 20 seconds before setting in again for several minutes. I thought I would be able to handle labor because I had always had such painful cramps with my periods. My baby was turned so I was having back labor. I couldn’t get to the car so we went to the waiting room where we stayed for several more hours. The hospital won’t give you a room until you are dilated to some cm, I don’t remember the number. After 18 hours I never did dilate.
    I ended up with an emergency C-Section. The cord was around her neck.
    She is beautiful and now heading to college in a few months. She was my first and last. Labor was a terrifying and isolating experience for me. So sad.
    In my mind this is unacceptable and could have been improved in many ways.

  9. Anita says:

    Hello…here’s another issue which many young, child bearing women might think about. I am 63 years of age and have noticed some spotting. Unable to get an appointment with my Gyn, my primary care Dr. said she’d check it out. During the exam, she seem frustrated. She could not use (whatever tool they use) to pass the cervical scar tissue to examine the uterus. After calling another Dr. to try, it ended up in her not trying at all. Now, I will be seeing a GYN for them to take a turn. I’m hoping it’s not too painful. One more reason to avoid cervical scar tissue.

  10. Alyssa says:

    I am going through this right now. I have had a leep and iud (misplaced), and I’m pregnant with twins at 36 weeks. I have reg contractions 2-4 min apart and am not dilating. The dr doesn’t seem to care even though I told him with my last baby I had scar tissue and didn’t dilate even with 12 hours of pit. I’m so frustrated.

  11. Sonya Jenkins says:

    I came across this website and just wanted to share my story.
    I had all of these signs during my last labor and ended up delivering my baby at home as a result of my OBGYN not being aware of cervial scarring. My water broke on June 15, 2014 at 36/4 weeks. I went to labor and delivery immedialty as this was my 7th child, a VBAC, and I have a histoy of precipitous labors. I was having contractions,was told my cervix had scarring on it but 100% effaced but my 1st nitrazine test was negative so I discharged. When i stood up to get dressed, a pool of fluid hit the floor. I asked to be checked again and this nitrazine test was positive but then the fern test was negative so i was sent home. I leaked fluid all night. As long as i was lying down there was no leaking but as soon as i stood up,it would gush out. I went back to the hospital the next day. Was checked again and told that there was pooling in the birth canal that contained vernix, the nitrazine was positive and the doctor advised there was scarring on the cervix as it felt like a rubber band. Again the fern test was negative so i was daignosed with with a bladder infection and sent home. (Urine spec was normal). The next morning around 2 am, i started having contractions that I could no longer sleep through, about every 7 minutes. I waited until they were closer together and went to the hospital around 7 am. I was put on a monitor, and checked for dilation. Still only 2 cm. I was sent to walk for 2 hours (no longer leaking fluid at this time). Once I returned to the room. I could not walk or talk through the contractions. I was checked again and still only 2cm. I was discharged again. I was devastated and frustrated as i was very confused. My body felt like i was in labor but the medical staff was saying no. I left the hospital, needing help from my husband as i walked to the car. My contractions were every 2 minutes, lasting 40 to 60 minutes. I went home and got in the bathtub to relax but couldnt find any relief. So my husband helped me out and I was able to put on a nightgown only as i felt the urge to use the restroom. I sat down on the toilet and it hit me at that time that I did not have to use the restroom. I got up went to my bedroom, laid in my bed and decided to try to push to see if I could feel baby drop into the birthcanl. Yep, I did indeed. I told my husband to call 911 and delivered my baby with 2 more pushes. The home birth experience was great. Doubting my own body and mind, not so much!!!

  12. Lacy says:

    I had never heard of this until today during my annual exam. My husband and I are trying to conceive and my obgyn said let’s check for scarring! He was able to check and remove it as there was some scaring from a cryo I had two years ago! I had also had colposcopy 11 years ago and I had to have a c-section with my daughter ten years ago! Makes sense now!

  13. Tracey says:

    Thank you so much for the information! It is nice to know how to avoid a c section when I am pregnant since I recently found out I had significant scarring from a LEEP procedure. However, to improve my chances of conceiving I need to have a fibroid removed that is blocking half of my cervix and I was curious as to how this may be accomplished given my OBGYN’s inability to reach my uterus due to the scar tissue and the unsuccessful attempt to dilate. Is there a particular procedure I should research? Do I need to see a specialist?

  14. Shanell says:

    OMG thank you so much. I was ding some research on why some women wouldnt dilate. i became so hopeless thinking I would have to have another c section with this pregnancy. My previous pregnancy i was 41+ weeks so i had to be induced. The foley bulb was too painful as they didnt inflate gently so i only dilated to 5cm because i made them deflate until it barely anything left in the bulb. After my water broke dilated maybe 1-2 more cm and that was it. I was in active labor for 48+ hours and right when they scheduled my c section i felt this uncontrollable urge to bear down like i was about to have a BM. But when they checked me they said i wasnt ready to push. Im thinking its due to a D&c i had when i was 16. thank you so much! Now i know what to discuss with my doctor!!

  15. I had a mom who tried VBAC. She was fully dilated according to the Dr. but with a little cervical lip. So, I would say, not quite fully dilated isn’t it? Dr did a VE and I guessed she must have “massaged” her cervix but with no progress and the mom’s cervix was swollen too. She then ended up with a repeat c-section. My question was would Foley bulb insertion be helpful at this point?

  16. Heya i am for the first time here. I found this board and I find It truly useful & it helped me out
    much. I hope to give something back and aid others like you aided me.

  17. You’re amazing! Imagine keeping records on patients like that. They don’t keep records of treatment outcomes at Fox Chase Cancer hospital. I’m wondering if cryoablation surgery on the prostate also results in bigtime scar tissue that creates urinary, maybe kidney etc. problems. Your information suggests YES. No official info on that yet. Many thanks.

  18. I should also add that I am a VBAC provider (40 years), and have frequently seen this scenario occur in previous hospital births, and management was Pitocin augmentation, epidural anesthesia (which restricts movement), and subsequent fetal distress and resulting cesarean birth.

  19. I have also seen cervical scarring and resistance to contractions in clients with prior LEEP procedure, cold knife cone biopsies, IUD insertions, and years of oral contraceptive use and the Depo-Provera injections. Clients with a history of any of the above are counseled during pregnancy that there might be a need to break up the scar tissue during labor, which can be quite uncomfortable. Typically labor presents a described above – strong contractions fairly close together which would on the surface seem like the client had more cervical dilation than appreciated on vaginal exam. The uterus, I believe, senses the resistance of the cervical muscle, and ramps up the contraction strength and timing to overcome the resistance. Once the scar tissue has been released, rapid progress in dilation usually occurs. I have never seen this to be an issue with subsequent births however. They proceed “normally”…. Thanks for bringing this issue to light.

  20. Peta says:

    I was aware of severe scar tissue on my cervix ahead of labor as I had required surgery ahead of IVF to clear it. I was told that the impact of the scar tissue on labor would not be fully known until labor started. I was induced and 8 hrs in I had not dilated at all despite severe and regular contractions. They could not even break my waters so a c section was recommended. I can relate to the comment about being in’ transition’ as my contractions were on top of each other, I was crying and vomiting just before the epidural for surgery but being told by the duty midwives that I was not technically in labor as I had not dilated to 4cm. I think your article is great as labor stages are defined by dilation but there needs to be more info and awareness of this so women like myself can be properly supported. There is significant pain involved when dilation does not occur and there is a baby trying to get out through an exit that won’t open. The c section saved both our lives but it annoys me when I’m told I wasnt in labor based on no dilation as I certainly wasn’t enjoying a picnic in the park… thank you for your article.

  21. Jackie Dow says:

    This is very interesting. I was a midwife apprentice,and never heard of this. Personally,I had cone biopsies prior to giving birth. I was able to deliver at home,all four times.I had what appeared to be a textbook labor with my 1st,and precipitous labors with the last three. It was difficult to tell though, It seemed as if I was in early labor for over a week. I don’t actually know if I was or not. At one birth I attended that we needed to transport to the hospital,the nurses kept wanting to hook me up to a monitor,I was very pregnant,but not due for a couple weeks,it appeared I was having regular contractions that looked more intense than the woman I was helping. I just told them to ignore my belly,I was not ready yet. I gave birth a week later,my husband had to drag me off the hiking trail because I started to moan with contractions,we barely made it home. It was painful,but I was used to lots of pain and learned to ignore it till unbearable. Your article was very enlightening,Thank you.

  22. Danielle says:

    Thank you so much for this article. I had a baby 4 years ago. After being in labour for 6 days, having my waters broken and being induced I only got to be 7cm dilated and stayed that way for hours until the situation started to get dangerous for myself and my baby and I was rushed off for a c-section which didn’t go very well and I ended up being able to feel the whole thing. The doctors couldn’t explain to me why I couldn’t have a baby naturally then just said sometimes it happens. My husband & I have wanted another baby for a while now but I have been to frightened after what happened last time. I decided to do some research on the reasons why people have problems during labour and I came across the article you wrote and suddenly it all came rushing back to me, during one of my many internal checks I had the doctor asked me had I ever had any type of surgery done, at the time I didn’t realise that the procedure I had done was what they were talking about but after reading everything I realised it was. I now have some hope that this is what caused my problems and that I may be able to have a natural birth. Thank you.

  23. Drea says:

    Thank you for getting this information out there! I had a LEEP procedure a few years ago, and my Ob/Gyn didn’t inform me of any side-effects, let alone this.

    A complementary discussion to this one would also be non-surgical treatments for cervical dysplasia, just to rpevent this problem before it causes problems. I’ve read a little bit about it, but haven’t found anything that sounds tested, only personal stories. The Western medical model of just cutting things out of the body (especially women’s bodies) seems counter-productive in some cases. Yes, we should protect ourselves against cervical cancer, but what if we could heal the “abnormal” cells?
    Just a thought. I hope they’ll be more research into this in the future.

    Thank you for your work!

  24. Lauren says:

    This exact thing just happened to me, but luckily I was able to avoid c-section. I was wondering: should I expect this to be a problem on a subsequent birth? Or since my scar tissue was broken during the first birth, is it broken permanently?

    1. Bree says:

      Lauren – did you have another child or get an answer to this? I have the same question. Take care.

      1. Jessica says:

        I am not Lauren but, I can speak from personal experience. I had a LEEP procedure done between baby #1 and baby #2. I had cervical scar tissues we had to break through for baby #2 and baby #3-both resulted in several false labors to work through the bands of scar tissue. We did not notice any issue with baby #4 but, I did have a few days of on and off contractions where I spent quite a bit of time in the tub with magnesium phosphate supplements leading up to her actual birth-no “false labor” though. I had quite a bit of scar tissue again with baby #5. I labored on and off with him for 3 weeks before he was born-I lost my mucous plug and was 7 cm dilated with no labor pains at 10AM the day of his birth. With herbal assistance, I went into labor around 12:30PM and he was born at 2:47PM. I am due with baby #6 in 5 weeks and am researching options to reduce the cervical scarring and labor issues this time around. For reference: My surgery was in January, baby #2 came in November. 16 months between baby #2 – #3, 2.5 years between babies #3 and #4. 2 years between babies #4 and #5. There will be 5.5 years between babies #5 and #6.

  25. Rachana Shivam says:

    Good article. Thank you. Acknowledging the cervix in this way is most important. I would include terminations and some forceps deliveries as another times when the integrity of the cervix is compromised. In the DVD ‘The Lotus Birth of the Malcolm Twins’ When talking about how it was birthing the breech twin, the mother gives an exquisite account of how important it was not to hurry the birth. She felt her cervix quivering as her babe descended and how to interrupt that by pulling on the baby would had been ‘like interrupting an orgasm’ I would say that the cervix is often put under duress and that we need to heed its needs. I am not a fan of too many pap smears.

  26. Elena says:

    I had scarring after cryosurgery but did not know it until my medwife, realizing after several hours of intense labor, I was not progressing. She “broke” through the scar tissue, however, I was having intense back labor due to my first child being posterior. Something she missed until it was too late. I ended up with a c/s.

    My next birth was a homebirth, HBAC, with two “real” midwives who were fabulous. After less then 3 hours of labor, my daughter was born! What a healing experience.

  27. Sheridan says:

    Wow, IUD insertion. That is something I have never asked my doula clients about. But SO important to know!!! Especially because I had an IUD.

    1. Cynthia says:

      So did i, cold that have contributed to my c section?

  28. Tara says:

    Such great info! I was in labor for 2 wks with my last baby, and my cervix was funnelling and dilating on the outside, but then less on the inside. I completely believe this was due to scar tissue from an IUD removal prior to getting pg. My strings had curled up inside the uterus and the dr had to “fish” them out with a pokey metal instrument. I think this caused scar tissue on the inner part of the cervix but not the outer which caused the funnelling (I was a 7 on the outside and 5 on the inside 4 days prior to his birth). I finally massaged and stretched my cervix myself the morning my son was born because I was desperate for something to change and he was born a few hours later. Thought this story might give you some insight on other strange cervical phenomenon!!

  29. Donna Hayes RN, CD, CLEC says:

    Nice Job Dawn! I’m so inspired by you. Love D

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