Wednesday, February 24, 2010

Cervical Scar Tissue

Picture of a healthy cervix taken from The Beautiful Cervix Project


I copied this important article from San Diego Birth Resource Network’s blog. I will now also ask all of my client’s about any history of cervical operations or procedures. Coincidently, I just read about cervical scar tissue in Elizabeth Davis’s Heart & Hands: A Midwife’s Guide to Pregnancy & Childbirth. It is nice to know that there is a pretty simple fix for this scenario, too. Heart & Hands recommends massaging the cervix (the mom can do this herself) with evening primrose oil twice daily for several minutes (this is contraindicated for any woman with a history of premature labor until she is at least 37 weeks). This can also be done in early labor, in case it is prolonged. The evening primrose massage will soften tissues and break up adhesions, preparing the cervix for dilation. Here is yet another way to treat our bodies gently!


Cervical Scar Tissue – A Big Issue That No One Is Talking About.

by Doula

In my first year of being a birth doula, I had this client. She desperately wanted a VBAC (vaginal birth after c-section). She told me how in her first birth that she was in labor for hours. Waters broken, Pitocin, epidural, tubes and wires coming from every direction. During her extremely long ordeal the only change to her cervix was the effacement (the thinning of the cervix). Her cervix never opened at all. I assumed at the time that this was because her baby was just not ready to come out. This time could and would be different. She would wait for labor to start. We would stay at home and labor where she was comfortable. When the day came, that is exactly what she did. Her labor seemed to be moving right along. When we got to the hospital I expected they would tell her that she was 4-5 cms. Instead what we got was, 100% effaced but only a finger tip dilated. I think I may have even gasped out loud. I immediately started beating myself up in my head. How could I have read her labor so wrong? 6 more hours would pass with her, her husband and I working hard. Moving from the birth ball to the shower and I swear every inch of that hospital room in between. After 6 hours, still a finger tip dilated. Obviously there is something wrong with her cervix, but what. No one seemed to know. Not the two different nurses that we had the pleasure of getting to know or the doctor who we saw just once when he was coming to explain that she would be having yet another c-section. This is one of those moments in my career that I really wish I knew then what I know now.

I have never stopped thinking of her. There has always been this part of me that wanted to call her and say “I know what it is now, can you have another baby so we can fix it?” I just know this would not make her feel any better. Instead, I keep her close to me whenever I ask the question now during each and every prenatal visit, “Have you ever had any procedures done to your cervix?” Every single birth professional that is assisting clients should be asking this question.

Look, I’m not a scientist, researcher, doctor and anything else that would know how to study this stuff. What I am is a doula that has had the pleasure of attending over 100 births. I know that the client I mentioned above was not the only one who had a c-section because of scar tissue during my earlier days. I can look back and think of all the clients that seemed to be in transition (7-10 cms) but when checked were still only 4cm. Stuck there for hours and hours. Then wondering for days after their c-section if there was something I could have done differently to help.

A New Day!

The day that changed my life as a doula forever, my very own sister was having a baby. She was having her second baby. I told her how great it would be and it would be so much faster than her first. When she started having surges just a few days before her due date, we were excited. I went to her home (3 hrs away) and stayed the whole weekend. She had surges off and on all weekend but nothing really steady. I went home after three days and decided that maybe my being there was freaking her out. For the next week, she had surges every day. I kept telling her it was going to be great. All this work would get her cervix open slowly and gently. Then she visited her midwife. She was just a finger tip dilated. I chalk this up to my sister being a big drama queen. All the surges have been Braxton Hicks! The next weekend comes and I find myself making the drive because this time her water broke. Now we know this baby is coming. 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 even 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? My client from before comes rushing back to my head. Of course! 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.

As you can imagine, I asked that Midwife a ton of questions. I wanted to know all I could about this scar tissue stuff. Besides “massaging”, what can you do before hand? She shared her knowledge with me. Told me 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.

Once I was armed with the knowledge, my successful VBAC rate shot up as did my vaginal birth rate in general. I would ask the question and if the answer was yes, I would tell them what I knew. I would suggest that they mention it to their doctor so that if anything came up during labor, would he or she be willing to massage the cervix. Also I learned from that Midwife that evening primrose oil taken orally and vaginally would help break up the scar tissue before labor. (Orally taken the entire pregnancy and vaginally each night only after 36 weeks).

Since this very important day 3 1/2 years ago, 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.

Written by: Doula Dawn Thompson


28 comments:

  1. I would say informative and nice blog.

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  2. I love this post. Very informative!

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  3. Wow, its a shame I can't find anything else written on this, as I would love to look into it further....

    thanks for sharing - it is one to remember!

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  4. thank you so much for this article and stories you have shared, i can say without a doubt i have seen the same with one of my clients who ended up with a c-s, and not sure if any others too...I will also ask my mums early on about their procedures - Nadine Richardson, doula, childbirth educator

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  5. Thank you so much for this! It really got me thinking.

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  6. That is precisely the reason I have had 2 C-sections... With my first, I labored for 12 hours in the hospital without proceeding past 5 cms when I actually started to lose ground. My son's head was pressing against the cervix and caused the opening to swell. The Dr. seemed to know there was scar tissue there but did nothing to help me... except "permit me" to labor some more and then eventually inform me that we would need to do the c-section. I WISH someone had told me there were alternatives. Thanks for posting this very helpful info.

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  7. oh my god! THIS must be why I wasn't progressing during my home birth!! Almost makes me want to give it another go!!

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  8. finally,an answer!stopped dilating at 7cm with my son,had to have a c-section.had a d&c years before.luckily had a normal birth with my next son

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  9. The doctors probably don't know about it because they probably aren't taught it. No one can get famous for it or make money off of it so no one bothers to pay attention to it. It's just anecdotal and isn't considered real science even though it gets a much simpler and easy outcome like you've experienced. Sometimes it seems as if they don't want to learn new things. Almost like they know it all....

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  10. Makes perfect sense! My first labor, they had to "manually" dilate me with each contract at the end (excruciatingly painful) as one side of my cervix wasn't properly dilating. The year before I delivered I had had a LEEP procedure. I am grateful the midwife knew what to do. With my 2nd, all systems were go even though 7 years previous to his birth, I had cryosurgery. Knock wood, that this 3rd birth the cervix will dilate very easily since I haven't had any surgeries done on my cervix.

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  11. Thank you so much for sharing...I wish I knew all of this before my 3 c-sections!!!! If I ever have another baby I will keep this in mind and make sure to ask a lot of questions...I will also have a mid-wife/doula. I will be sharing this info with all the women I know! Again thank you :)

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  12. Everyone, thank you for all of the comments. I am so glad the word is getting out!

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  13. as a doctor.... who didn't dilate past 4 cm and ended up with a c-section, who has never had any cervical procedures, I would suggest that not everyone start counting their chickens that this is the problem. I would also suggest that the suggestion of taking evening primrose oil daily and then massaging at 36 weeks or greater is a risk. Not so much the massage after 36 weeks but the daily medication. Yes, MEDICATION! Evening Primrose Oil is a medication. It is an estrogen. Taking supplemental estrogen can cause elevated blood pressure and other complications through the pregnancy. Trading off a potential vaginal delivery for pre-eclampsia or eclampsia is not, in my mind a good idea.
    As for doctors not knowing about this, or caring, because you can't make money off of it, why do you even bother demanding appropriate health care when you don't appreciate it? All I do is deliver babies. I am very good at it. You can ask my patients. I have a much lower c-section rate than my partners. I always ask my patients about surgery and procedures, its part of the history taking at the beginning of any pregnancy that everyone should be taking. I like doulas, ask my patients. (Although I must admit I have run across one that I think was more of a detriment to her patients than a help!) I HATE BAD information being put across as the gospel truth and being blamed for an 'unnatural' delivery. Sometimes, nature isn't on our side. I am not indelibly scarred for eternity because I have had 3 c-sections. I continue to deliver babies, and again, you can ask them, try to reassure them that there is no reason to assume that they will not deliver vaginally. I strip membranes (sweep membranes, whatever you want to call it), I monitor contractions, I encourage position changes (a hot shower on a ball is by far the best thing I have ever found for the majority of patients) . I explain options. Don't throw all doctors in the same pile and don't assume that just because you read the info on the internet that it must be true!

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  14. So informative thanks!!

    Laurie from Lynchburg

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  15. Thanks for sharing this!

    I too have seen cervical massage work magic on these situations, and evening primrose oil (EPO) is a great tool! I'm surprised about the "estrogen" comments above. From my unerstanding EPO is an omega 6 oil with gamma linoleic acid that acts similar to prostglandin gel or semen on the cervix.

    Something to add to mix. I've also seen the cervix have similar challenges with some women who have been on birth control hormones for many years (I don't have a line to tell you after this many years its an issue - wish I did!).

    I totally agree tho that once you know this you look at long drawn out labors with a whole new light.

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  16. this doesn't make sense, how do you "break up" scar tissue by massaging it, its SCAR TISSUE, a SCAR, just like if you cut your arm, no matter how much you rub a scar on any other part of your body, it's not going to go away. so why do you expect anybody to really believe that not only is a minuscule scar on the surface of the cervix is preventing full dilation, but that somehow rubbing this spot will make the scar magically go away.

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  17. Abigail: what you say does make sense, I have a hard time wrapping my mind around this concept as well, but it does work. I just heard a birth story from a woman who experienced it. She was having a home birth but just wouldn't open all the way. She went in to the hospital where she was examined by a doctor who felt her scar tissue, massaged it through a few rushes, and it released and she opened right up and had her baby.

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  18. Thanks for sharing this. As a doula its something that I will have to look into further. Obviously this isn't the reason for every person who didn't dilate but I am sure it has affected many laboring women. There are many many things that can prevent or stall dilation. Education and knowledge about procedures is obviously extremely important and will help women have more satisfying birth outcomes!

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  19. Thank you for writing about this, (and gratitude to my doula for sending me the link to your post!)

    I had my first child three months ago, at the age of 41, feeling so well-prepped and open for whatever may transpire. (Birth plan: Have a baby, live through it.*smiles*) While my husband and I packed a swimsuit, hopeful we'd be able to have a water birth with at least one of our two-doula-team in tow, what ensued was a long, non-progressing, painful labor experience lasting 36 hours (similar to what you describe above. I actually thought I was even reading my own story for a minute!) In my case, however, the nursing/ midwife/ medical staff at this hospital (which has one of the lowest c-section rates in the country) KNEW and ASKED ME early on about whether I ever had cryotherapy done. Twenty years ago, I had two rounds of it actually. Despite the nurses massaging efforts, (after finally FINDING my cervix!) I never dilated past a pencil tip. (My midwife could never reach my cervix; and by the time the surgeon checked me, she affirmed that everything we tried was not helping. My only option was a c-section.)

    Today, after a yoga class with my three month old at a local birthing center, I was told by the staff that I could have a VBAC. I must be honest, though: I have really no desire to experience this kind of pain and lack of progression again. The second gift coming out of our birthing experience (after the arrival of our daughter!) is knowing that the next go round, I just have to schedule an appointment, and can go in and have our baby. (God willing.) It's amazing comfort, when your body seemingly has "failed" so incredibly.

    Thank you. I send love and good thoughts to any and all who experience this kind of birthing challenge. May ease, trust, progression, miracle energy be known!

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  20. Today, after a yoga class with my three month old at a local birthing center, I was told by the staff that I could have a VBAC. I must be honest, though: I have really no desire to experience this kind of pain and lack of progression again. The second gift coming out of our birthing experience (after the arrival of our daughter!) is knowing that the next go round, I just have to schedule an appointment, and can go in and have our baby. (God willing.) It's amazing comfort, when your body seemingly has "failed" so incredibly.

    Thank you. I send love and good thoughts to any and all who experience this kind of birthing challenge. May ease, trust, progression, miracle energy be known!

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  21. This is wonderful information! Passing it along.

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  22. This is an amazing post and I will have to keep this information in my archives! I too am plaqued with abmornal paps during my annual. Before I was due to have the abnormal cells shaved off, we found out we were pregnant (which meant I had the biopsy at 2-3 weeks pregnant! ouch!). Labor progressed quickly, regardless of the fact that we went to the hospital a little preemptively, and made me nervous.

    After a year of being a mom to a beautiful son, we are thinking of the possibility of a second one. Yet, after a recent pap, it has come back abnormal. The very lowest grade but I have had this for a few years now and the doctors are nervous to leave it there. I come from a very natural, holistic, yoga back ground and the thought of delivery by c-section scares me and scared me through out my pregnancy. Is there any way to ensure, if I go through with the cryotherapy, that cervical massage will work? Are there any medical links we can check out?

    Thanks for all the information and uplifting stories!

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  23. I wish I had got this info earlier I had letz treatment in march 2010 and became pregnant in june that year on monday my waters broke and I went into labour from that point my contractions were coming every 1 to 2 minutes although my cervix was only dilated by 1cm. For 24 hours my contractions remained this regular and my cervix only managed to dilate to 4 cm. I dont know how I coped with such agony in 1 to 2 minute intervals. When I reached 4cm dilated had an epidural but it didnt. Work so finally 24 hours from the beginning of labour I had a c section and gave birth to my beautiful son jack

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  24. The story above reminded me of my story also. I sobbed hard once I realized that I felt like my body failed me. I'd hoped and planned for a "Natural" birth, only to have a C-Section after a little over 7hrs which excuse my french is bullshit. We plan on having another ending 2012/2013 and we are praying for a successful VBAC.
    And.... for the "Doctor" (wink, wink) understanding the patient I thought was the first line of business besides providing proper medical attention/care??? Is it not for the patient that the DR. has a job??? So should OUR feeling be put into the equation??? Understand that there is a professionalism that plays in this but as a woman, mother, and going through this experience would make you a little more aware of all the emotional turmoil that this can cause to some patients and a softer edge you seem to be a little hard on someone whose trying to actually help.

    DR.'s would not get a bad rap if all of women didn't have these experience which should be a wake up call just saying. My prayer is FOR ALL WOMEN to get some MORE information so that Ceaseran(money grubbing) loving obgyn's.

    Thank you for all of your knowledge about this matter because like we agree Dr.'s are not talking ENOUGH about it. As times change so should our mindset and with HPV running more rampid than HIV and more of us younger women are having these proceedures done with no mention of our futures being possibly compromised or mentioned when we agree to the proceedure. Thank you once again and forever <3 <3 <3 :-)!!!!!

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  25. Thank you for this.. It really made me cry.. thinking of my C section 2 years ago. I had an the same thing happen to me, but not one nurse, midwife or doctor asked me if I had a procedure done on my cervix. I now know in my heart that I could have had a regular birth. My problem was a little different. I was 9 cm dilated and but half my cervix was effaced. I am wondering if this could be from the scar tissue I had from a cryo?

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  26. Thank you, so much. I'm working hard to have a natural labor and delivery after a VBAC, but we only just found out that I have scar tissue on my cervix. I've already been scheduled to be induced because I'm almost a week late.

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  27. Thank you for this post. Tears are streaming down my face, because finally I am beginning to believe there IS a chance, I could get pregnant and have a vaginal birth...someday.

    You are absolutely RIGHT NO ONE IS TALKING ABOUT THIS! I was diagnosed with precancerous glandular cells but that was ONLY confirmed after my Dr.s scared me into terminating the pregnancy due to the risk it posed to the 13week fetus.

    Now my cervix is SO scarred from biopsies, surgery, and the D&C there is about a toothpick sized opening through the scar tissue..making conceiving; seemingly inconceivable. And a vaginal birth not my reality.

    During each follow up biopsy every 4 months, the oncologist has had to break the scar tissue to take the samples high on the cervix into the uterus. Each time it's more painful than the one before...because scar tissue grows back stronger and thicker- when broken with an instrument.

    And, at the suggestion of was massaging the cervix a possibility to break up the scar tissue the oncologist (a woman, a mother- in San Diego-no less) laughed in my face.

    An acupuncturist friend suggested an acupuncturist/fertility specialist, herbs, and Castor oil (on cheesecloth over the uterus with a warm water bottle to draw the properties into the skin and ultimately help to disintegrate the scar tissue).

    Until now I haven't had the will to even try. I just gave up hope it was a devastating experience- that I still pay for in many ways in addition to the hospital bills. But, your article that I randomly searched for is helping me to find the strength to want to turn it all around.

    I am eternally grateful for when woman act in accordance of their true nature of loving kindness and compassion. Thank you for giving that gift!

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