Sunday, December 30, 2012

Cervical Scar Tissue – A Cause of Preventable Cesareans

Dawn Thompson is a doula and the founder of  She has spent the past eight years on a mission to understand how scar tissue on the cervix affects women in labor, and to let the public know about it.  In her article below, she identifies a variety of gynecological procedures that can potentially cause Cervical Scar Tissue, such as treatments for abnormal Pap smears.  (I also discuss the topic on pages 132-133 of my book, which includes a list of additional medical procedures that may be the cause of CST.)  Other resources on CST include: 
  • an excellent article by O'Nell Starkey, doula and founder of The Beautiful Cervix Project
  • photographs of the cervix from The Singapore Family Physician (images are graphic but informative -- see Figures 24a and 24b for scarring of the cervix); and
  • an article by Dr. Fred Licciardi of New York University, with drawings that demonstrate how gynecological procedures may cause scarring 
Below, Dawn Thompson describes her investigation of the topic of CST, and the ways she has helped mothers with this condition avoid complications in labor.

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 Scar Tissue.” How is it that I had been a doula for four years and had never heard of this before? Those words changed my life.

I sat down 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. People are now indeed “talking” about it. Some women have even found the blog during early labor, looking for a reason why their labor wasn’t progressing after days and days of surges.

Since that time I have dedicated most of my doula career to learning more about cervical scar tissue (CST) and, specifically, helping families who experienced a c-section with their first birth. I started working closely with a local ob-gyn who was very aware of cervical scar tissue. We referred all of our VBAC (vaginal birth after c-section) clients to each other. 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, 3 had c-sections because of a breech presentation, while the other 18 were given the diagnosis “failure to progress” during their first birth. Seventeen of the 21 had a long, prodromal labor pattern. They also “seemed” to be having transition-like labor, but were only 4 to 6 centimeters dilated when they arrived at the hospital. In all 17 women, the doctor observed obvious scar tissue during their subsequent births. After the doctor treated the scar tissue in labor, the majority of these women went on to deliver between a few minutes and two hours later. In all cases, the labor progressed quickly.

Most interestingly, not all of these women had had the typical cervical procedures associated with scar tissue like LEEP, cone biopsy, or cryosurgery. The scar tissue also presented differently in some of these women. Some women had tight rubber band-type scarring on the interior of the cervix. Others 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 ob-gyns, 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 the placement of an IUD. 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 scar much anyway. Some people naturally produce more keloids. Keloids are the excess growth of scar tissue at the site of a healed injury. This might explain why some people would be affected and others would not.

Signs of CST:

•           Prodromal labor
•           Dilation stall
•           High effacement/low dilation
•           Mom describes surges, but experiences no dilation
•           Mom appears to be in transition, but dilation reflects early labor
•           Overwhelming urge to push, but low dilation

Since this small group four years ago, I have gone on to help many more women and witness their joy and relief when their scar tissue was recognized and resolved. Thankfully, though, many of them were first-time moms who might have otherwise been recovering from a preventable c-section.

Publisher's note:  During labor, treatment of CST consists of a pelvic examination by a doctor or midwife who is willing to massage, stretch, or press on the scar tissue for several minutes until the fibers soften and break down.  Women seeking this treatment should inquire with their healthcare provider about whether they are able to perform the procedure.


  1. I'm a nurse midwife & I had this. I had a LEEP & my cervix was "scarred shut" at term when my water broke. After 14 hours, I was still not in labor. I needed a balloon in my cervix with a lot of pitocin, and of course- an epidural. I did have a vaginal delivery & for that I'm thanksful. Hopeing to go natural next time, usually once the scar is broken up the next time is easier. Thanks for bringing this topic to peoples attention.

  2. So glad there's another article with more information about cervical scar tissue! It's something I bring up with all my doula clients. In your study, did you find that women all stalled before 6 cm? Or is there ever instances (in your findings) where women can get to 7-9 with that "rubber band type scarring" that leads to c-section?
    I would love to see a follow up post that talks about how to recognize this early in labor, as well as things a mom can do to reduce the amount of laboring time, if you know of any.
    Thanks for your work!

  3. I had two cryosurgeries prior to my first birth, 15 years ago. For that birth, I had nearly 72 hours of prodromal labor, bit when "real" labor kicked in, it was very fast, less than 4 hours. My next three births exhibited a similar pattern- 24+ hours of prodromal labor followed by a <5 hr birth. My last/5th birth, I was FTP for nearly 7 hours at 7 cm. Thankfully, I was with an abundantly patient OB who never pressured me for any intervention. All 5 births were all natural, unmedicated, and vaginal. I had thought that this was just my birthing "style" but as I read more about cervical scarring, I'm thinking that scarring from the cryosurgeries must be to blame. Knowing now that many women with similar histories have worse symptoms than me - such as filing to dilate at all- makes me grateful that my own births haven't been more complicated.

    I'm on my 6th pregnancy now and planning a home birth. I have discussed my previous births and cryosurgeries with my midwife but now, at our next appointment I will bring it up again, after reading this.

    Thank you!

  4. with my first birth which ended in a c-section, I had nothing previously done with my cervix except your typical pap smear and i stalled at 8 cm...I'm pregnant again and worried now because i had a miscarriage last year that ended up with my having 2 d&c's. Is this procedure something a midwife would do or is it something i need to see a specialist for in order to determine if I even have any scar tissue on my cervix? also, i saw a fertility specialist for about 6 months because i had uterine scaring that was removed, is cervical scaring something he would have noticed and talked to me about? wondering if i need to contact him and see if there is anything he could tell me about this...thanks for this post! i had no idea about this whatsoever

    1. Prenatally, a midwife or a regular OB may be able to see scarring on the cervix during a pelvic exam with a speculum. Or, they may be able to feel it during a pelvic exam without a speculum. During labor, most practitioners should be able to masssage, stretch, or press on cervical scar tissue to break it up, but they may have never had a patient request this. You can go ahead and ask! You may also want to contact your fertility specialist with your questions, as those specialists may be more likely to know about cervical scarring.

    2. In my first pregnancy this happen to me. I stop dilating at 3cm for 8hr to 10hrs in labor. my doc was able to break the scar tissue band and then i dilating quickly after that. my question is after the scar tissue band has been broken will it come back again with the 2nd pregnancy?

  5. Hi. As a new birth doula, this information is very helpful! I do have one question though. What does prodromal mean? Thanks for sharing this. My second birth client was told twice she was "failure to progress". The third time she had me as a doula and did fine, but I am wondering about her first two births now.

  6. Prodomal labor refers to a long phase of early labor contractions, which could last for several days, before the cervix begins to dilate. "Failure to progress" is a (debated) diagnosis that is usually declared AFTER the cervix begins to dilate.

    Best wishes in your journey as a doula!

  7. I too have a LEEP for C1N3 between baby3 and baby4. I was assured that it would have no effect on labour but as I went into labour at 43+3 I failed to dilate for 8 hours but had strong conx. and urges to push. Births before had been 8hrs, 1.5 hrs and 1 hr so this was out of place. Eventually transferred in (was having third HB) to find CST was prevent dialtion further than 1 cm. Just as we were discussing CS, scar ruptured and baby4 was born in 2 mins. Hideous experience, undermined my faith in myself and I am still angry as I not only ask about risks before LEEP, I asked for a check in pregnancy and not one MW knew about the massage of scar. So glad this is being discussed more...

  8. The third paragraph describes my labor to a tee. Thankfully, I now know to talk to my midwife about the potential for CST.

  9. yes I agree with all the above.
    However is they a cream that can be internaly used or any form of healing for a woman with CST.

    I have it following letts treatment and Sex is effected this was never ever told to me before this treatment for Cin 3 was carried out .

    I am not to inpressed about it at all.!!!!!

    1. If you are pregnant, you can read the information above about ways that a doctor or midwife can massage the scars during labor to help them go away.

      If you are not currently pregnant, here are some links to information about possible treatments:

      Please be sure to ask your doctor or midwife to help you find treatments for this. If they cannot help, ask to see another doctor who is more informed about this issue. You are not alone.

      Best wishes to you.