One of the first articles I ever bookmarked was this one. Reading this story made me wish there was a way I could share this information with everyone I meet! If it never came up in conversation before then let me share it with you now. As before, my comments are in maroon, I have also highlighted some of Dawn's words. The original article can be found HERE
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.
I would like to point out here that procedures done to your cervix would include a D&C which is not only performed in abortions but also sometimes for miscarriages (and other things). 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 mentionead 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).
My midwives had me use evening primrose oil vaginally after 36 or 38 weeks (the details are fuzzy) to help ripen and prepare my cervix even though I did not have scar tissue. However, I would definitely make sure to talk to your midwife about this before hand. 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. If you believe this could be an issue for you, ask your care provider if they are willing to break up scar tissue during labor. If they blow you off or tell you that they don't do that, find a new provider. It does not matter how far you are into your pregnancy, you can change. I have had clients change at 40 weeks.
We all need to start talking about it because unless women are being asked the question, they just don’t know.
by: Dawn Thompson
Doula Dawn Thompson has been a Labor and Postpartum Doula since 2003. She is considered these days as the VBAC queen. It has become her passion to assist families through the VBAC journey and educate first time moms on how to avoid the many pitfalls of our modern day medicalized birth. You can get more information about her at www.douladawn.com.
Doctors should know about this. Midwives should know about this. Women should know about this. And not just during labor, women need to be informed about this whenever a procedure that can leave cervical scar tissue is discussed. I have a friend who was offered an optional D&C to help with her miscarriage- the main reason she decided to avoid it if possible was because she knew about the risk of scar tissue to her cervix.
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