One of the biggest issues facing pregnant women today is how to avoid a c-section.

In most countries, surgical birth rates are double the World Health Organization’s recommendation of 10-15%.

We know c-sections are occurring unnecessarily, and in many cases this can be attributed to increasing rates of interventions and inductions.

But there is another reason why c-sections happen, and it’s one that many women are not informed about or, in fact, even aware of.

Cervical scar tissue can affect the cervix’s ability to dilate. A long labour with little or no dilation is chalked up as ‘failure to progress’, in which case a c-section is scheduled.

What Is Cervical Scar Tissue?

A scar is the body’s natural response to injury. At the site of a wound, tougher, fibrous tissue regrows to repair softer tissue. Some people make more scar tissue than others and it’s impossible to predict exactly how much scar tissue will form.

Women who have had procedures or conditions that have caused scar tissue to grow might not be aware of this fact.

What Causes Cervical Scar Tissue?

There is a number of reasons why you might have scar tissue on your cervix. Some of the causes are:

Cryosurgery: freezing of cervical tissue to treat cervicitis (inflammation of the cervix) or cervical dysplasia (precancerous growth of abnormal cells on the cervix).
LEEP and LLETZ procedures: removal of abnormal cells from the cervix, using a low voltage electrified wire loop.
Cone and punch biopsies: removal of abnormal tissue (the name refers to the shape and method of removal).
Dilation and Curettage (D&C): dilation of the cervix, and scraping and suctioning of the contents of the uterus, following a miscarriage, or as a pregnancy termination.
Cervical tearing during birth: as a result of manual dilation, pushing before dilation, or large fetal head/shoulders.
Cerclage: a stitch placed in the cervix, to prevent premature dilation
Pelvic Inflammatory Disease: an infection that spreads from the vagina to the cervix, Fallopian tubes and endometrium (lining of the uterus).
Certain sexually transmitted infections, viruses or bacterial infections of the cervix.
Endometriosis: occurs when the lining cells of the uterus grow outside of it.
Asherman’s syndrome: a condition causing the formation of scar tissue inside the uterus and/or the cervix.

How Can Cervical Scar Tissue Affect My Labour?

During the first stage of labour, the cervix needs to soften, thin and dilate. Depending on the level of scar tissue present, the cervix might be able to soften and thin, but it either won’t dilate, or open only slightly.

Women who have cervical scar tissue might:

Have a very long prelabour
Experience their waters breaking after a long prelabour
Be stalled at a certain dilation
Experience contractions with little to no dilation
Have a cervix that is very thin but not dilated
Appear to be in transition but have little to no dilation
Feel an overwhelming urge to push with very little dilation

A woman in this situation often becomes extremely fatigued and discouraged. She might try many different positions, take a bath or shower, walk or lie down – yet nothing changes.

At some stage, her ability to cope with exhaustion and the pain of contractions will reach a limit. She might try pain relief, or her care provider will decide augmentation is needed (artificially stimulating contractions with medical or mechanical methods). However the cervix can’t open, and these methods will generally lead to more pain and tiredness, with the likelihood of distress to the baby. A c-section is inevitable.

How Do I Know I Have Scar Tissue?

If you have had a cervical procedure and you are planning pregnancy, or are already pregnant, you might want to find out whether you have scar tissue on your cervix.

The best way to do this is to get to know your cervix. During different stages of your cycle, your cervix changes – feeling soft and low near the time of ovulation, and harder and higher at other times during your cycle. A scar will feel thicker and lumpier than the other tissue of the cervix.

If you choose to check for scarring yourself, make sure you wash your hands thoroughly. It’s often easier to stand with one leg raised, then insert a clean finger into your vagina toward your tailbone, until you feel your cervix. It usually feels like the tip of your nose and, depending on your cycle, might have a small dip in the middle or feel like a hard bump.

If you are not sure how to check your own cervix, your general practitioner, midwife or gynaecologist will be able to determine whether you have scarring.

What Should I Do If I Have Scarring?

If you have cervical scar tissue and you’re pregnant, you might be concerned about how the scarring will affect your labour. Discuss this with your care providers ahead of time so they can look for the signs during labour, to avoid interventions.

Some care providers recommend the use of evening primrose oil, taken orally during pregnancy, and used internally after 36 weeks. Evening primrose oil is thought to soften scar tissue, which would help the cervix dilate more effectively during labour. There are no studies showing if this actually helps or is safe, but it is something you can discuss with your midwife or doctor.

If you have excessive scar tissue, during labour your midwife or doctor can check your cervix and massage it. This will help the scar tissue to release, allowing the cervix to dilate. Often dilation will begin to happen quite rapidly when the cervix is massaged. Having the scar tissue massaged can cause some discomfort but in most cases is successful.

If you have mild scar tissue present, time and patience might be all that are needed for the tissue to release on its own. Be informed and prepared to wait for this to happen, and for labour to last a little longer. If you have an active birth and are well supported to rest and move as you wish, you might be able to avoid interventions that can lead to a c-section.

Not all women who have cervical procedures end up with scar tissue. The extent of the scarring depends very much on the body’s response to injury. If you have already experienced a stalled labour or failure to progress, and have had a previous cervical procedure, it’s a good idea to become as informed as possible, for future pregnancies, so as to avoid further unnecessary interventions.

Recommended Reading: 8 Natural & Effective Tips For a Slow Or Stalled Labour.