Cervical Scar Tissue: A Huge Problem No One Is Talking About

# Understanding Cervical Scar Tissue: Implications for Birth

## The Impact of Cervical Scar Tissue on Labor

I originally wrote this post on 28th April, 2016, on my website in Houston, with updates in 2019, and now in 2025.

What is Cervical Scar Tissue?

Cervical scar tissue refers to scarring that can occur on the cervix, leading to difficulties with cervical dilation during labor. This condition creates a tight "rubber band" effect around the outer os, often accompanied by a ridge of scar tissue felt on the lower left part of the cervical os. In many cases, significant contractions are needed to stretch this tissue and facilitate cervical opening.

Several factors contribute to cervical scarring. Here are some common causes:

• An abnormal pap smear followed by a follow-up procedure (e.g., Colpo, Cryo, LEEP)

• Long-term hormonal birth control usage (over 12 months)

• Miscarriages needing D&C or D&E procedures

• Any form of termination, whether medical or instrumental

• A history of using an IUD/coil

• Previous surgical births, with or without labor

• Using Plan B, even just once

• Previous vaginal delivery resulting in cervical laceration

• A history of sexual abuse

  
  

How Does Labor Progress with Cervical Scarring?

Labor can progress differently for someone with cervical scarring. I can share an example that highlights this scenario. One night, I received a call from a concerned husband. His wife was a few days past her due date and had been experiencing very painful contractions for 3-4 hours, occurring every 3 minutes and lasting over 90 seconds. Upon arrival at their home, I found her having contractions similar to the transition phase of labor. She was using a birthing ball and moaning through contractions while her doula applied counterpressure to her back.

During my examination, I found she was only 1cm dilated. We discussed the risks and benefits of massaging the scar tissue to help break it up, and she agreed. Remarkably, her dilation soon increased to 4cm. Later, after making the decision to transport to the hospital, she received an epidural. Within four hours, she went from 4cm to 10cm and successfully delivered her baby vaginally. Her body had to exert a great deal of energy for the scar tissue to finally release.

Typical symptoms of "scar tissue" labor include:

• Prodromal labor, which resembles early labor without progress

• Transition-type contractions with minimal dilation

• High effacement with low dilation (e.g., 1cm dilated but with a thin cervix)

• Water breaking earlier in labor, often before contractions start

• An early urge to push

• Stalled dilation until the rigidity of the scar tissue breaks

  
  

It’s often observed that once scar tissue begins to release, labor can progress rapidly. For example, I had a client who remained at 4cm dilated for about 19 hours. After receiving IV pain medication, she relaxed just enough that she went from 4cm to holding her baby in just 20 minutes. Once the cervix loosens, labor can advance quickly.

What Can You Do About Cervical Scarring?

If you suspect cervical scarring may be an issue for you, consider these steps:

1. Assess Your History

   Evaluate whether you meet the criteria for cervical scarring. Have you experienced a surgical birth due to "failure to progress"? Did you have a prolonged and difficult vaginal birth with a stall followed by rapid dilation?

   
   

2. Find the Right Provider

   Seek out a healthcare provider experienced in cervical scarring. Many providers may overlook this issue, especially if they attribute scarring solely to LEEP procedures. Without a prior LEEP history, cervical scarring is often disregarded. This oversight can prevent you from receiving the proper diagnosis and care, potentially affecting your birth experience.

   
   

3. Explore Softeners for the Cervix

   Consider options known to soften the cervix, such as prostaglandin family substances: semen, evening primrose oil, and borage oil. Applying these substances to the cervix near term may help soften the scar tissue ahead of labor. (Update: I no longer recommend evening primrose oil due to recent research connecting it with premature rupture of membranes.)

   
   

4. Use Castor Oil Tampons

   Incorporating castor oil tampons into my practice has yielded remarkable results for clients. My apprentice at the time, Rowan TwoSisters, took a course on scar tissue remediation and suggested this method. The outcomes have been impressive.

   
   

During my years in home birth practice in Houston, I would address potential scarring at the initial prenatal consultation. If clients agreed, I performed a cervical exam around 38-39 weeks to check for scarring. Should I detect scar tissue on the outer os, we would explore various options to help encourage relaxation and softening of the cervix.

Is this Relevant to You?

Do you feel you have experienced or are at risk for cervical scarring? Are you concerned about potential complications with dilation during labor? It's important to have these discussions, as they can significantly affect your labor experience.

Let’s get the conversation started!

Addendum: Please note that I do not provide specific advice through email or blog posts. If you're interested in a virtual consultation to discuss holistic approaches and risk factors, feel free to email me to arrange a session or you can book a one-hour consultation here. Additionally, explore this excellent DIY course by Rowan TwoSisters, LM CPM, which provides skills for self-managing your scar healing, or purchase her book here.

-Shannon Stellhorn - Sacred Keeper of Birth