Every injury leaves a scar. Some fade to invisibility, while others are there for life. Whether accidental or intentional, every deep cut has the potential to heal with adhesions. The role of adhesions in a person’s daily life does not get enough attention. The role adhesions may play in a pregnancy and birth gets even less. There is a dearth of research on the topic. This literature review gives a rundown of what is known and unknown on the topic, and yet the effect of scar tissue on labor and birth is conspicuously absent. While it includes a hypothetical mechanism for adhesion formation, admitting that second and later cesareans often take longer due to scar tissue from previous surgeries, this particular review does not address scar tissue in labor, nor do any of the studies it references. Scar tissue from surgeries is an acknowledged downside, so its absence from labor progress factors seems very out of place.
Dr Neel Shah is among few willing to discuss the adverse effects of c-sections. He took some heat for describing a woman’s tissues at repeat c-section as a melted box of crayons. While it’s laudable that he is taking the issue on, even he did not address what that melted box of crayons might look like in labor. Would it shift the uterus in such a way that the baby takes longer to engage? Would it slow dilation in other ways? Would it have no effect at all? The silence is deafening.
There is a range of how much adhesions impact the individual. Take Dawn Thompson, for instance. Before she was the founder of Improving Birth, she was a mom navigating her birth options. Her VBA2C attempt ended in a third cesarean, complicated by scar tissue from her surgeries. While she went on to have a VBA3C, there is no denying the effect of scar tissue in her case.
Anecdotally, Dawn Thompson is hardly alone. Many a birth has been slowed or stopped by a uterus pulled out of alignment, by pain that may have signaled a uterine rupture but was limited to dense adhesions with an intact uterine scar, or by the pain of adhesions amplifying any labor pain.
Are you doomed if you’ve had abdominal surgery, including cesareans? Of course not. The overall VBAC success rate in the US is over 70%, and is even higher among community births. However, don’t be discouraged by a longer labor than you expected. Even “labor on the installment plan” in the form of prodromal labor is a common response in a VBAC or post-surgery labor.
What else can you do? Pamela Vireday of ICAN lays it out well.
Nutrition and exercise can have so much positive influence on overall health, and on scar formation to begin with. Good nutrition and exercise promoting mobility will help any scar tissue remain flexible.
Before pregnancy, Mayan abdominal massage may help.
Before and during pregnancy, physical therapy with a practitioner well versed in women’s health can be an empowering experience and a proactive step toward a healthy pregnancy and birth.
And last but certainly not least, having a birth attendant who is willing to walk with you through whatever your labor brings, in a location where you feel most supported, will help you have the confidence in your body, and that you are doing all you can to prepare for a healthy birth. Knowledge is power.
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