What impact will a cervical tear have on future births? It was an inch long tear and was surgically repaired. I'm wondering if I'll still be able to birth out of hospital/in the water/with my midwife? I might be done having kids if I'm too high risk.
There are a lot of people with cervical scars, and vey little discussion about it, so I don't have hard and fast answers for you. However I can talk from my experience and the very few studies that I found that actually respond to this question.
First, when might a cervical tear happen?
With a very fast birth in which the cervix isn't able to dilate as quickly as the contractions are pressing the fetus down.
During operative deliveries such as vacuum or forceps assisted vaginal deliveries
If the cervix swells from pushing before it is fully dilated, the stiffened tissue can tear
If a cervical cerclage has been used to keep the cervix closed during the pregnancy (stitches used to hold the cervix closed)
The cervix is repaired with stitches, often under general anesthesia or an epidural block. If it isn't repaired, patients can lose significant amounts of blood. Occasionally a laceration might happen without bleeding and without anyone identifying the laceration. In that case it can heal on its own, though the healing is slow. Click here for a NSFW photo of a healing/healed cervix with a laceration and read the story. The repair or self-healing leaves the cervix with scar tissue that may or may not affect future births.
Who else has scar tissue on their cervix?
People who've had a colposcopy with biopsy, removing a small piece of tissue from their cervix to assess for pre-cancerous cells.
People who've had cryotherapy or a LEEP procedure to remove cancerous or pre-cancerous cells and tissue from their cervix.
Very rare instances in which the tools used for an abortion scuff the inside canal of the cervix, causing some small abrasions.
Am I likely to have a second cervical laceration after I had one with my first birth?
I can't say for sure, but I think not. It looks like all the research that has been done so far has shown that you're not likely to have a repeat laceration. Tearing once does not increase the likelihood of tearing again in that spot or others. It's most likely that the mode of birth will indicate whether or not you tear.
People with scar tissue can have two opposite problems during pregnancy. If a big chunk of the cervix was removed during something like a LEEP procedure, the cervix is less strong. The weight of the baby and the amniotic fluid and the placenta and the huge uterus pressing down on the cervix can cause it to open prematurely, risking the integrity of the pregnancy. In this case people might need a cervical cerclage (stitches to hold the cervix closed during pregnancy) which we already learned increases the risk for a laceration.
The other consideration is that once labor occurs, the scar tissue might stop the cervix from dilating appropriately. In this situation, people might be able to dilate to a certain degree and then stop. They might be told that they need a cesarean section for failure to progress. Some midwives say that they are now routinely assessing patients for cervical scar tissue so that in the case that this situation occurs, they're able to figure out where the scarring is and massage it during labor until the scar tissue breaks up and allows the cervix to continue dilating. I haven't seen this, and I could only imagine that is is very uncomfortable, but I keep it in the back of my mind in case I experience this situation.
So no, I don't think that the history of a cervical laceration makes your pregnancy high risk. You'll have to talk to your midwives to see if they're comfortable having you deliver at home, but I don't see it being a major issue.
THIS IS NOT A REASON TO AVOID LEEP PROCEDURES OR COLPOSCOPIES. Avoid cervical cancer first and foremost - worry about your labor and birth later. You can't be a good parent to your baby if you're dead.
