Labor and delivery

After surgeries for cervical cancer, it is natural to be concerned about pregnancy and labor and delivery. For women who have an incompetent cervix, if a cerclage was sewn into the cervix, the baby's birth requires removing the stitch first. That's usually done a few weeks before the due date, around 37 weeks. Interestingly, removal doesn't lead to immediate delivery for most women. It seems strange that removing a stitch that was necessary to keep the baby in doesn't suddenly lead to a baby falling out!

For women who have a transabdominal cerclage or a trachelectomy, vaginal delivery is not an option. The transabdominal cerclage is permanent, and these women have to have c-sections.

There are various studies that disagree on whether women who have had LEEPs or cone biopsies deliver early. Of course, there is always a chance, but there appears to be just as good a chance of going to full term.

Can babies catch HPV during delivery?

I asked my doctor if having a baby vaginally would transmit HPV to the baby. Essentially, the answer is no. Now, if you have the kind of HPV that causes warts, your baby might get that, but babies can get over it, usually without treatment.

Cervical stenosis

Women who made it through without any problems may still have some challenges at delivery.  Cervical stenosis caused by scar tissue may prevent dilation from progressing normally. Often, these women don't dilate at all until labor has started, and then they don't dilate much. Dilation may stall even as contractions increase in strength and frequency. The pain gets worse, but it appears from internal exam as if you're not progressing. 

The cervical scar tissue can usually be loosened up to allow progression to a vaginal delivery. The doctor reaches in and springs the cervix open with two fingers or an instrument. This can be pretty painful, but it is fast. It can be quite dramatic, with dilation going from 1 cm to complete in seconds. 

After birth, recovery is no different than it is for other women. Now that the scar tissue has been stretched, it may dilate normally in future pregnancies. 

In general, unless you have a transabdominal cerclage or trachelectomy, you should be able to attempt a vaginal delivery. Even scar tissue is something that can be easily dealt with, and once it is, delivery may come quite rapidly. 

You may consider having a doula or other trained birth assistant with you. They can help you get through the pain if you don't want pain medication, and they can help you prepare mentally for your delivery because you don't know exactly what will happen. You may have a perfectly normal, uneventful delivery, or you may have a stalled labor. 

No matter what, in the end, you have a baby!