C-Section Scar Care: Your Guide to Helping It Heal
Most women come through pregnancy with a few souvenirs like stretch marks, saggy skin, and poochy tummies. If you delivered via C-section like one-third of moms, you likely have another addition to the collection: a C-section scar. Here are some FAQs about the most common surgical incision around.
Why do you scar after a C-section?
Cesarean sections (C-sections) are a procedure used to deliver a baby through a mother's abdomen. Closing a C-section incision involves reuniting multiple layers of muscle and fascia (a web-like layer of connective tissue that surrounds all of the body's organs) with sutures, then reapproximating, or matching up, the skin as exactly as possible before closing with more sutures, or staples. Appearance-wise, the goal is to avoid unnecessary dimpling and puckering.
How big is a C-section scar?
C-section scars are surprisingly small. Most baby’s heads fit through a four- to six-inch skin incision made horizontally just below the pubic hairline. The abdominal muscles are moved aside (not cut through) and a horizontal incision is also made in the uterus.
In rare cases, doctors make a vertical incision from below mom's belly button to the pubic bone. That's pretty unusual in the U.S. and most developed countries. In fact, vertical incisions are only used in extreme emergencies when doctors don't have time to do the more intricate and less visible "bikini" incision. If they do a vertical skin incision, they're likely to do a vertical uterine incision, too.
What do C-section scars look like after they heal?
Since they're usually made below the pubic hairline, you might not see your C-section scar at all. It'll look red or pink for several months but eventually it fades to a pale, flat, thin line. Some women create bigger, thicker, or raised scars than others—however, they are rarely very obvious. As a matter of fact, many of the bikini-clad women you see at the beach or pool have C-section scars and you never notice them.
"We generally make the incision as low as possible and into the pubic hairline so that it is not visible when wearing bikinis or low-riding clothes," says Leena Nathan, MD, an Ob-Gyn at UCLA Health in Westlake Village, California.
What’s involved in post-op C-section scar care?
Before you're discharged from the hospital (typically around four days, depending on your insurance coverage and the specifics of your delivery), your doctor will remove the staples from your incision; if you had sutures, they'll dissolve on their own. Your C-section scar will be covered with a paper tape-like product known as Steri-Strips. These will fall off on their own in about a week; don't mess with them before that. They're keeping your wound closed and clean.
While your scar is fresh—usually for the first two weeks—you'll be instructed not to lift anything heavier than your baby so as not to disturb the healing process. During this time, you can shower freely using a mild soap without scrubbing the area. It's fine to get the incision (and the Steri-Strips) wet, but you should avoid submerging your scar in a bathtub or swimming pool during the early days. At this point, your scar will likely be puffy, and the area around it will be pink.
What are the C-section scar side effects?
In the first few weeks after the procedure, you may experience C-section scar pain, bleeding, numbness, and cramping. You might also have C-section scar itching, but resist the urge to scratch the healing wound. If you notice heavy bleeding or oozing from your incision site, reddened edges, increasing C-section scar pain, or have a fever higher than 100.4°, call your doctor right away, as these could be signs of infection.
Can you do anything to encourage C-section scar healing?
Eat well so your body has the right nutrients for healing and creating healthy tissues. Keep it clean during the initial C-section scar healing period to prevent infection. Avoid heavy lifting, housework, or any big movements that might stretch or irritate the scar for the first six weeks.
When will my C-section scar fully heal?
After about six weeks, your C-section scar will be healed—meaning you'll likely be able to resume all regular activity without disturbing it. Giving yourself at least six weeks of healing time “allows the incision lines to mature, so that when strenuous activities are performed, the integrity is not compromised," says Dr. Gala.
And although the integrity of the scar may be intact, you may still note that it has turned a reddish-purpleish color. Don't worry, that's completely normal. The color will persist for about six months before fading to a less noticeable whitish line, says Dr. Tassone.
- RELATED: How Many C-Sections Can You Have?
What’s a keloid C-section scar?
In less common cases, your scar may have a raised characteristic, known as a keloid. Doctors aren't sure what causes keloid C-section scars, "but there is obviously a hyper reaction to the healing process that causes the scar to grow outside its original boundaries," says Dr. Tassone. Some physicians attempt to counter the effect by injecting cesarean wounds with a steroid called Kenalog at the time of surgery, but the results are mixed—as are treatments such as lasers and injections of interferon.
Do I need C-section scar creams?
You may be eager to try vitamin E or over-the-counter creams like cocoa butter in an effort to reduce the appearance of your C-section scar. Go for it, but manage your expectations. "There have not been any good scientific studies demonstrating that any over-the-counter preparations are better than just proper wound care," says Rajiv B. Gala, M.D., the American College of Obstetricians and Gynecologists' young physician at large. "Most of the expectations presented in online advertisements are best-case scenarios and may not be realistic in typical cases."
You should also be mindful to avoid certain cosmetic creams if you're nursing. "There are things that will work on scars and stretch marks, like Retin-A, but these need to be administered after pregnancy and breastfeeding," says Shawn Tassone, M.D., an Austin, Texas-based Ob-Gyn and author of the books Hands Off My Belly! and Spiritual Pregnancy.
Does a C-section scar prevent you from having a subsequent vaginal birth?
In more than 99% of cases, C-section scars heal well and create strong tissues that knit the uterine tissue back together. It's almost always strong enough to withstand the stretching of another pregnancy and pressure of contractions. In very rare cases, however, the scar can tear. This is more common (but still rare) with vertical incisions than horizontal ones, which is one of the reasons vertical incisions aren't done very often. If the C-section scar tears, called uterine rupture, it causes massive bleeding (hemorrhage) and is a life-threatening emergency for both the mother and baby.
Even though uterine rupture is rare, many doctors and hospitals won’t do vaginal births after cesarean (VBAC). That’s because they can't afford to take the risk. Insurance providers won't cover them—or make it crazy-expensive—if they do VBACs. The American College of Obstetricians and Gynecologists (ACOG) says about 60-80% of women who attempt labor after a C-section successfully deliver their babies vaginally.
What are other C-section scar treatment complications?
Usually none, once it has healed properly. In some cases though, your C-section scar changes the way the placenta grows in the next pregnancy. The more C-sections she has, the greater a woman's risk.
Women who have a scar on their uterus are more likely to develop placenta previa, characterized by the placenta growing over the opening to her cervix. There's no way to safely deliver a baby vaginally if there's a placenta in the way. Placenta previa is associated with increased risk for serious bleeding, shock, blood transfusions, and hysterectomies.
Placenta accreta is also more common in a scarred uterus. That's when the placenta grows through the scar tissue and/or attaches to the uterine muscle, which increases risks for premature delivery and bleeding during pregnancy, labor, and birth. Placenta accreta also makes it difficult for the placenta to separate from the uterine wall after birth and can cause hemorrhage. In rare cases, when doctors have a really tough time separating the placenta from the uterine wall, they just have to take out the uterus.
Should I give myself a C-section scar massage?
Massages can reduce C-section scar tissue formation and can help ensure a smooth, flat, pain-free, and supple scar, says Leslie Lo, DPT, a women's health physical therapist at Northwestern Memorial Physicians Group in Chicago. Beginning four to six weeks post-surgery (get your doctor's clearance first), massage the scar, working it with a rubbing motion—first side to side, then up and down; then diagonal. "You can also lift and roll the scar between your thumb and forefinger," Lo says. Doing this two to three times a day for five to 10 minutes at a time can keep the scar pliable, soft, and cosmetically appealing.
Appearance concerns aside, Lo says a C-section scar massage can help prevent chronic pelvic pain. "If the scar is thick and deep, it can limit the mobility of muscles and connective tissue, contributing to pain and immobility," Lo says.
How can you reduce the appearance of a C-section scar?
If the appearance of your C-section scar is upsetting you, there are possible ways to change its look—and not all require surgery. A scar revision, which takes place under local anesthetic or sedation, involves opening the scar (but not the underlying muscle) and re-closing it. Recovery time is about three to four weeks, says David Cangello, M.D., who's in private practice in New York City and an attending plastic surgeon at Lenox Hill Hospital and NewYork-Presbyterian Hospital.
For a less invasive option, you can apply a silicone sheet to the scar, starting two weeks post C-section. It may prevent long term redness or bumpiness by hydrating the scar, Dr. Cangello says, "but you need to wear it 24/7."
Should I consider C-section scar removal?
While a C-section scar's appearance should act as a reminder of your female strength, some moms prefer they disappear. Maybe that's why more women are hiring plastic surgeons to join them in the surgical suite for their planned section. Dr. Cangello, for example, says he has attended hundreds of C-sections for just this purpose.
He performs the initial incision, then the OB delivers the baby and closes up the uterus and deepest layers of muscle. Dr. Cangello then returns to bring the fascia, fat, and skin back together in as picture-perfect a manner as possible. Subtle differences in technique, such as inserting the scalpel perpendicular to the skin and using sutures made of materials known to minimize inflammation, can make all the difference to an image-conscious mother. Plastic surgeons, he adds, may be more skillful at closing the incision in a way that minimizes the chances of invagination, medical speak for the common phenomenon of a C-section scar looking as if it's tethered to the muscle beneath it.
"I'm not at all saying that OBs don't know how to close [a wound] properly," Dr. Cangello emphasizes. "But an OB's concern is delivering a healthy baby—that's their expertise. In this case, our expertise is making things look beautiful." Insurance does not cover a plastic surgeon's involvement; Dr. Cangello charges $3,000 and says that fee is on par with other surgeons'.
Keep in mind, however, that not all moms are concerned about the look of their C-section scar—some choose to appreciate what it symbolizes, instead. A website called The Shape of a Mother is devoted to normalizing the various physical changes that can happen postpartum. On the site, you can view photos of how pregnancy impacted the bodies of real moms. It not only has C-section scar pictures, but also depictions of stretch marks, bellies of moms of multiples, and more.
Will my doctor use the same scar for my next C-section?
Yes, almost every time. If you're among the growing percentage of women who will have (or have had) a C-section, the odds are in your favor you'll be just fine. Yes, C-sections increase your risks for complications but they're still a very safe operation most of the time. They're the most frequently performed surgery in the U.S., and that means there are a whole lot of scars out there. You're in good company.
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