Surprisingly small. Most baby 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 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 and only used in extreme emergencies when they 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.
Since they're usually made below the pubic hairline, you might not see your 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 but 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.
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) in the early days.
At this point, your scar will likely be puffy, and the area around it will be pink. But if you notice bleeding or oozing from your incision site, reddened edges, or have a fever higher than 100.4°, call your doctor right away, as these could be signs of infection.
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 scar. Go for it – but manage your expectations. "There have not been any good scientific studies demonstrating that any of the 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.
Eat well so your body has the right nutrients for healing and creating healthy tissues. Keep it clean during the initial 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.
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.
In less common cases, your scar may have a raised characteristic, known as a keloid. Doctors aren't sure what causes keloids "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.
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 that scar tears, (called uterine rupture), it causes massive bleeding (hemorrhage) and is a life threatening emergency for both mother and baby.
Even though uterine rupture is so rare, however, 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. ACOG says about 60-80% of women who attempt labor after a C-section successfully deliver their babies vaginally. Currently, only about 8% of births are by VBAC. Scars are usually pretty strong but apparently, insurance companies and liability risks are stronger.
Usually none, once it has healed properly. In some cases though, it 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. That's when the placenta grows 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. This increases risks for premature delivery and bleeding during pregnancy, labor, and birth. It 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.
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 here in the U.S., and that means there are a whole lot of scars out there. You're in good company.