C-section scar: everything you need to know

Once the caesarean section and incision have taken place, the layers of the wound are brought together edge to edge. This is done using sutures at the level of the uterus, then at the level of the skin — using thread, staples, or surgical glue. The uterine incision is internal and cannot be seen. 

These layers must heal on their own. The edges of the uterus must close by themselves — peritoneum to peritoneum, muscle to muscle, and skin to skin. By day 7, the scar will be covered by cells so that it eventually becomes invisible. A protective crust will form in the process. This is the inflammatory phase. You may notice redness, swelling, and mild discomfort. 

Consolidation refers to the stage where the edges of the scar are closed (touching and bonded together). This is the repair phase, during which the wound gradually closes. A red and sometimes raised scar will also appear. It consolidates over the course of about a month.   

Maturation is the stage at which the tissues function optimally together. The scar becomes finer and lighter. Redness gradually fades, as do any feelings of tightness around the area. This process takes between one year and one and a half years. The healing time varies from woman to woman.

Caesarean scar care in the maternity unit

In the first days after the birth, a nurse applies a dressing and monitors the wound. Stitches or staples are generally removed between 5 and 10 days after the procedure.

Being mindful of your movements

After the birth, it is important to move around generally whilst minimising strain on the scar area. The more you move, the less the tissues will be able to stick together. Staying still can also cause pain. 

When you go to the toilet, choose a position that makes elimination easier and requires as little effort as possible. Raise your feet with a small footstool, for example. This will also help prevent and relieve the discomfort of any haemorrhoids. When you feel the urge to go to the toilet, go straight away and wait for your body to begin making natural bowel movements before bearing down. 

You should also be careful when getting up not to pull on the scar. 

To do this, while lying down, bring your legs in one at a time, bending them towards you. 

Roll onto your side keeping your legs bent. 

Finally, use your upper arm for support to sit on the edge of the bed, then stand up. 

A few tips

Ask for help! Don't hesitate to ask for help, whether it is for looking after the baby or getting around. This avoids putting too much pressure on your body and causing pain. It could affect the stitches or staples. 

Try to walk.

Take pain relief for at least 5 days, or as recommended by your doctor. The more pain you are in, the more you will hunch forwards. This compresses the scar and causes the organs to adhere to one another. If you are in pain, you will not be able to stay upright.

In bed, to avoid bending your back, adjust the bed to the height of the cot so that movements are easier. 

For clothing, opt for high-waisted knickers to support the scar and avoid the fold of skin that forms above this area. Also be careful that waistbands are not too tight, and avoid zips.

For your diet, drink enough water and eat foods rich in fibre, vitamins A, E, C, iron and zinc to support good healing. A good postpartum diet is particularly essential in your case. A postpartum food supplement rich in these nutrients can also help. Marine collagen is also beneficial. Our food supplement for pregnant women and for the postpartum period, one rich in collagen can be a support for you. Our postpartum bone broths are also rich in collagen.  

If you are feeling low, it is important to talk about it. Having had an unexpected caesarean can create a psychological block around the scar. You may not want to look at it or touch it. If this continues, you will not take care of your scar (massage, ointments), and as a result adhesions will be more frequent and more significant. 

Caesarean scar care at home

In general, you will be able to go home once the stitches or staples have been removed.

Avoid lifting heavy loads, particularly anything heavier than your baby (and this applies from your time in the maternity unit). 

Avoid positions that put strain on the scar. 

Try to organise things in advance if possible. Pay attention to the height of the bed. Equally, when it comes to changing nappies, organise your changing mat well, as well as the baby bath, etc. Put together a nursery basket in which you place your essentials (nappies, cleanser, etc). This will make it easy to carry around the house.

Have a third party manage the household. You can, for example, contact the CAF to request a family support worker who can help with running the home; your family; the other parent; etc. Also try to avoid carrying out certain tasks if you can.

Also avoid baths. We tell you more in our article bath after birth. Keep the scar clean and dry. Clean it with a gentle soap and rinse thoroughly. 

Avoid scratching the scab so as not to delay the healing process. 

The first few days

Clean and disinfect it thoroughly if needed. The peak healing period is around day 7 to day 12. Around day 12, the scar may ooze and feel uncomfortable. This can be entirely normal, but do not hesitate to consult a healthcare professional (midwife, gynaecologist, nurse, etc) if needed. 

After 2 to 3 weeks

Start the massage with a cream, shea butter for example, or an organic oil (coconut, rosehip, etc). Continue the massage for several months if possible (especially to prevent adhesions). Do not hesitate to ask a healthcare professional (midwife, gynaecologist, nurse, etc) to show you how to perform the massage. 

After 1 month, you can also use a silicone dressing. 

Ideally, massage every day at first, as part of a routine, for a few minutes. Do not press too hard during the massage at the start, as it can be uncomfortable or even cause pain. 

You can then space out the massages and do one several times a week. 

Once the skin has healed and is fully closed, after about 3 weeks or 1 month, you can resume hair removal or shaving.

Please bear in mind that the scar remains sensitive. Waxing can in fact be painful for a long time. Test on a small area first. Every woman is different — do what feels right for you. 

For several months

Ask to be supported by a physiotherapist, particularly for your abdominal rehabilitation. This support can take place over 2 months after the birth. This corresponds to 10 sessions over 2 years and 2 months, which are reimbursed at 100%. 

An osteopath, although not always reimbursed, is also important for scar adhesions and for your back. 

Acupuncture and chiropractic care also offer interesting solutions for adhesions. 

Immediately after birth: 

- Keep the scar clean and dry

- Cleanse with a mild soap and rinse thoroughly

- Avoid picking at the scab

- Be mindful of movements and avoid strenuous effort

Once fully closed: 

- Moisturise with a healing cream

- Massage gently 

- Protect from the sun with a total sunscreen to prevent hyperpigmentation

- Be mindful of movements and avoid strenuous effort

Do not hesitate to seek support from healthcare professionals (doctor, midwife, gynaecologist, etc.). 

A poorly treated scar can lead to infections or complications. Consult a doctor, your obstetrician-gynaecologist, etc., if you notice:

Excessive redness and warmth around the scar.
Suspicious discharge (pus, yellowish fluid, unpleasant odour).

Persistent severe pain.
Unexplained fever.
Scar opening.

These signs may indicate an infection, inflammation or poor healing. Medical treatment may then be necessary depending on the diagnosis.

Caesarean scar infection

In the first few days following your caesarean, if you are in pain, your scar is red, oozing, and you have a fever, it is very likely that you have an infection. 

Please note: your scar may ooze without this being a sign of infection. The presence of fever is the key indicator of infection. Do not hesitate to seek medical advice for a proper diagnosis and appropriate treatment. 

Itching and discomfort of the caesarean scar

It is common for a scar to cause itching. During the healing process, you may also notice tingling, an unpleasant sensation to the touch, loss of feeling, tightness, or blistering. 

A scar that itches during the first 15 days is directly linked to the healing process. In most cases, this is completely normal.

However, this itching may also be caused by the following. 

Adhesions  

This is characterised by the different tissue layers not healing properly against one another, but instead forming a network. Several different layers heal together, which can cause varying degrees of pain. These adhesions can bind organs together. Simply experiencing pain should prompt you to reflect on how your healing is progressing and to take action. 

The main goal is to prevent the formation of these adhesions or to "break" them through massage: osteopathy, physiotherapy (100% reimbursed by the French social security system following a prescription, for up to 2 years after birth), and tecar therapy: radiofrequency treatment applied to the scar (a technique partly reimbursed by French social security). When adhesions are extensive, surgical intervention may be considered, though the risk of recurrence remains significant. 

A keloid scar

Keloid caesarean scars appear from the inflammatory phase, between 7 and 10 days after birth. These scars are fibrous, raised, hard to the touch, and can sometimes cause a painful sensation. This type of scar extends beyond the wound itself, raising the skin and spreading beyond the edges that have closed. It may persist for more than 18 months. 

A hypertrophic scar 

Hypertrophic caesarean scars will be raised after 3 weeks; they will gradually reduce over a few months and diminish after 1 to 2 years. They will be red, raised, and more or less sensitive.    

A few possible actions: 

Corticosteroids may be prescribed via injection or in the form of creams or ointments.

Collagen infiltration.

Compression therapy using silicone.

Wearing compression garments.

Fixed dye laser.

Surgery. 

Skin ridge following a caesarean

Depending on the caesarean technique used, a ridge may be visible above the scar. This ridge consists of accumulated lymphatic fluid. It will normally reabsorb on its own, and can be resolved through regular massage or with the help of a healthcare professional (an osteopath or physiotherapist). They may use LPG, a mechanical drainage technique using a device, or manual lymphatic drainage. 

Taking care of your caesarean scar is essential for a smooth and complication-free recovery. With appropriate care and regular massage, it is possible to minimise its appearance and reduce the risk of infection. Remember that this scar is a reminder of one of the most beautiful encounters of your life! If you have any concerns or notice unusual symptoms, seek advice from a healthcare professional (GP, midwife, or gynaecologist) promptly.

Once a caesarean, not always a caesarean! A vaginal birth may be possible in certain cases for a subsequent pregnancy. However, there is a risk of uterine rupture. To find out more, see our article onvbac (vaginal birth after caesarean).

Thanks to caesarean mum for reviewing this article.