How to care for a scar after a cesarean section?

In Poland, so many women are afraid of childbirth - after hearing and reading stories from delivery rooms - that a huge number of them decide to have a cesarean section . Sometimes - despite the lack of medical indications (you can read about why it is not worth choosing "cesarean section on request" in this article ). The rate of cesarean sections in the country is very high. While the World Health Organization (WHO) recommends it to be 10%-15% , in Poland it is almost 50% . This is one of the largest numbers in Europe. For comparison, in Iceland this rate is only 14.8 % . The European average is 25% . The reasons why so many women in Poland are afraid of childbirth and decide to have a cesarean section are a topic for a separate article (an interview with the head of the Rodzic po Ludzku Foundation here ) .

Let's focus on a slightly more tangible problem: the scar from this surgery and its care . Because, contrary to the popular belief that a cesarean section is just a "procedure", it is a very serious operation after which a woman needs long weeks to fully recover.

A scar after a cesarean section - a "souvenir" for life.

During the operation, the skin is cut, the subcutaneous tissue and abdominal fascia are cut and torn, and the uterine muscle is cut. A scar after a cesarean section is a souvenir of this intervention in the body , which we carry throughout our lives. Therefore, it is good to know how to care for it so that it heals well and does not cause problems later. And it's not about aesthetic issues, although these are also important. However, definitely not to the same extent as scar mobilization, which women are often simply not told about . But let's start one by one.

How long does a cesarean section scar heal?

During a cesarean section, the doctor makes an incision above the pubic symphysis . This is where a scar will form as the skin heals. By then it will be several weeks. However, before this happens, you need to observe this place and take proper care of it. As midwives emphasize, such a wound needs, above all , time to heal . The stitches will be removed about a week after the cesarean section - the external ones. Those that remain in the body will dissolve after about 3-6 months . Initially, the place where the scar will appear is an angry red, usually convex welt. Only after many weeks will a white line remain .

How to care for a scar after a cesarean section?

Before leaving the hospital, the nurse or midwife will put a fresh dressing on the wound, which can be removed after a few days, usually 2-3 . It's about air access to the wound. In the first days, you should wash it carefully - with the same detergent as always - and avoid long soaking . No baths, only showers. Underwear should be comfortable and airy - postpartum panties will work - those made of mesh, and later - cotton ones. The wound should be disinfected with an antiseptic several times a day and aired frequently . Midwives recommend not to depilate the pubic area for a few weeks after the operation and not to use the quite popular postpartum belts, which make the abdominal muscles lazy .

Even though patients after a cesarean section are quickly placed in an upright position, which avoids the risk of thrombosis and adhesions, convalescence after such surgery is long . It is worth doing breathing exercises at this time to improve the functioning of the diaphragm. Changing the position from lying to sitting should always be done by lying on your side so as not to strain the abdominal tissue. When you sneeze, cough or laugh, hold your stomach or place a pillow over it. Thanks to this, the wound will not tear so much. Of course, do not carry any objects that weigh more than the child. Save yourself. Take the stairs as little as possible.

Why do you need scar mobilization after a cesarean section?

The incision site itself should not be massaged until the wound heals. This is when mobilization should begin - to avoid stiffening of the scar and further - painful and potentially dangerous - complications. Even if the scar looks well healed on the outside, it doesn't have to be so "nice" on the inside. Tissues deep in the skin may grow together, which negatively affects elasticity and mobility. Massaging the scar and the skin around it helps avoid these unpleasant consequences .

A massaged and "well-prepared" scar, as physiotherapists say, means greater comfort during the next pregnancy (if we are planning one). This is because as the belly grows, the pregnant woman will not feel the pain radiating from the scar. What is not talked about are the serious health consequences that may occur several years after a cesarean section. What? Not only pain in the lower back , but also loss of sensation at the site of the scar , pelvic pain, obstruction related to small/tight bowel syndrome and dyspareunia, i.e. sexual dysfunction , which manifests itself by pain during and after intercourse. Importantly, "pathological postoperative adhesions may make it difficult to get pregnant in up to 20% of patients .

When should you start mobilizing the cesarean section scar?

Scar mobilization can begin approximately 4-5 weeks after surgery . It is a good idea to consult a urogynecological physiotherapist who will professionally assess the scar and recommend an appropriate method of working with it. The specialist will teach the patient how to properly perform massage and self-drainage . You can also use commercially available preparations that, apart from massage, will additionally soften the tissue . Popular ones include ointments and gels with onion extract, allantoin and heparin. Many women also use silicone-based patches . When used regularly, they are effective because they soften the scar and reduce its visibility. Remember, however, that the most important thing is regular massage to improve the tissues and prevent the scar from stiffening.

Bibliography:

1. “Caesarean sections in Poland”, parentpoludzku.pl, May 15, 2019.
2. Paulina Nowosielska, Klara Klinger, Poland breaks records for cesarean sections. One of the highest indicators in Europe, Serwisy.gazetaprawna.pl, August 19, 2021.
3. Alicja Misztal, “Wound care after cesarean section, part I”, Szpitalzelazna.pl, accessed August 1, 2022.
4. As above.
5. “Mobilization of the scar after a cesarean section”, November 27, 2017, physiotherapist.pl.
6. As above.