10 Common Questions About C-Section Scars

1
What Type of Abdominal Incision Will Be Used?

Cesarean scar with staples and baby
Photo © Westend61/Getty Images

You'll likely have questions about c-section scars before and after your cesarean section. The questions may pertain to healing, or perhaps you want to know what your c-section scar will look like. You may be worried about pain and practical issues like clothing. There's an answer to each of your questions. Reading up on them can reduce some of the anxiousness you feel.

First, you may wonder what type of abdominal incision your surgeon will use, which will determine the type of scar you'll have. This is a question to best ask your doctor, but know that the horizontal or bikini incision (Pfannenstiel incision) is the most common type used. It is at the top of the pubic hair or just over the ​hairline. This provides a much more cosmetically appealing scar once healed.

Vertical incisions are very rare, but they were the original type of incision used and are thus sometimes called classical incisions. Medically, this type of incision is known as the vertical midline. It is only used in extreme circumstances.

2
What Type of Uterine Incision Is Used?

The scar on your uterus may look similar to the scar on your abdomen. It can go up and down (classical) or horizontal (bikini). It'll also determine if you are a good candidate for a vaginal birth in subsequent births, also known as vaginal birth after cesarean (VBAC). Ask your surgeon whether you have a horizontal or vertical incision on your uterus so that you have the information handy.

You might also ask specifically about vaginal birth in subsequent pregnancies, because some incisions on the uterus may be more at risk, like in the case that your incision is extended. The most common uterine incision is a horizontal incision on the lower segment of the uterus (low flap transverse incision). Having a preterm baby, a baby in an odd position, or a medical emergency may necessitate a different type of incision.

3
What Materials Will Be Used to Close My Incision?

The materials used to close your incision may depend on several factors, including your body type and your doctor's preference. Your doctor may use:

  • staples
  • sutures (stitches)
  • steri strips (specialized tape)
  • glue
  • combination

Some closure materials, like staples, are used temporarily and will be removed after a certain period of time. This again​ depends on the preference of your practitioner and how you are healing.

4
What Do I Do If I Have Pain in My Incision?

There are some warning signs that indicate that you are having complications with your incision. If you have any redness, swelling, extreme pain, or worsening pain, you should contact your doctor. You should also call right away if you have anything oozing out of the incision. These can be signs of infection, which needs prompt care. Call your practitioner, no matter what the time of day.

5
Is It Normal for My C-section Scar to Itch?

It is normal to experience itching during the healing process. Be careful about scratching because you want to avoid infection. If you have both itching and numbness, it is possible to hurt yourself from scratching. Some mothers find that holding something tightly over their scar can help reduce the itching sensation.

The itching can also be caused by the pubic hair growing back if it was shaved just before the surgery. If, after your pubic hair grows back, you still have itching, it may simply be from healing.

6
What Do I Do If My Cesarean Scar Is Irritated?

Be sure to keep your c-section incision site clean and dry. If you are having trouble keeping the area dry due to the shelf of skin that can sometimes hang over the incision, ask your doctor about using something like cornstarch once the site is completely healed. You can also use gauze or cotton. Be sure to thoroughly dry the skin after bathing.

Try to avoid clothing that sits directly over your c-section scar. Consider doing this for a few months. As the tissue heals, you can try introducing your old wardrobe back in and may not have a problem with it.

7
Is It Normal to Have a Numb Cesarean Scar?

Numbness around the incision is not a complication, but can be worrisome. Some moms report that they feel nothing around or just on top of their c-section scar. For some it is a temporary lack of sensation, for others it is permanent. Mention this to your doctor if you have questions about it or if it concerns you.

8
What Will My Scar Look Like?

Healed, a c-section scar is four to six inches long, though this length can vary due to the placement of the incision and the length required to birth your baby. The redness will also diminish over time.

Some scars are flat while others are more raised. This depends on how your body heals. Sometimes, during the healing process, your body reacts to the surgery by kicking into overdrive. This may mean that you have a thicker scar, known as a hypertrophic scar. This type of scar stays in the exact spot your surgeon originally cut, unlike a keloid scar, which can be thicker and extend beyond the original incision.

9
How Long Does It Take for an Incision to Heal?

You will notice that the area of the c-section scar slowly changes, so slowly that you may not notice the difference on a daily basis. You can take pictures to see how the healing process looks through time. In the beginning, right after your c-section, the healing process is fairly rapid and daily changes can be noticed, but after that you may not find the subtle changes as noticeable.

The time it takes for a c-section scar to heal varies from woman to woman. Sometimes there are considerations that will slow or impede your healing, like poor nutrition, infection, etc. Staying healthy and eating well will help your body do its job.

10
Are There Cosmetic Fixes Available?

Everyone who has an incision will have some sort of scar. How it looks after the surgery will depend on many factors, including:

  • How long ago you had your c-section
  • The type of incision made
  • How many incisions have been made in the same space
  • The type of repair your surgeon did
  • The materials used (steri-strips, sutures, glue, or staples)
  • How your body healed
  • Your skin integrity
  • Your body's tendency to scar

Once your scar has healed, and usually, once you are done adding to your family, you can look at ​long-term cosmetic solutions. This might include a trip to the plastic surgeon or dermatologist for prescription or medical options.

You can also try to minimize the prominence of the scar by using some over-the-counter products like silicone strips or other products recommended by your practitioner. You should also avoid sun exposure for at least a year to minimize the damage to the scar tissue. Some practitioners also recommend special massages by specially trained massage therapists.

After the initial healing period is over, if you are really unhappy with your scar, there are some options to minimize its look. This can include medications like steroid injections and in severe cases, you can have a revision done to try to remove excess scar tissue, though this is not commonly done. 

A scar revision is usually done at least a few months after your initial surgery. It is a surgical procedure that may or may not be covered by insurance, but involves cutting the scar tissue away and creating a new scar that is hopefully more aesthetically pleasing.

Steroid injections around the scar can be started soon after the surgery to hopefully help prevent hypertrophic or keloid scarring. It may be covered by insurance, but that will depend on your coverage. The injections may need to be given monthly for up to six months, depending on your scar.

Laser therapy is another option, but it does not completely remove the scar. This out-of-pocket expense takes multiple sessions and results in a scar that is less rigid and has less coloring. This treatment can be started shortly after the initial healing.

The most intense option would be an abdominal repair, often known as a tummy tuck. This cuts away the c-section scar, but also additional skin and fat in the area. The resulting scar from a tummy tuck can be larger, so be sure that you are well informed prior to getting the procedure done.

A Word From Verywell

Having a cesarean birth can leave you with a lot of questions, particularly if it was not planned. Your incision is something that requires medical attention and care. You will get instructions on how to care for it as you heal. The process of healing is in phases.

It is perfect normal to have your scar itch or feel numb. Pain is also common in the early days after your surgery. Your doctor will prescribe pain medication when appropriate. You can also provide comfort care by keeping your scar dry to avoid irritation.

If you are concerned or have questions, you should bring them to your doctor. You should call him or her immediately if your scar is red or has discharge, or if you are running a fever. Work together with your doctor to get the healing results you want.

Sources:

Gabbe, S, Niebyl, J, Simpson, JL. Obstetrics: Normal and Problem Pregnancies.  Fifth Edition.

Huppelschoten AG, van Ginderen JC, van den Broek KC, Bouwma AE, Oosterbaan HP. Different ways of subcutaneous tissue and skin closure at cesarean section: a randomized clinical trial on the long-term cosmetic outcome. Acta Obstet Gynecol Scand. 2013 Aug;92(8):916-24. doi: 10.1111/aogs.12142. Epub 2013 Apr 22.

Ledon JA, Savas J, Franca K, et al. Intralesional treatment for keloids and hypertrophic scars: a review. Dermatol Surg 2013; 39:1745.

Mackeen AD, Berghella V, Larsen ML. Techniques and materials for skin closure in caesarean section. Cochrane Database Syst Rev. 2012 Nov 14;11:CD003577. doi: 10.1002/14651858.CD003577.pub3.

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