Cesarean Scars

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A Guide to C-Section Scars

Cesarean Scar after Two Days
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You may have some questions about c-section scars either before or after your cesarean section. The questions may pertain to healing or during or just after the surgery. Perhaps you want to know what your c-section scar will look like when it is done healing. Or maybe you're worried about pain and practical issues like clothing when it comes to c-section scar questions. Here you will find some answers to the most often asked questions about c-section scars.

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What type of abdominal incision is used in a c-section?

Vertical incisions are very rare. This is called a classical incision by lay people because it was the original type of cesarean incision used. The medical term for this type of incisions is a vertical midline. These are only used in extreme circumstances.

The horizontal or bikini incision (Pfannenstiel incision) is a very common type of incision used on the abdomen. It is placed at the top of the pubic hair or just over the hair line as the c-section is started. This provides a much more cosmetically appealing scar once it is healed.

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What type of uterine incision is used in a c-section?

The scar on your uterus may look similar to the scar on your abdomen. It can also be going a different direction, like up and down (classical) or horizontal (bikini). This can play into whether you are a good candidate for a vaginal birth in subsequent births, also known as vaginal birth after cesarean (VBAC), so always be sure to ask your surgeon whether you have a horizontal or vertical incision on your uterus. You might also ask specifically about vaginal birth in subsequent pregnancies, because some incisions on the uterus may be more at risk, for example, if your incision extended. The most common uterine incision is a horizontal incision on the lower segment of the uterus (low flap transverse incision), a preterm baby, a baby in an odd position or a medical emergency may necessitate a different type of incision.

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What materials will be used to close my c-section incision?

Steri Strips for Cesarean Section
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This 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 or a combination. Some, 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.

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What do I do if I have pain at my c-section scar?

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.

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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 will want to avoid infection. If you have 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 from the area of pubic hair that was shaved just before the surgery. If after your pubic hair grows back you still have itching, it may simply be from healing.

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What do I do if my c-section scar is irritated?

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

Try to avoid clothing that sits directly over your c-section scar. This can mean choosing different underwear or even pants. 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.

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 corn starch once the site is completely healed. You can also use gauze or cotton to tuck into the shelf. Be sure to thoroughly dry the skin after bathing.

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Is it normal to have a numb c-section 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 mothers this is a temporary lack of sensation, for other mothers this is permanent. Mention this to your doctor if you have questions.

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How big will my c-section scar be?

Cesarean Scar Healed After Birth
Photo © Yana Bukharova/Getty Images

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. Most scars are also horizontal, but some are potentially vertical. 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.

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How long does it take a c-section scar to heal?

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

You will notice that the area of the c-section scar slowly changes, so much so that you may not notice the difference on a daily basis. You can consider taking pictures to see how the healing process looks for various time periods. 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.

 

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Cosmetic Fixes for Your C-Section Scar

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

  • 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
  • You skin integrity
  • Your body's tendency to scar

So once your scar has healed, and usually once you are done adding to your family, you can look at long term cosmetic solutions to your scar care. 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 it's 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 typically 

Steroid injections around the scar can be started as soon as the actual 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 monthly for up to six months, depending on your scar.

Laser therapy is one example. This does not remove the scar. This out-of-pocket expense takes multiple treatments and results in a scar that is less rigid and has less coloring than your previous scar. This treatment can be started shortly after the initial healing, with the blessing of your provider.

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.

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. Though the resulting scar from a tummy tuck is larger, so be sure that you are well informed prior to getting the procedure done.

You should always contact your doctor with questions about the c-section scar.

Source:

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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