Birth / 12 October, 2021 / Dr Ellie Rayner
Caesarean sections are by far the commonest major operations that are performed worldwide, and in the UK around 1 in 4 babies are born via Caesarean birth. If you have had or are planning a caesarean, or know someone who is, then here is the commonest questions and answers covering everything you need to know about Caesarean Section scars.
A caesarean birth scar is a horizontal scar, usually between 10-15cm just above your bikini hair line. Initially your scar will be a red/pink colour straight after birth, however over the first few months, this will fade gradually to a pale white line that many people may not even notice in time. The scar is just big enough to deliver your baby safety, so rarely it can be slightly longer but shouldn’t be visible when you are wearing underwear or a bikini.
If you have had a previous Caesarean birth and are planning another caesarean, in a subsequent pregnancy your obstetric surgeon will look carefully at your scar and its location and size and discuss with you how best to deliver your baby this time. In the majority of cases, the incision is made in the exact same spot and the old scar is either removed or no longer visible so you will still have just one scar line afterwards. If your previous scar isn’t in the right place to safely deliver your baby (for example your weight has changed significantly), then they may discuss needing to make a new, separate incision which may leave two scars afterwards. Sometimes this can’t be helped to reduce the risk of complications for you or your baby, and they will discuss this with you at time if this is the case.
Like any wound, cut or operation site, it is possible to get an infection afterwards and this can happen in around 1 in 10 women and is more common if your procedure was performed as an emergency, you are overweight, smoke or have diabetes.
If you notice your scar or the surrounding skin is becoming more sore or painful, if it looks swollen or if it looks red or inflamed then you should speak to your midwife straight away. It is especially important to seek advice if you notice the wound opening or discharging pus or foul-smelling fluid as this could indicate a more serious infection.
You should aim to keep the area clean and dry to reduce infection and aid wound healing. Avoid using soaps or perfumes on the area. You will either have dissolvable stitches, which absorb by themselves, or your midwife/doctor will remove any non-dissolvable stitches or staples between 5-7 days after birth. Once the dressing is removed, try and ensure air can get to the wound and avoid any clothes that will rub in that area and irritate the scar/surrounding skin. Cotton underwear and loose, comfortable clothes are recommended. It is important to take regular pain relief so you can be comfortable whilst recovering from birth. Both paracetamol and ibuprofen are safe to take if you are breastfeeding and are usually enough pain relief for most women, so if you can normally take these, make sure you have a supply ready for after birth.
Your Caesarean section scar can impact future pregnancies and your obstetrician will talk to you about this during the consent process beforehand and again in more detail in a subsequent pregnancy. Many parents may understand this to be the skin scar, when in fact it is the internal scar, on your womb (uterus) that can cause complications. During a Caesarean Birth, a small incision is made on your uterus to reach the baby and deliver the baby through. After birth, this scar is re-stitched back together, often in two layers using dissolvable stitches. Even though this is stitched back together carefully, this is still an area of potential weakness compared to the rest of the uterus. Because of this, during future labour, there is a small chance (around 1 in every 200 women if one previous caesarean) this area of the uterus could separate/tear which can cause serious complications for you and your baby. With this in mind, in a future pregnancy, you will be referred to an Obstetrician to discuss in detail the pros and cons of your different birth options of having either a vaginal birth after caesarean (VBAC) or an elective repeat caesarean section. If you prefer a vaginal birth, you will be recommended to labour in a consultant-led unit and to have continuous fetal monitoring of your baby using a cardiotocography (CTG) machine as this can help identify any concerns early and ensures you will be in a place with immediate access to an emergency caesarean if needed. Overall, serious complications for you and your baby are rare.
Current national guidance doesn’t recommend measuring or assessing the thickness of your scar either before or during a future pregnancy but the chance of scar complications occurring does increase with the number of caesareans you have. It is therefore especially important to discuss and consider how many children you are hoping for in your family with your doctor and midwife when discussing your birth options so you can make informed decisions.
A Caesarean is a major operation so it is important to remember it can take some time for you to heal and to return to normal. Although the outside skin edges will heal after a couple of days, the internal healing of the other tissue and muscle layers will take months, so allow yourself time to recover. If would like any more info on Caesarean sections or recovery afterwards head to the NHS websites for more information.
Dr Ellie Rayner is a practicing Obstetrician and Gynaecologist and founder of The Maternity Collective. She is the only Obstetrician to offer private and group, expert-led Antenatal and Hypnobirthing Classes both Online and face-to-face. She is passionate about providing parent-centred, evidence-based care for all pregnancies and supports all methods of birth.
Follow Dr Ellie Rayner @maternitymedic for the latest evidence-based information on pregnancy, birth and women’s health issues.