Birth Blog
How to Look after your C-section Scar
Jenny
Mumtobe Guest Blogger Jenny - a Midwife, Nurse, Author and Mum of 3 writes a mixture of pregnancy and birth information, family life, homes and interiors and family reviews. Jenny shares with us her tips to help heal and reduce scarring from a C-section.
Whether your C-section was elective (planned) or an emergency, the end result is the same. C-sections are more and more common, with some trusts having a c-section rate of 30% or more. I had my eldest via emergency cesarean, after giving birth vaginally to his twin. I had to be put under general anaesthetic, and the recovery was standard, but I hated my scar for a few years afterwards. I felt it was jagged (which it may have been, as it was such an emergency to get him out), it healed differently on one side and remained red for a long time. Now, 8 and a half years later (!) it’s now white and barely noticeable. It’s part of my battle scars becoming a mother. When I was in recovery, I was not aware of anything I could have used to aid healing, I wish I had, it may have helped my feelings towards accepting it and could have improved the time it took. I’ve been doing some research into ways to promote scar healing, and here are my findings. They vary from natural methods to silicone gels. I will start by answering some frequently asked questions about c-sections and what to expect after a Cesarean section with regards to the scar, then move on to products to use.
A standard c-section scar will be around 10-12cm long, and sits where the bikini line is at the bottom of your abdomen (tummy). This is the same for a planned or unplanned operation. In some extreme circumstances, it may be necessary to perform what’s known as a classical incision, a vertical cut from your belly button downwards. Even rarer still, when they have tried the horizontal way and then go on to the vertical, leaving you with an inverted T shape scar. I have only seen this once in my 14 years experience and it was an exceptional case.
Mostly the surgeons will use dissolvable stitches inside and out, so you won’t have to worry about them being removed. The other type is called prolene with beads, where they use dissolvable stitches inside, then a running stitch along the skin, leaving a plastic bead each side of the scar. Around day 5 (the day of the birth being day 0), the stitch will be removed by cutting one of the beads, then your Midwife will gently place a hand over the scar and pull the other side to take the stitch out. It sounds worse than it is, they come out very easily. The last type of stitch that may be used is staples. These are becoming less popular, but still may be used in some cases. They are like the staples you use in an office, and again will need to be removed around day 5. Your Midwife will have a special sterile staples remover and will take them out one by one. You will feel them being removed but it isn’t very painful. Removing the dressing is often described as the worst part, especially if the pubic hair catches.
This may vary according to your local hospital where you had your c-section. At the moment where I work, they put on a gel type dressing directly after the operation, which promotes wound healing and helps prevent infection. It’s also waterproof. You then have that removed on day 5, or you can remove it yourself. It’s very sticky, but your Midwife will know the best way to remove it gently. Another method is to place a large white plaster type dressing on after the operation, then the next day when you get up to have a shower it is removed. The dressing is not usually replaced, as it’s better for healing to be open to the air. You should allow some time for the wound to be open to the air, keep it clean and dry, wear loose clothing and big knickers! If there is still some oozing from the scar or you find it rubs on your clothes, put a large maternity sanitary towel over the wound to make it more comfortable.
It is not compulsory to use anything on your scar, as it will heal naturally. However, there are some proven methods that can improve the chances of optimum healing and reduced scarring, particularly if you have a history of Keloid or Hypertrophic scarring (raised and/or red scarring, increasing beyond the original scar in the case of Keloid scarring). Here are some of the treatments you may have heard of, or people may recommend and some more information to help you decide what to use. I would recommend getting whichever treatment in advance if you are planning a c-section. They are all safe for use whilst breastfeeding.
Vitamin E
Creams and oils that include vitamin E can help with scar healing, although studies show that they perform better when used in combination with a silicone therapy (Tanaydin et al, 2016).
Silicone gel
Silicone has long been used in medicine as a safe clinical material, and the benefits of silicone on wound healing and prevention and reduction of Keloid and Hypertrophic scars has been thoroughly researched. In an observational study of 105 patients, Sandhofer and Schauer (2012) examined the effectiveness of silicone gel in accelerating epithelialisation, reducing inflammation and preventing scarring. They observed that silicone reduced wound healing time and scar formation, and that it could be used in combination with other treatments. In October 2017, a quick-drying silicone scar gel, containing five different types of silicone called Nourisil MD was launched, and became available for prescription on the NHS drug tariff from February 2018. Nourisil™ MD helps to flatten, soften and smooth scars, relieve the itching and discomfort of the skin caused by scars, as well as reduce any associated pain and redness. You can also buy Nourisil MD silicone gel yourself from Amazon, it does not need a prescription, although you may be able to ask for it from your GP prior to your planned C-Section and you won’t have to pay under the maternity exemption.
Silicone sheets
Kim et al (2014) randomly assigned 30 surgical scar patients to treatment with either silicone gel sheeting or a topical silicone gel. Their results found no significant difference in efficacy, but that topical products were more convenient, and advocated the use of topical silicone gels as a first-line therapy in the management of postoperative scars. The gel also dries quicker and leaves no sticky residue.
Turmeric
Turmeric seems a cure all at the moment, but it does contain the yellow pigment curcumins, which have been shown in studies to reduce inflammation, and contains antiviral and antibacterial properties. You can get Turmeric supplements in tablet or liquid form, or just use it in cooking during your recovery. There are Turmeric creams, but none I can find specific for c-section scars. Mahmudi (2015) concluded in his randomised double-blind trial into the use of Turmeric cream that Turmeric was effective in faster healing of wounds after a Cesarean.
Fusidic Acid Cream or Ointment
This is an antibacterial cream and often prescribed by the GP if you are developing signs of infection.
Hypericum perforatum (St John’s Wort)
St John’s Wort ointment or cream can be used, there may be some benefits to scar formation. A study performed by Samadi et al (2015) of 144 women were divided into a treatment group receiving an ointment of St. John’s wort 24 hours post-operation, a placebo group who received a placebo ointment 24 hours post-operation, and a control group who received no treatment. The study found a significant difference in the St. John’s wort group’s wound healing and scar formation from the placebo and control group, while there was little difference in wound healing or scar formation. Compared to the placebo and control group, using St. John’s wort ointment 24 hours post-operation, significantly led to faster wound healing, less pain and itchiness, and lowered instances of pigmentation, raised height, and lack of pliability.
Honey
Honey is so versatile, with elements of honey that can help you get pregnant, there are also parts of honey that are brilliant for eczema and wound healing. It is sticky to apply though!
Lavender
Lavender essential oil is known for its relaxation properties, and a few drops in the bath can work wonders after the early days. It’s also a good pain reliever and has antimicrobial properties. You can get lavender creams too, which have shown some small benefits to scar healing.
Aloe Vera Gel
Aloe vera gel is purported to be good for burns and as a soothing gel for skin problems, but the effects on cesarean section scars is not proven. According to a randomised double blind clinical trial by Molazem et al (2014) they concluded that there was a slight improvement after 24 hours post c-section, but that at 8 days post op, there was little difference between the Aloe Vera group and the control group.
Arnica Gel/ Tablets
Arnica is a homeopathic remedy you can take in tablet form or gel form. It is said to relieve bruising, pain and inflammation. There is scant evidence that it works, but anecdotally women find it helpful in their recovery.
In conclusion, the best option that has a proven evidence base is the silicone treatment, with a silicone gel combined with vitamin E offering the best results and a more comfortable way to apply it. The new silicone gel Nourisil MD is the best one in the UK market at the moment. With alternative remedies, dose standardisation and quality control are two of the challenges in applying such products to clinical settings.
You must wait until the stitches have been removed and only after the wound has healed and the skin surface is intact, so no broken skin. If there is any possibility of infection, you must only use ointments or creams if they are prescribed. If any part of the skin is broken around the scar you must wait. With alternative remedies such as Turmeric, honey, lavender and Arnica, the dosage and application is harder to quantify unless you have specific instructions from your therapist. If you have been prescribed a cream from your GP, they will come with guidelines.
For quick drying silicone gel such as Nourisil MD, there are specific guidelines:
Nourisil™ MD contains safe ingredients and is suitable for the use on skin types of all ethnic background and on children. Nourisil™ MD should not be applied on dermatological conditions that disrupt the integrity of the skin. There are no severe safety risks expected for Nourisil™ MD, if used appropriately on adults and children. Any risks associated with the use of Nourisil™ MD are likely acceptable when weighed against the benefits to the patient. Nourisil™ MD can be applied only after the wound has healed (or sutures are removed) and the skin surface is intact. Nourisil™ MD should not be brought in contact with mucous membranes or applied too close to the eyes.
Be kind to yourself – you’ve had major abdominal surgery! Whilst most people recovering from surgery are encouraged to rest and recuperate, you’re handed a baby, expected to feed and be responsible for it, often straight after the surgery. Make sure you ask for help picking up the baby, for suitable positions for breastfeeding and pain relief when you need it. Some hospitals allow partners or close relatives to stay with you, which will help. When you go home, don’t be tempted to get back into your routine, particularly housework and childcare. Learn to delegate! Here are some general tips which may have some effect on your wound healing:
It takes approximately 6 weeks for the wound to fully heal and when you can resume your normal activity. Before then, light activity is fine, and listen to your own body. Do not do any heavy lifting, anything heavier than your baby is a no-no. Driving is down to when you feel ready, I would say at least wait until 7 days, and consult your insurance documents or speak to your provider. As Midwives, we tell women that when they can wear a seat belt comfortably and would feel comfortable in performing an emergency stop, then you’re ready to drive. You may feel numb around the scar for quite some time, with some women never regaining total feeling in that immediate area. Your scar will likely remain red for up to a year afterwards, then fading to silvery white. You can resume sexual activity whenever the vaginal bleeding stops and when you feel ready, there is no set time. You will still get the same vaginal bleeding regardless of the mode of delivery.
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