According to the CDC, in 2014 32.3% of births were by C-section in the United States. Accordingly, if you look at the SETX area, local hospital C-section rates appear to match the national average. To me, this means that a lot of us momma’s have had a C-section birth in the SETX area.
I, myself, had my daughter via C-section in December 2014. To my surprise, my doctor provided me with no information regarding caring for my new scar. If I was not already an occupational therapist, I would have been dismayed by the complications that scars can cause- including pain, redness, tenderness, numbness, etc.
Before we begin discussing C-section scar management strategies, I find it helpful to first discuss scar tissue and its relationship to the rest of the body.
Scars are “areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. Scar tissue is composed of the same protein (collagen) as the tissue that it replaces, but the fiber composition of the protein is different; instead of a random basket weave formation of the collagen fibers found in normal tissue, in fibrosis the collagen cross-links and forms a pronounced alignment in a single direction. This collagen scar tissue alignment is usually of inferior functional quality to the normal collagen randomized alignment.” (Sheratt, 2010). For example, scars in the skin are less resistant to ultraviolet radiation, and sweat glands and hair follicles do not grow back within scar tissues. (Scar Facts, 1999).
There are three stages of wound/scar healing, with different modalities of treatment at each stage.
Phase 1: Inflammation
This stage occurs one to three days after injury and is essential for healing. During this phase, vasodilation and swelling occurs, causing white blood cells and phagocytes to travel to the wound site. These cells fight against infection and kill bacteria.
For the C-section scar, this stage generally occurs while you are in the hospital and just getting home. You can expect your scar to look similar to the photo below. Different physicians utilize different closure methods (suture, staples, medical grade glues, or a combo of the above).
Photo © Universal Images Group/Getty Images
Phase 2: Proliferative Stage
Throughout this phase, granulation and epithelialization occur, and the phagocytes are replaced with fibroblasts. Collagen, a fibrous, insoluble protein, is produced and deposited within the wound, eventually replacing the fibroblasts. The wound becomes stronger and able to tolerate stress. Contraction begins, and the wound begins to close.
For the C-section scar, this would be around the time that your wound closures (staples, stitches, etc) are removed at the physician’s office (2 weeks post-op). You can expect your scar to look similar to this photo (note: the photo is not of a C-section scar, but of a scar that has just had staples removed).
Phase 3: Remodeling
The final stage, remodeling, occurs anywhere from three weeks to two years from injury. Scar adhesions begin to form and mature as new collagen is produced. At this stage of healing, scar management should begin.
At first, a scar site may appear red or purple in color and will gradually fade to white or light pink as it matures. When managed properly, scar tissue will become smooth and pliable. Without care or treatment, scars can become painful, hypersensitive and thickened. See image below.
Now that we are educated about scars and what to expect, what can we do to prevent complications that can arise from C-section scars?
- Binding: This saved me in the early days. Binding is best utilized once you get home, during the Phase 2- Proliferative stage of healing. From the scar perspective, binding aids in reducing fluid retention and swelling, while aiding in bringing the tissue around your scar closer together (promoting strong new collagen bonding). Consistent pressure to a healing scar can help flatten and smooth scar tissue. Another benefit of binding is the protection of your scar while it is sensitive to touch- this definitely helps if you’re breastfeeding. You can couple the abdominal binder with a silicon patch (my binder had a silicon patch built in) which also aids in reduction of scar redness.
- Scar Massage: Scar tissue is managed most effectively from six to 12 weeks following would closure, during Phase 3- Remodeling. The perfect time to speak with your doctor regarding scar tissue massage is at your 6 week postpartum visit. Scar massage should be no more than 5-10 minutes at a time, a couple of times in the beginning. It is best preformed in bed on yourself lying flat. Scar massage begins with simple range of motion of the skin surrounding the scar. Placing your hands above/below/right/left of the scar and gently stretching the skin until you feel a “hard stop.” Maintain that position for a minimum of 90-120 seconds in each direction to effectively release any trigger points. Once you can tolerate more tactile input to the scar itself, you can repeat these stretches with your fingers on the scar itself (versus the skin above/below/right/left of the scar). Other strategies to try include scar ‘bending,’ where you bend the skin with the scar; or scar ‘rolling,’ where you roll the skin with the scar up/down. Physical manipulation of the scar breaks down the chaotic fibrotic (collagen) tissue that laid down during the first two phases, causing your body to ‘re-lay’ new tissue in a more even pattern. The result is a flattened scar with less redness and pain (as nerves can get trapped in the chaotic webbing and become dysfunctional).
- Desensitization: This is an important step to reduce nerve pain and works in conjunction with scar massage, with management being most effective during the 6-12 week stage post-surgery (Phase 3-remodeling). Initially, you may experience numbness not only in the scar itself, but also in the skin surrounding the scar. This occurs as the nerve endings are severed when the incision is made. As the nerve endings re-grow, this can cause discomfort and extreme sensitivity to touch from clothing. Desensitization of the scar occurs from repeatedly touching the hypersensitive areas of skin to decrease the pain associated with healing. This is achieved by not only repeatedly touching the tissue, but using a variety of textures against your scar, according to your personal tolerance. You would want to start with soft, smooth textures including: your own skin (fingertips), silky materials (silk panties, use of eyeglass lens cleaning cloth), cotton balls, or any other soft cotton item you have at home. Once tolerance was established, you would move to more rough textures. With the use of different textures, you would also want to grade the amount of pressure used against the scar, moving from light to firm pressure.
Kara is an Occupational Therapist, wife, mother and Trusted Community Member in WMC’s Facebook groups, as well as an all-around awesome chick. We are so excited to have her aboard, and look forward to bringing our communities more informative and fascinating articles from her like the one you’ve just read!
Abler, S. (2009). [Restrictions after a cesarean section: Recover from a C-section]. Unpublished raw data. Retrieved from http://www.suite101.com/content/restrictions-after-a-caesarean-section a143433.
American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed). American Journal of Occupational Therapy, 62, 625-683.
Centers for Disease Control and Prevention. (2007). National hospital discharge survey: 2005 annual summary with detailed diagnosis and procedure data. Vital and Health Statistics, 13 (165), 1-193.
Clopper, D.J. (2003). Basic tenets of scar management. Advance healthcare network for occupational therapists. Retrieved from http://occupational-therapy.advanceweb.com/Article/Basic-Tenets-of-Scar-Management-1.aspx.
Few, R. (2010). OT & childbirth: Therapists can help cesarean mothers recover after welcoming their new babies. Advance healthcare network for occupational therapists. Retrieved from http://occupational-therapy.advanceweb.com/Features/Articles/OT-Childbirth.aspx.
Scar Facts. (1999). [Electronic Version]. Retrieved March 23, 2002, from The Scar Information Service Web Site: http://www.scarcare.org/scar_facts.html.
Sherratt, Jonathan A. (2010). “Mathematical Modelling of Scar Tissue Formation”. Department of Mathematics, Heriot-Watt University. Retrieved 20 August 2010. This is composed of the same main protein (collagen) as normal skin, but with differences in details of composition. Most crucially, the protein fibers in normal tissue have a random (basket weave) appearance, while those in scar tissue have pronounced alignment in a single direction.