Scar after a Caesarean section: what to do?

While the etymology of the word "caesarean" remains a subject of debate, it is known today that the origins of this practice lie in antiquity. However, it is worth noting that, contrary to popular belief, it is highly unlikely that Julius CAESAR was born by caesarean section. At that time, the chances of survival for the mother following this operation were almost non-existent, and it is understood from the writings of certain ancient authors, such as Suetonius, that Aurelia COTTA, the mother of Julius CAESAR, lived for at least 60 years.

The term "caesarean" refers to a delivery via the abdominal route. This surgical procedure involves delivering the baby from the mother's abdomen through a transverse incision, known as a "Pfannenstiel" incision. It is a more common operation than one might think, as it accounts for approximately 20% of births. A caesarean may have been scheduled in advance, when vaginal delivery presents a risk to the mother or child, or it may be performed as an emergency, when the conditions of labour necessitate it to preserve the health of the woman and her baby.

In all instances, a caesarean section leaves a scar, both on the uterus and the skin of the abdomen. The process of epidermisation of the scar generally begins once the stitches and staples are removed. Before turning white, the scar first turns red, then takes on a pink hue.

After a caesarean section, the scar is covered with a dressing to protect it. This is generally removed after a few days. The sutures or staples are then removed between 5 and 10 days after the delivery. Subsequently, it is necessary to adopt certain precautions to promote healing.

• Keep the scar dry for the first three days following the caesarean section.

  It is crucial to keep the scar dry after a caesarean section. This includes refraining from showering. Indeed, the limestone content in the water could potentially harm the skin, which is already weakened by the surgery, and delay its healing process.

• Protecting the scar from the sun.
  In the months following a caesarean section, it is crucial to shield the scar from UV rays. Therefore, favour long shirts or jackets that cover the lower abdomen, or place a dressing over your scar. As a last resort, if you really must expose yourself, generously apply a broad-spectrum sunscreen. The skin at the site of the scar is indeed thinner and more fragile, allowing more UV rays to penetrate. This poses a risk of hyperpigmentation, meaning the scar could permanently turn a brown colour.

• Avoid smoking.

  Tobacco is the enemy of healing. Indeed, the carbon monoxide contained in cigarettes impairs the ability of the blood circulation to transport oxygen. This element is essential for tissue regeneration. Studies have also shown that nicotine, found in tobacco, has a vasoconstrictor effect and reduces blood flow rate, thus negatively impacting the distribution of nutrients to cells.

• Massage the skin.

  To promote healing and stimulate cellular renewal, it is recommended to massage the skin where the operation took place. However, wait about two weeks for the wound to be well closed and perform gentle movements. Lightly press on the scar with your index finger and make circular massages. You can also apply a regenerating cream to stimulate the activity of fibroblasts. Certain vegetable oils rich in omega-6, such as theavocado oil or the rosehip oil possess this property. If the massage is painful, this may mean that your skin is not quite ready yet. In this case, it is better to wait.

Generally, the techniques used for performing a caesarean section result in discreet scars. However, complications can occur and cause a infection. It should be noted that this happens in less than 5% of cases. The scar then becomes red and oozes, and it is necessary to perform a new operation as soon as possible.

It can also occur that the post-caesarean scar thickens, becomes hard and is accompanied by itching. This is referred to as hypertrophic scarring. This type of scar is due to an overproduction of collagen in the dermis. The amount of fibrous tissue is so great that it distorts the scar and increases its volume. Hypertrophic scarring generally resolves itself over a few months. To optimise its healing, corticosteroid creams may be prescribed.

Conversely, the scar may have edges that sink deeply to form a groove. This is referred to as a scar that is invaginated. It is more difficult to diminish with creams and often requires a new surgical operation if one wishes to completely remove it.

• SILVERSTEIN P. Smoking and wound healing. The American Journal of Medicine (1992).

• Thèse de Julie PEYRE. La prise en charge à l'officine des cicatrices linéaires post-chirurgicales (2021).