What’s involved in a C-section procedure

During the caesarean section an incision is made on the skin and subsequently the muscle and other layers under the skin are opened. Following that, the uterus is carefully opened, and the baby is delivered. Placenta is delivered afterwards and then the uterus is closed in one or two layers and subsequently the muscle layer and skin are closed.

Almost always the skin incision is lower transverse, meaning just lower than the “bikini line”. A midline incision below the belly-button is sometimes needed if surgical difficulty is expected, for example a large fibroid obstructing the access to the uterus or a Fetal abnormality that requires more space for delivery, for example conjoined twins.

The incision on the uterus is almost always transverse but can at times be midline (classical caesarean) for the same reasons as outlined above. Note that it is possible to have a lower transverse incision on the skin and a midline incision on the uterus. However, when a skin midline incision is used, almost always there will be a midline incision on the uterus as well. If the incision on the uterus is midline, we always recommend a caesarean section for every future pregnancy.

How C-sections incisions are closed

Caesarean section incisions are closed with sutures. All the sutures used inside the body are dissolvable (absorbed by the body), but the sutures used on the skin can be either dissolvable or removable.  The NICE guideline does not recommend one type of suture over another. It is uncommon to use staples for a Caesarean section closure.

Problems that might occur when C-section scars don’t heal properly

A common problem with caesarean scar healing can be wound infection. This is usually treated by antibiotics and it is uncommon for there to be any significant long-term problems. Sometimes the Caesarean section scar can become hypertrophic (thicker than average) or keloid (a type of very thick scar).

Tips to help them heal their C-section scars 

Typical advice is that women should try to keep their caesarean scar clean and dry. A shower is okay, but women should ensure the wound is dried afterwards. Prolonged coverage with a plaster or similar may not be helpful as the prolonged exposure to sweat/moisture may encourage the growth of bacteria and infection.

Signs that a C-section scar might be infected

Typical signs of wound infection are redness around the scar (often localised on one area of the scar) or some pus-like fluid draining from the scar. Women should seek advice if these problems happen and they will probably need antibiotic treatment. The chance of wound infection is 4-5%.

It is common for some numbness to exist around a caesarean section scar. Indeed, this happens around any scar on the body. This is because the nerves that supply that part of the skin are unavoidably cut during the incision and therefore the sensation around the scar is reduced. This numbness tends to get better over time. Itching around the scar is also common and again improves over time. All caesarean scars are painful initially, but the pain improves quickly over the first few days. Most women will need regular painkillers (usually paracetamol and Ibuprofen) for 7 to 10 days and usually no further painkillers after that time.

Ways to minimise C-section scarring

There are no universally proven methods to minimise caesarean scar scarring, but good surgical technique and avoidance of infection are likely to be the most important factors. The caesarean scar is usually removed for a subsequent caesarean section but obviously there will be a new scar in its place. If there are scarring complications such as keloid scarring, a referral to a dermatologist or plastic surgeon may be indicated for further advice about treatment to improve the cosmetic effect. This can involve special injections or revision of a scar, but it is generally uncommon.

Credit – Mr George Attilakos, Consultant in Obstetrics and Fetal Medicine at The Harley Street Centre for Women