Scar care after caesarean section: How to achieve the best results

Mutter hält Baby in ihren Armen

Every scar tells a story. It is a natural tattoo of an event that makes the injury to the skin and deeper structures visible for a lifetime. 

It is the same with the caesarean scar. The scar represents the birth of your child. Even though the traces of this gift will be visible forever – with the right care you can support the healing process. 

Every 3rd birth in Germany is a caesarean section 

In Germany, one in three births is often delivered by caesarean section. A distinction is made between two types: 

Primary caesarean section: The caesarean section is planned before the birth – either as a so-called elective caesarean section or due to medical indications. 
Secondary caesarean section: The birth has already begun, but cannot be continued safely. 

In any case, the attempt is made to perform the caesarean section in such a way that the mother is allowed to experience the procedure awake. This means that, if possible, the woman is given an epidural anaesthetic so that she does not feel any pain during the birth and can hold the baby in her arms straight away. Only if it cannot be avoided or if there is an explicit wish, a general anaesthetic supervised by the anaesthetist is administered. 

Where does the term caesarean section come from? 

You can tell from the root of the word alone how long this operation has been performed. The medical term for a caesarean section, Sectio caesarea, comes from Latin. Sectio means “cut”, while the second part of the term probably comes from caedere, which means “to cut open”. Since the German word “Kaiser” was later derived from caesar, it is assumed that this is how the term “Caesarean section” came into being. 

How does a caesarean section work? 

When a caesarean section is performed, a 7-15 cm incision is made across the lower abdomen just above the pubic bone under sterile conditions. This is followed by the opening of the other tissue layers (including the abdominal muscles) either by cutting or stretching & tearing. Finally, the front wall of the uterus is opened and the baby is delivered as quickly as possible. This can take between 3-10 minutes from the first cut. After the umbilical cord is cut, the baby is handed over into the mother’s arms. 

The caesarean scar – typical symptoms 

A caesarean section is comparable to an abdominal operation. The result is a rather large scar, which is accompanied by typical complaints: 

pain during the first weeks of wound healing and scar development 
Red and raised scar tissue 
Sensitivity to touch around the stitches 
Itching & feelings of tension 
Long-term retracted scar, often with a small fold of skin over it (in the sense of excess skin).

Wound healing during a caesarean section – what you can do 

Your first point of contact before and after the birth is usually your midwife. She also has the most experience in how you should behave before and after the birth in order to give your body the best possible support in healing. After an incision has been made, she can assess the healing process of your scar. It takes place in several steps.  

The caesarean scar in the 1st month 

The caesarean section has created a deep wound. This means that the scar is not only superficial at skin level, but goes deep. This causes significant muscle pain after birth. The muscle receptors “fire” a sharp, burning pain, especially after an injury. Any movement of the trunk or build-up of pressure in the abdomen, such as coughing, sneezing or laughing, causes the abdominal wall to ache. This pain will be present in your life for about the first four weeks.  

Therefore, the most important tip is to take care of your upper body and avoid heavy lifting and carrying. 

The caesarean scar in the 2nd month  

It is important to avoid tension in the skin level for at least the first 6-8 weeks. If the scar is pulled and stretched, it may react with redness or an excessive scar reaction in the form of red raised scar tissue. For you this means:  

Avoid movements and strains that put the scar area under tension. 
Do not expose the scar to strong sunlight. This can lead to pigmentation disorders. 

When can I start caring for my scars after a caesarean section? 

While you are concentrating on your baby in the first days and weeks after the birth, you are probably also wondering when scar care after a caesarean section is possible or sensible. In fact, the timing is crucial for effective scar care after a caesarean section. 

Wound healing usually takes 12-14 days at skin level. You should not use scar ointment after a caesarean section during this phase. After this time, the stitches or staples can be removed. By then, a scar will have formed after primary wound healing.  

Your scar care can start now, 2 weeks after your caesarean section. The structures in the layers under your scar will gradually heal more slowly. The messenger substances of healing make them stick together at first, and new collagen fibres develop. This means that the deeper tissue heals over a longer period of time than can be felt at skin level. This process can take up to 9 months. For you, this means that the scar care of the deeper structures is different from that of the visible scar.  

Can I use cooling elements on my caesarean scar? 

You may know from sports injuries that a swollen and overheated area is treated with cold. However, the caesarean scar is a different story. A fresh wound needs to be well supplied with blood for healing. If you cool this area, the blood flow is greatly reduced because the vessels close up. The newly enclosed vessels can also no longer pump blood. The poor blood circulation leads to an undersupply of nutrients and, in the worst case, to wound healing problems.  

If wound healing is already complete, i.e. after the 14th day, you should also not cool your scar. The scar needs to reorganise its architecture under the skin and is still dependent on optimal blood circulation.  

Creams & Co.: What to do with the caesarean scar? 

During pregnancy, you certainly cared for your skin regularly with an oil or a soothing cream. If the healing process is normal, you can start taking care of your scar after 14 days.  

A special scar cream or scar ointment is best. Apply it gently to the scarred tissue once or twice a day, preferably directly in the morning and in the evening before going to bed. The following products are also suitable for scar care: 

Scar gel 
Skin oils

How long do I have to use scar care after a caesarean section? 

A scar lasts between 12-18 months on the body. And this includes the Sectio scar as well. Since the healing process can only be conclusively assessed after these 1.5 years, the care of the caesarean scar should also extend over this period.