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Birth is this amazing, complex journey that might have brought along a few souvenirs after nine months. When I talk my kids about their births, we briefly highlight a couple of things that catch their attention, one being the lovely C-section scar as evidence of their entry into this world.
I admit, it’s a much easier explanation to a seven- and four-year-old that they came from mama’s belly rather than delving into the intricacies of vaginal delivery (I’m a pelvic health physiotherapist but even I think it’s a little too soon for the complexities of delivery!) However, as easy an explanation as it is, the scar remains.
I joke to friends that the surgeon gutted me like a fish and sent me on my way… not that far off! My husband and I weren’t given a care manual with our babies and I didn’t get a user’s guide sent home with my postpartum body.
Of the 1.27 million C-sections performed in the U.S. every year, most mothers are taught little about how to care for their body after delivery, much less their incision site. OB-GYNs often clear moms for return to activity after six weeks, and we assume all is well if the incision is closed and well healed — not necessarily! 6 to 18 percent of the 1.27 million women may have chronic scar pain related to their Cesarean surgery, resulting in difficulty and pain with daily activities including childcare. It’s major surgery, so why don’t we get a little more guidance?
If you recall, arms gently strapped down, body flopping around like a flounder (because it’s freezing in the surgical suite and that anesthesia, whoa…), our baby is safely born and we’re reassured that our tummies are perfectly flat and will heal nicely once repaired (gravity is much more kind to your abdominal contents when you’re flat on your back.) We’ll have a cute “bikini line” scar and it will be like we were never pregnant, right?
Voila, you’re good to go! Just don’t lift anything for six weeks and you’re all set — which isn’t so easy if you’ve another kid who hangs on you like a monkey!
Let’s break the procedure down a little so you can understand the layers of repair, and thus your scar.
First an incision is made in your skin. The rectus sheath (the fascia that blends all your abs together at the center of your belly) is pulled apart, then incisions are made in the peritoneum (the lining of your abdominal cavity) and the uterus. The baby and placenta are delivered and then the uterus, rectus sheath and skin are sutured back together again.
Scars are your body’s way of forming a bandage, and you want a scar to heal well and be mobile. Here’s a simple analogy: it’s like you have several layers of waxed paper and someone put a curling iron down through it. All the layers sort of blend and melt together. The tissues from your skin down to your uterus, although sealed closed, are somewhat adhered when they used to glide on each other.
Collagen, a building block for tissues and scars, is laid down in multiple different directions (kind of like when your kid dumps their crayons all over the floor). Collagen is influenced by tension and can be re-organized to be more aligned and mobile.
Depending on your surgeon, the uterine scar may be horizontal or vertical, but this is still a lot of layers of tissue that were repaired. It’s for this reason that when mobilizing your scar, you need to think about massaging in every direction you can think of.
With scar massage, we apply gentle force to the collagen, encouraging it to redirect and thus help the tissues become more mobile, less restrictive and less painful.
This a technique that has been shown to improve pain and mobility restrictions associated with C-section scars. A small 2018 study just published in the Journal of Women’s Health Physical Therapy looked at the effectiveness of superficial and deep massage techniques, finding both resulting in improved pain and function after just four sessions of skilled physical therapy .
That’s not to say you can’t take a try at getting your own scar moving! It’s never too late to try to mobilize a scar that’s painful, restricted or has little sensation. That said, it can be too early to massage a scar. Even though a wound may appear to be closed, it’s important to wait until after at least six weeks postpartum to start self-massage. Tissues may be closer to full healing at that time and less likely to disrupt or open the incision site. Full healing of the tissues should be achieved by eight to twelve weeks.
Prior to the six-week mark, moms can work on returning sensitivity to areas that feel numb. Brushing the area lightly with a cotton ball or washcloth can introduce a slightly rough texture to the tissues and the healing nerves, working to improve sensitivity to the area. Adding massage cream such as cocoa butter can be helpful in improving the scar texture and aesthetics, but may only be applied only after the incision site is fully closed.
After six to eight weeks of healing, more aggressive tissue massage can be applied. You can stretch the tissues by sinking the pads of your fingers down into the tissue above, below and adjacent to the healed incision and pulling or pushing in a direction that feels restricted for a brief time. Remember to work in every direction to get the full benefits.
Other helpful techniques can include massaging in a circle and skin rolling, where you take the tissue and roll it in a multi-directional way between your fingers (this may be uncomfortable and feel a bit like a rug burn, so work your way up to it).
There should never be any bleeding, redness lasting more than a few hours or open incision site after self-treatment.
Many of these techniques can be applied three to five minutes per day but can be challenging to do on your own since we’re often reluctant to knowingly perform activities that cause pain. Furthermore, it may also difficult to get at some of the angles. If you’re ever worried that you may be doing the wrong thing, most pelvic physical therapists can assess your technique and give you recommendations as well as treatment that can help you with your scar!
Remember, even though you weren’t sent home with a user’s guide to your C-section scar, it’s important to understand it’s not too late to get it moving!
Note from GGS: To find a pelvic health physical therapist in your area, search one of the following websites.
If nothing comes up in your area, a general Internet search using one of the following terms: pelvic health, pelvic floor, women’s health physical therapist, or women’s health physiotherapist and the name of the city will provide some leads. In the U.S. use the term physical therapist. Outside of the U.S., use the term physiotherapist.
Wasserman JB, Abraham K, Massery M, et al., Soft tissue mobilization techniques are effective in treating chronic pain following cesarean section: A multicenter randomized clinical trial. J of Women’s Health Phys Ther. 2018:42(3).