Stephanie Martin

C-Section Guide - Everything You Need To Know About Having A Caesarean

Around one in four women who give birth in the UK have a c-section. Find out everything you need to know about a caesarean section including the difference between an elective versus emergency c-section, and the best postnatal remedies to help you recover after birth.

A caesarean section, or C-section, is an operation to deliver your baby through a cut made in your tummy and womb.

The cut is usually made across your tummy, just below your bikini line.

A caesarean is a major operation that carries a number of risks, so it's usually only done if it's the safest option for you and your baby.

Why caesareans are carried out

A caesarean may be recommended as a planned (elective) procedure or done in an emergency if it's thought a vaginal birth is too risky.

Planned caesareans are usually done from the 39th week of pregnancy.

A caesarean may be carried out because:

  • your baby is in the breech position (feet first) and your doctor or midwife has been unable to turn them by applying gentle pressure to your tummy, or you'd prefer they did not try this
  • you have a low-lying placenta (placenta praevia)
  • you have pregnancy-related high blood pressure (pre-eclampsia)
  • you have certain infections, such as a first genital herpes infection occurring late in pregnancy or untreated HIV
  • your baby is not getting enough oxygen and nutrients – sometimes this may mean the baby needs to be delivered immediately
  • your labour is not progressing or there's excessive vaginal bleeding

If there's time to plan the procedure, your midwife or doctor will discuss the benefits and risks of a caesarean compared with a vaginal birth.

Asking for a caesarean

Some women choose to have a caesarean for non-medical reasons.

If you ask your midwife or doctor for a caesarean when there are not medical reasons, they'll explain the overall benefits and risks of a caesarean to you and your baby compared with a vaginal birth.

If you're anxious about giving birth, you should be offered the chance to discuss your anxiety with a healthcare professional who can offer support during your pregnancy and labour.

If after discussing all the risks and hearing about all the support on offer you still feel that a vaginal birth is not an acceptable option, you should be offered a planned caesarean. If your doctor is unwilling to perform the operation, they should refer you to a doctor who will.

Risks of a caesarean

A caesarean is generally a very safe procedure, but like any type of surgery it carries a certain amount of risk.

It's important to be aware of the possible complications, particularly if you're considering having a caesarean for non-medical reasons.

Possible complications include:

  • infection of the wound or womb lining
  • blood clots
  • excessive bleeding
  • damage to nearby areas, such as the bladder or the tubes that connect the kidneys and bladder
  • temporary breathing difficulties in your baby
  • accidentally cutting your baby when your womb is opened

What happens during a caesarean

Most caesareans are carried out under spinal or epidural anaesthetic.

This mean you'll be awake, but the lower part of your body is numbed so you will not feel any pain.

During the procedure:

  • a screen is placed across your body so you cannot see what's being done – the doctors and nurses will let you know what's happening
  • a cut about 10 to 20cm long will usually be made across your lower tummy and womb so your baby can be delivered
  • you may feel some tugging and pulling during the procedure
  • you and your birth partner will be able to see and hold your baby as soon as they have been delivered if they're well – a baby born by emergency caesarean because of foetal distress may be taken straight to a paediatrician for resuscitation

The whole operation normally takes about 40 to 50 minutes.

Occasionally, a general anaesthetic (where you're asleep) may be used, particularly if the baby needs to be delivered more quickly.

Find out more about how a caesarean is carried out

Recovering from a caesarean

Recovering from a caesarean usually takes longer than recovering from a vaginal delivery.

The average stay in hospital after a caesarean is around 3 or 4 days, compared with an average of 1 or 2 days for a vaginal birth.

You may experience some discomfort in your tummy for the first few days. You'll be offered painkillers to help with this.

When you go home, you'll need to take things easy at first. You may need to avoid some activities, such as driving, until you have had your postnatal check-up with the doctor at 6 weeks.

The wound in your tummy will eventually form a scar. This may be obvious at first, but it should fade with time and will often be hidden in your pubic hair.

Recovering in hospital

The average stay in hospital after a caesarean is around 3 or 4 days.

You may be able to go home sooner than this if both you and your baby are well.

While in hospital:

  • you'll be given painkillers to reduce any discomfort
  • you'll have regular close contact with your baby and can start breastfeeding
  • you'll be encouraged to get out of bed and move around as soon as possible
  • you can eat and drink as soon as you feel hungry or thirsty
  • a thin, flexible tube called a catheter will remain in your bladder for at least 12 hours
  • your wound will be covered with a dressing for at least 24 hours

When you're well enough to go home, you'll need to arrange for someone to give you a lift as you will not be able to drive for a few weeks.

Looking after your wound

Your midwife should also advise you on how to look after your wound.

You'll usually be advised to:

  • gently clean and dry the wound every day
  • wear loose, comfortable clothes and cotton underwear
  • take a painkiller if the wound is sore – for most women, it's better to take paracetamol or ibuprofen (but not aspirin) while you're breastfeeding
  • watch out for signs of infection

Non-dissolvable stitches or staples will usually be taken out by your midwife after 5 to 7 days.

Controlling pain and bleeding

Most women experience some discomfort for the first few days after a caesarean, and for some women the pain can last several weeks.

You should be given regular painkillers to take at home for as long as you need them, such as paracetamol or ibuprofen.

Aspirin and the stronger painkiller codeine present in co-codamol is not usually recommended if you're breastfeeding.

Your doctor will be able to advise you on the most suitable painkiller for you to take.

You may also have some vaginal bleeding.

Use sanitary pads rather than tampons to reduce the risk of spreading infection into the vagina, and get medical advice if the bleeding is heavy.

You can also ask a GP at your 6-week postnatal check.

Reference nhs.uk

How big will my C-Section scar be?

A standard c-section scar will be around 10-12cm long, and sits where the bikini line is at the bottom of your abdomen (tummy). This is the same for a planned or unplanned operation. In some extreme circumstances, it may be necessary to perform what’s known as a classical incision, a vertical cut from your belly button downwards. Even rarer still, when they have tried the horizontal way and then go on to the vertical, leaving you with an inverted T shape scar. I have only seen this once in my 14 years experience and it was an exceptional case.

3 weeks post c-section with first baby, courtesy of Lycrawidow.com

What sort of stitches are used for a C-Section and how are they removed?

Mostly the surgeons will use dissolvable stitches inside and out, so you won’t have to worry about them being removed. The other type is called prolene with beads, where they use dissolvable stitches inside, then a running stitch along the skin, leaving a plastic bead each side of the scar. Around day 5 (the day of the birth being day 0), the stitch will be removed by cutting one of the beads, then your Midwife will gently place a hand over the scar and pull the other side to take the stitch out. It sounds worse than it is, they come out very easily. The last type of stitch that may be used is staples. These are becoming less popular, but still may be used in some cases. They are like the staples you use in an office, and again will need to be removed around day 5. Your Midwife will have a special sterile staples remover and will take them out one by one. You will feel them being removed but it isn’t very painful. Removing the dressing is often described as the worst part, especially if the pubic hair catches.

c-section-scar-what-to-use
5 days post c-section 2nd baby, with staples. Courtesy of Lycrawidow.com

How long will my C-Section dressing stay on for and will it need changing?

This may vary according to your local hospital where you had your c-section. At the moment where I work, they put on a gel type dressing directly after the operation, which promotes wound healing and helps prevent infection. It’s also waterproof. You then have that removed on day 5, or you can remove it yourself. It’s very sticky, but your Midwife will know the best way to remove it gently. Another method is to place a large white plaster type dressing on after the operation, then the next day when you get up to have a shower it is removed. The dressing is not usually replaced, as it’s better for healing to be open to the air. You should allow some time for the wound to be open to the air, keep it clean and dry, wear loose clothing and big knickers! If there is still some oozing from the scar or you find it rubs on your clothes, put a large maternity sanitary towel over the wound to make it more comfortable.

What can I use to help my C-Section scar heal?

It is not compulsory to use anything on your scar, as it will heal naturally. However, there are some proven methods that can improve the chances of optimum healing and reduced scarring, particularly if you have a history of Keloid or Hypertrophic scarring (raised and/or red scarring, increasing beyond the original scar in the case of Keloid scarring). Here are some of the treatments you may have heard of, or people may recommend and some more information to help you decide what to use. I would recommend getting whichever treatment in advance if you are planning a c-section. They are all safe for use whilst breastfeeding.

Vitamin E

Creams and oils that include vitamin E can help with scar healing, although studies show that they perform better when used in combination with a silicone therapy (Tanaydin et al, 2016).

Silicone gel

Silicone has long been used in medicine as a safe clinical material, and the benefits of silicone on wound healing and prevention and reduction of Keloid and Hypertrophic scars has been thoroughly researched. In an observational study of 105 patients, Sandhofer and Schauer (2012) examined the effectiveness of silicone gel in accelerating epithelialisation, reducing inflammation and preventing scarring. They observed that silicone reduced wound healing time and scar formation, and that it could be used in combination with other treatments. In October 2017, a quick-drying silicone scar gel, containing five different types of silicone called Nourisil MD was launched, and became available for prescription on the NHS drug tariff from February 2018. Nourisil™ MD helps to flatten, soften and smooth scars, relieve the itching and discomfort of the skin caused by scars, as well as reduce any associated pain and redness. You can also buy Nourisil MD silicone gel yourself from Amazon, it does not need a prescription, although you may be able to ask for it from your GP prior to your planned C-Section and you won’t have to pay under the maternity exemption.

Silicone sheets

Kim et al (2014) randomly assigned 30 surgical scar patients to treatment with either silicone gel sheeting or a topical silicone gel. Their results found no significant difference in efficacy, but that topical products were more convenient, and advocated the use of topical silicone gels as a first-line therapy in the management of postoperative scars. The gel also dries quicker and leaves no sticky residue.

Turmeric

Turmeric seems a cure all at the moment, but it does contain the yellow pigment curcumins, which have been shown in studies to reduce inflammation, and contains antiviral and antibacterial properties. You can get Turmeric supplements in tablet or liquid form, or just use it in cooking during your recovery. There are Turmeric creams, but none I can find specific for c-section scars. Mahmudi (2015) concluded in his randomised double-blind trial into the use of Turmeric cream that Turmeric was effective in faster healing of wounds after a Cesarean.

Fusidic Acid Cream or Ointment

This is an antibacterial cream and often prescribed by the GP if you are developing signs of infection.

Hypericum perforatum (St John’s Wort)

St John’s Wort ointment or cream can be used, there may be some benefits to scar formation. A study performed by Samadi et al (2015) of 144 women were divided into a treatment group receiving an ointment of St. John’s wort 24 hours post-operation, a placebo group who received a placebo ointment 24 hours post-operation, and a control group who received no treatment. The study found a significant difference in the St. John’s wort group’s wound healing and scar formation from the placebo and control group, while there was little difference in wound healing or scar formation. Compared to the placebo and control group, using St. John’s wort ointment 24 hours post-operation, significantly led to faster wound healing, less pain and itchiness, and lowered instances of pigmentation, raised height, and lack of pliability.

Honey

Honey is so versatile, with elements of honey that can help you get pregnant, there are also parts of honey that are brilliant for eczema and wound healing. It is sticky to apply though!

Lavender

Lavender essential oil is known for its relaxation properties, and a few drops in the bath can work wonders after the early days. It’s also a good pain reliever and has antimicrobial properties. You can get lavender creams too, which have shown some small benefits to scar healing.

Aloe Vera Gel

Aloe vera gel is purported to be good for burns and as a soothing gel for skin problems, but the effects on cesarean section scars is not proven. According to a randomised double blind clinical trial by Molazem et al (2014) they concluded that there was a slight improvement after 24 hours post c-section, but that at 8 days post op, there was little difference between the Aloe Vera group and the control group.

Arnica Gel/ Tablets

Arnica is a homeopathic remedy you can take in tablet form or gel form. It is said to relieve bruising, pain and inflammation. There is scant evidence that it works, but anecdotally women find it helpful in their recovery.

In conclusion, the best option that has a proven evidence base is the silicone treatment, with a silicone gel combined with vitamin E offering the best results and a more comfortable way to apply it. The new silicone gel Nourisil MD is the best one in the UK market at the moment. With alternative remedies, dose standardisation and quality control are two of the challenges in applying such products to clinical settings.

What are the guidelines for using gels, oils and creams on my C-Section scar?

You must wait until the stitches have been removed and only after the wound has healed and the skin surface is intact, so no broken skin. If there is any possibility of infection, you must only use ointments or creams if they are prescribed. If any part of the skin is broken around the scar you must wait. With alternative remedies such as Turmeric, honey, lavender and Arnica, the dosage and application is harder to quantify unless you have specific instructions from your therapist. If you have been prescribed a cream from your GP, they will come with guidelines.

For quick drying silicone gel such as Nourisil MD, there are specific guidelines:

  • Wash hands before and after use.
  • Ensure the skin area is clean and dry.
  • Remove cap from dispenser. Press the pump a few times to make the gel appear.
  • Gently massage a small amount of Nourisil™ MD on the scar and allow to dry. If needed, carefully wipe away any excess with a tissue to avoid staining of clothing.
  • Once dry, Nourisil™ MD may be covered with sun block or cosmetics.
  • Apply Nourisil™ MD twice daily; once in the morning and once at night.
  • The recommended duration of treatment is 60-90 days. For larger or older scars, longer treatment may be required.

Nourisil™ MD contains safe ingredients and is suitable for the use on skin types of all ethnic background and on children. Nourisil™ MD should not be applied on dermatological conditions that disrupt the integrity of the skin. There are no severe safety risks expected for Nourisil™ MD, if used appropriately on adults and children. Any risks associated with the use of Nourisil™ MD are likely acceptable when weighed against the benefits to the patient. Nourisil™ MD can be applied only after the wound has healed (or sutures are removed) and the skin surface is intact. Nourisil™ MD should not be brought in contact with mucous membranes or applied too close to the eyes.

General Recovery Tips For C-Section Mums

c-section-scar-what-to-use

Be kind to yourself – you’ve had major abdominal surgery! Whilst most people recovering from surgery are encouraged to rest and recuperate, you’re handed a baby, expected to feed and be responsible for it, often straight after the surgery. Make sure you ask for help picking up the baby, for suitable positions for breastfeeding and pain relief when you need it. Some hospitals allow partners or close relatives to stay with you, which will help. When you go home, don’t be tempted to get back into your routine, particularly housework and childcare. Learn to delegate! Here are some general tips which may have some effect on your wound healing:

  1. Keep hydrated
  2. Eat fibre rich and iron rich foods, like fruit, leafy green vegetables and wholegrain foods
  3. Keep mobile – rest where possible but don’t sit or lie too much, keep the circulation going
  4. Wear supportive clothing and/or support bandage. It won’t help with the wound or getting your tummy to go down quicker, but it will make you feel more comfortable
  5. Avoid anything perfumed or containing alcohol on your skin
  6. Keep the wound clean and dry
  7. Pat dry rather than rub dry

How long until I can resume normal activity after a C-Section?

It takes approximately 6 weeks for the wound to fully heal and when you can resume your normal activity. Before then, light activity is fine, and listen to your own body. Do not do any heavy lifting, anything heavier than your baby is a no-no. Driving is down to when you feel ready, I would say at least wait until 7 days, and consult your insurance documents or speak to your provider. As Midwives, we tell women that when they can wear a seat belt comfortably and would feel comfortable in performing an emergency stop, then you’re ready to drive. You may feel numb around the scar for quite some time, with some women never regaining total feeling in that immediate area. Your scar will likely remain red for up to a year afterwards, then fading to silvery white. You can resume sexual activity whenever the vaginal bleeding stops and when you feel ready, there is no set time. You will still get the same vaginal bleeding regardless of the mode of delivery.

5 months post c-section scar example, via Lycrawidow.com, no topical treatment


Reference: How to Look after your C-section Scar written by Midwife, Nurse, Author and Mum of 3 Jenny from midwifeandlife.com

Future pregnancies after a caesarean

If you have a baby by caesarean, it does not necessarily mean that any babies you have in the future will also have to be delivered this way.

Most women who have had a caesarean section can safely have a vaginal delivery for their next baby, known as vaginal birth after caesarean (VBAC).

But you may need some extra monitoring during labour just to make sure everything is progressing well.

Some women may be advised to have another caesarean if they have another baby.

This depends on whether a caesarean is still the safest option for them and their baby.

For more information, the Royal College of Obstetricians and Gynaecologists has a leaflet on birth options after previous caesarean section (PDF, 357kb).

Reference nhs.uk

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