As explained in part 1 of this series, a caesarean section is an abdominal operation and there are different phases you need to take into account. Now is not the time to start exercising any which way, or to eat without a nutritional plan, or for huge or tiny portions. There are ways and then there are SMART ways. Smart means time-efficient, especially from the very beginning, so as not to have to deal with issues arising from your caesarean birth for a long time or be affected by them in the future.

We have also gone through how important it is to process your surgery emotionally and how you can start to help your body heal in the best way possible with the help of your diet. Today we want to talk about C-section scars.

There are 3 different stages of scar healing:

Phase 1: Inflammatory phase
The inflammatory phase is the first phase and starts the second you get a wound. This is followed by coagulation and the removal of bacteria, dead tissue and foreign objects from the wound. This process causes swelling and heat. Fluid may also seep out of the wound.

The dead cells release substances that irritate nerve endings, causing pain. Once the area is cleaned up, the inflammation period ends.

Phase 2: Proliferative stage
This is the start of the growth phase and new formation. Collagen and ground substance are produced and the skin regenerates gradually, starting from the bottom of the wound, gradually causing the wound to close.

This phase can take anything from a few days up to a few weeks.

Phase 3: Remodelling phase
There is now a remodelling phase and scar tissue is formed. Blood vessels that are no longer needed disappear and this causes the scar to fade. How the scar looks depends on how much collagen is needed. Collagen forms into clumps to make the wound as resistant as possible.

Your scar, regardless of its size and age, can affect you more than you think – in terms of both muscle function and core stability. Scars are linked to our nervous system, and scar tissue (which can be caused by a caesarean section) can affect you locally in the form of loss of sensation – which is also very common among women who have had a caesarean section. How the scar may affect your nervous system depends on the scar’s orientation. Is the scar horizontal or vertical? Horizontal scars tighten much more than vertical scars and will therefore affect your body more than vertical scars. The most common Caesarean section today is what is known as a bikini incision, i.e. a horizontal incision.

The scar can be located in the muscles and connective tissue (fascia), so you may experience problems with your core and hips. Muscles that are affected by a caesarean section are: the rectus abdominis (known as the six-pack), the transverse abdominis (the deep abdominal muscle that goes around the entire torso), the hip flexors and the front of the thighs.

The scar itself is not just the part you see with your eyes, it goes deeper than that.

Skin consists of three layers: the epidermis, dermis and hypodermis.

The epidermis is the part of the skin you see, and it’s made up of keratinocytes and dead cells. This makes the skin resistant to external stresses.

There are plenty of blood vessels in the dermis to supply oxygen and nutrients. The dermis consists of connective tissue, which contains abundant protein fibres of collagen and elastin. This is why the dermis is strong and supple (the elastin is responsible for restoring the elasticity of the skin after it has been stretched). With age, the number of elastic fibres decreases, therefore the skin becomes looser and wrinkles appear. The dermis also contains lymphatic vessels, sensory receptors, nerves, hair follicles, sebaceous glands and sweat glands. There are different types of sensory receptors, and they respond to different sensations such as touch, pressure, heat and coldness. The skin also contains nerves that respond to pain, and these signals are subsequently transmitted to the brain.

The hypodermis contains fat cells that are heat-insulating and shock-absorbing. Underneath the hypodermis lies the fascia that surrounds every muscle, nerve, bone and organ. The fascia connects the whole body into one unit, think ‘suit’ and you get the idea.

As mentioned above, there are several layers of skin and scar tissue can form in all of these layers. In some cases, the scar tissue from different layers grows together (adhesions) and this can create stiffness and tension that can feel uncomfortable – it can also spread to the stomach, pubic bone and groin. Some women experience a lot of pain around their scar, some lose sensation in the surrounding area, and others may only experience increased tenderness, skin lumps along the scar line, pain in the lower back and pelvis, and the stomach muscles not being able to do their job.

Your skin and fascia should move freely and be able to glide apart when you move. Adhesions can restrict the skin’s mobility. One thing to try here is scar massage.

When should I start massaging?

  • Start around 6 weeks after the C-section, once your scar has dried and healed, but it’s a good idea to check with your GP at your 6-week check-up first.
  • It’s never too late to start massaging your scar. If you’ve ever had a C-section, you can start at any time, it’s not only for those who have just given birth.
  • Use coconut oil for massaging (almond oil is also good). DO NOT use vitamin E on fresh scars as vitamin E can slow down healing and some people may have an allergic reaction.
  • Start very gently and increase the pressure over time – definitely don’t use force in any way. It will probably feel strange and that is perfectly normal. Don’t pull the scar apart. Massaging shouldn’t hurt.

4-minute scar massage, spend 1 minute on each step:

From right to left: start by stroking the scar along the incision from right to left, using your 3 middle fingers. If the incision is too sensitive – you can also start with the skin above the incision and below the incision and as your skin becomes less sensitive, you can move towards the incision itself.

From left to right: same as above but in the other direction.

Use pressure: continue using three fingers, now press the area above the incision and then below the incision, from right to left and then back again.

Circles: use circular movements above the scar, around the stomach, then under the scar, towards the groin, and finally around your belly button.