Wondhealing after abdominal delivery
In this article, we would like to introduce you to the wound healing phases and treatment options for a scar after an abdominal delivery.
When healing this tissue injury, a distinction is made between four phases that contribute to wound healing: haemostasis, inflammation, proliferation and remodelling. We explain each one below.
An abdominal delivery, also known as a caesarean section, is a surgical method of delivering a baby. The baby is delivered through an incision in the mother's abdominal wall instead of through the vaginal birth canal. There are many reasons for this type of delivery, which we will not go into in detail in this article.
Anneke gave birth to her first child in this way in June 2024 and can now give you treatment recommendations from her personal perspective.
During the operation, the incision in the lower abdomen leaves a scar that requires treatment after the delivery. This aims to promote healing, alleviate pain, avoid complications and improve the cosmetic appearance. It is therefore also important for you as a mum to look after yourself so that you can take care of your little miracle. We explain below what measures can help you.
Immediately after the operation, your scar will be covered with a large plaster for the time being. There are stitches in the inner and outer area, which nowadays usually dissolve on their own and should otherwise be removed approx. 10 days after the operation. You can remove the cover (also with the help of the midwife) at the latest when the stitches are removed. There are various smaller plasters that you can use afterwards. You can apply waterproof plasters for showering, but this is not absolutely necessary. You should avoid bathing for the time being, as well as bathing in public waters (the latter anyway due to the lochia, the wound secretion of the uterus, which manifests itself as vaginal bleeding for a few weeks).
Wound healing phases
Haemostasis (a few hours):
The incision causes bleeding. Blood vessels contract in order to minimise and stop the bleeding. Various cells and proteins are involved in this process.
Inflammatory phase (a few days):
Once the bleeding has stopped, the blood vessels dilate again and the immune defence is activated by the metabolism. The affected area may swell and redden. Bacteria are flushed out of the tissue by the body's own cells.
Proliferation phase (a few weeks):
New blood vessels and tissue (collagen) are formed and scar tissue develops. During this time, it is important to find the right balance between load and unload so that the injured area regains its functionality without becoming inflamed or sticky again.
Remodelling phase (up to two years):
The final phase is the longest. It can take up to two years for the new tissue to be fully formed and stabilised.
Scar care
If there are signs of infection, such as prolonged redness, swelling or pus formation, the scar should be examined by a specialist. Regular follow-up examinations by your midwife or physiotherapist can ensure that the healing process is monitored.
Cleanliness:
Keep the scar clean, sterile and dry for the first few weeks to avoid infection.
Gentle cleaning:
Use only water to gently clean the scar. It is usually sufficient to simply run the water over the scar when showering.
Drying:
After showering, gently dab the scar with a clean towel, or preferably allow it to air dry properly.
Cooling:
A cooling pad can relieve swelling and pain. Never use one straight from the freezer, as this can have a negative effect on wound healing as the vessels contract due to the intense cold!
Scar creams or gels:
Products such as creams or gels can improve the appearance of the scar. You can gently massage the tissue after the stitches have been removed. We recommend the products from Decalys - Narbenfreie Hautregeneration.
Plasters:
There are silicone plasters that you can stick to the scar after giving birth. You can also use the products from Decalys - Narbenfreie Hautregeneration.
Sun protection:
Protect the scar from sunlight, especially for the first two years, as UV rays can darken the scar tissue. Use sun cream with a high sun protection factor, even if the scar is covered in the sun.
Treatment
Physiotherapy:
In all cases, physiotherapy may be recommended to improve mobility and prevent and release scar adhesions. At Physio Restart, we use kinesiotape and cupping glasses as well as manual techniques and exercises for stretching and stabilisation.
Kinesiotape:
You can use tape after the stitches have been removed. The tape has a decongestant effect and can reduce the firmness of the scar tissue. We physiotherapists can also help here.
Laser:
Your postnatal midwife can offer you treatment with the CO2 laser quite early on. Small pulses of energy can favour the stimulation of new collagen.
Massage:
After the stitches have been removed and the scar has healed externally (4 weeks at the earliest), a more intensive massage of the scar can help to promote blood circulation and make the scar tissue (collagen) more supple. You should massage in different directions and also pinch the scar with your fingers. Include the tissue above and below the scar. Massaging the entire abdominal wall helps to restore the internal organs and the entire fascia.
Important: We recommend that you take frequent breaks with the plasters and tape so that the scar can be treated with the other options and also get some air. For example, you can use the plaster for 3 days, leave the scar free for 1-2 days, massage it and then use the tape for 3 days.
Do you have any questions or need support? Get in touch with us.
Author:
Anneke Penny
References:
Wallace HA, Basehore BM, Zito PM. Wound Healing Phases. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470443/