C-Section Scars 101

What women want and need to know about the most common scar in America.

C-section-scars_700x700_getty-91801289.jpg Photo: gettyimages.com

There's no avoiding it. Pregnancy permanently changes you. Some women come through pregnancy with smooth bellies and unmarked skin but most of us have a few souvenirs like stretch marks, saggy skin, poochy tummies and surgical scars. Now that more than a third of all babies are delivered by c-section a third of all Moms have c-section scars. Here are a few FAQs about the most common surgical scar around.

How big is a c-section scar? Surprisingly small. Most baby-heads fit through a four to six-inch skin incision made horizontally just below the pubic hairline. The abdominal muscles are moved aside (not cut through) and a horizontal incision is made in the uterus. In rare cases, doctors make a vertical incision from below Mom's belly button to the pubic bone. That's pretty unusual in the US and most developed countries and only used in extreme emergencies when they don't have time to do the more intricate and less visible "bikini" incision. If they do a vertical skin incision, they're likely to do a vertical uterine incision too.

What do c-section scars look like after they heal? Since they're usually made below the pubic hairline, you might not see your scar at all. It'll look red or pink for several months but eventually it fades to a pale, flat, thin line. Some women create bigger, thicker or raised scars than others but they are rarely very obvious. As a matter of fact, many of the bikini-clad women you see at the beach or pool have c-section scars and you never notice them.

Can you do anything to encourage your scar to heal well? Eat well so your body has the right nutrients for healing and creating healthy tissues. Keep it clean during the initial healing period to prevent infection. Avoid heavy lifting, housework or any big movements that might stretch or irritate the scar for the first six weeks. You can try topical creams and ointments that have varying success rates for promoting healing.

Why does a c-section scar prevent you from having a vaginal birth with your next birth? In more than 99% of cases, c-section scars heal well and create strong tissues that knit the uterine tissue back together. It's almost always strong enough to withstand the stretching of another pregnancy and pressure of contractions. In very rare cases however, the scar can tear. This is more common (but still rare) with vertical incisions than horizontal ones (which is one of the reasons vertical incisions aren't done very often). If that scar tears, (called uterine rupture), it causes massive bleeding (hemorrhage) and is a life threatening emergency for both mother and baby.

But if uterine rupture is so rare, why won't many doctors and hospitals do vaginal births after cesarean (VBAC)? Because, they can't afford to take the risk even though the American College of Obstetricians and Gynecologists say it's usually safe. Insurance providers won't cover them (or make it crazy-expensive) if they do VBACs. ACOG says about 60-80% of women who attempt labor after a c-section successfully deliver their babies vaginally. Currently, only about 8% of births are by VBAC. Scars are usually pretty strong but apparently, insurance companies and liability risks are stronger.

What are other complications with c-section scars? Usually none, once it has healed properly. In some cases though, it changes the way the placenta grows in the next pregnancy. The more c-sections she has, the greater a woman's risk.

Women who have a scar on their uterus are more likely to develop placenta previa. That's when the placenta grows over the opening to her cervix. There's no way to safely deliver a baby vaginally if there's a placenta in the way. Placenta previa is associated with increased risk for serious bleeding, shock, blood transfusions, and hysterectomies.

Placenta accreta is also more common in a scarred uterus. That's when the placenta grows through the scar tissue and/or attaches to the uterine muscle. This increases risks for premature delivery and bleeding during pregnancy, labor and birth. It also makes it difficult for the placenta to separate from the uterine wall after birth and can cause hemorrhage. In rare cases when doctors have a really tough time separating the placenta from the uterine wall, they just have to take out the uterus.

Will my doctor use the same scar for my next c-section? Yes, almost every time.

If you're among the growing percentage of women who will have (or have had) a c-section, the odds are in your favor you'll be just fine. Yes, c-sections increase your risks for complications but they're still a very safe operation most of the time. They're the most frequently performed surgery here in the US and that means there are a whole lot of scars out there. You're in good company.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to jeanne@jeannefaulkner.com.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.