When managing patients sometimes it is important to put yourself in their shoes. In this blog, Kathryn Gutteridge, consultant midwife and mother, tackles one of the toughest challenges new mums face: accepting their new body post-caesarean. She shares advice with a focus on post-caesarean skincare, including how to manage expectations and empower mothers by providing them with the knowledge to encourage self-care.
Birth by caesarean: a mothers’ initial thoughts
Now the baby is here, it can be overwhelming. Mothers may be thinking, “How do I make sense of it all and what can I do to help feel myself again?” I am going to focus on how skin may be affected, which can often be overlooked.
Having a caesarean section might not have been in a mothers’ original plans for the birth of their baby and, as such, they may not have given it much thought. Most women today have a caesarean section for a medical reason, be that for something to do with their health or that of their baby. It is worth knowing that, although caesarean section is a common operation today, it is not a small procedure; it could be compared to a hysterectomy (removal of the womb) which should give an idea about what might be involved.
Aspects to consider:
During the next few days, many changes are happening in the mother’s body and scar. Having just given birth they are getting rid of lots of fluid, hormones are changing (again) and they will find that their breasts are changing to give their baby the milk it needs. As far as their scar is concerned, the cut should be clean and dry, although there may be a small amount of leakage but this is usually very slight. The leakage is sometimes called exudate (some valuable fluid composed of serum, fibrin, and white blood cells) which bathes the scar with nutrients to speed up healing. This process is necessary to prevent infection and bleeding. After a couple of days the wound should be dry and a dressing may no longer be necessary, although sometimes covering the scar means it is more comfortable against underwear.
After the first few days, tissue regrowth and a scab may form covering the scar, this shows normal healing. It is best to advise mothers to not to pick off the scab as this acts as a protection against bacteria and bugs entering their body. Eventually, during bathing, the scab softens and wears away, leaving behind a scar that has healed; often reddish at the start but quickly looks pink by about 6 weeks. It’s worth reminding mothers that the body has been through major surgery so time and lots of self-care will make a difference to healing.
Pain and Soreness
It’s important for a midwife to let mothers know that it is very normal to experience pain in the first few hours and days. Pain comes from the nerves and muscles being cut and therefore time is needed for healing to help this. Community midwives should continue to check the mother’s wound once they arrive home and advise that they take simple pain relief such as paracetamol or ibuprofen as prescribed by the hospital before they were discharged.
If the pain appears to be more than it should, it is best to look for any complications that may be causing it; for instance it could be haemotoma (a bruise or collection of blood behind the scar), infection or something not so obvious. In this case, it may be advisable to ask a doctor to further diagnose what might be happening.
If the skin around the scar looks red, and particularly if it feels hot, then there may be an issue with healing. This could be anything from mild irritation to infection. To explore the problem further, it’s advisable to check over the mother, in particular her temperature and pulse (these change if they are infected).
If the redness is where the dressing has been in place then it may be likely that the mother has had an allergic reaction to the product that was used. An antihistamine treatment (a product that reduces the reaction, sometimes cream or tablets) could help with this.
The skin is very forgiving and will tolerate a great deal however sometimes the smallest of irritants can be the most frustrating. Itchy skin is not always a bad sign; it is usually because the body has released histamines (a compound which is released by cells in response to injury causing contraction of smooth muscle and dilation of capillaries) in response to the surgery. If you are concerned about itching, it’s worth asking the doctor to review the mother and possibly prescribe some treatment.
Another cause of this irritation may be the drugs that are used for controlling pain particularly opiate based such as morphine. These drugs will not be prescribed for very long and the doctor will ensure that the mother is given alternatives that can help.
Sticky Smelly Wound
Generally the wound will be clean and dry with no distinct smell or problems. However, because the wound is near to the genital area and most women have an overlying flap of skin, it can be difficult to ensure that it remains clean and dry. Bacteria (bugs that cause infection) love to flourish in these conditions and therefore infections are highly likely. Signs of this happening may be that the wound is sticky or moist to the touch; a smell may also be evident which wasn’t there before. If this is the case, it may be worth taking a swab to see if there are any bugs that may be harmful to the mother. It is likely that they will be prescribed antibiotics to treat their wound and prevent a serious infection.
The mother may have lost a considerable amount of blood, this will result in some women feeling tired and breathless when walking. This may be anaemia and so iron replacement treatment may be necessary. It may also be worth recommending diet rich in folates (iron rich foods). Folate is found naturally in many foods so it is relatively easy to introduce into daily meals. These foods include asparagus, broccoli, nuts and seeds, eggs, and citrus fruits such as oranges, grapefruit, lemons and limes. Now there are many recipes online that can help guide mothers in eating a diet rich in folate.
Further aftercare advice for mothers:
- Encourage mothers to rest and take any help that is provided whilst they are getting to know their new baby and body.
- Recommend that they eat small and frequent nourishing meals and, just as importantly, drink plenty of fresh water as they will find they are increasingly thirsty
- Advise them to bathe regularly.
- It is important to ensure that the skin is clean and dry at all times. When taking a shower or bath, they should use a clean dry towel to dab the wound afterwards and avoid using any products on the scar itself as this may cause irritation and delay healing.
- Once the scar is healing, they should try to leave it open for some time during the day; perhaps lie on the bed after they shower and allow the wound to dry naturally.
- Once the scab forms on the wound, remind them to avoid picking or removing it as this will naturally break away when the skin underneath is healing.
Longer term wound care
After a few weeks (approximately 6) the wound will look healed and comfortable. The scar may still look red with a ridge, this is normal for this stage. The nerve endings are still recovering and the scar will feel numb; this can continue for a long time as long as 12 months. Eventually as the skin heals all of the outward signs improve and normal sensations may return. Gentle massage of a non-irritant emollient (such as Bio-Oil Skincare Oil) can help the wound elasticity and reduce tension across the skin, increasing new cell growth and healing.
Resources for midwives:
Bio-Oil Professional has several free resources for midwives on the topic of scarring and stretch marks, free to download:
Resources for your patients: