After a caesarean section, care and massages are necessary for healing. The young mother must also pay attention to her activities. What is prohibited? When to start rehabilitation? What if the scar opens? Dr. Cécile Pénager, obstetrician-gynecologist, Dr. Luka Velemir, obstetrician-gynecologist surgeon and midwife Céline Hattab Braha enlighten us.
For some pregnancies, a planned or emergency caesarean section is needed to deliver the baby. The surgeon then performs a surgical intervention and makes a fairly low horizontal incision just above the pubic bone, in order to extract the baby from the uterus. After the caesarean section, the young mother finds herself with a ten centimeter scar at the level of the pubis and a belly that is still quite swollen. Following this operation, it is recommended to massage his scar regularly to avoid sticking. Pain can also be felt (scar that shoots). What if the scar opens? What care should be taken? What is prohibited? When to resume sport, and reports? Answers with Dr. Cécile Pénager, obstetrician-gynecologist, Dr. Luka Velemir, obstetrician-gynecologist surgeon, and midwife Céline Hattab Braha.
After a caesarean section, the belly of the young mother does not immediately return to its initial shape. “The uterus will continue what is called uterine involution, that is to say, it will go down into the pubis. So after a cesarean section, for about two months, the belly resembles that of a pregnant woman of about 4-5 months. It regresses until the uterus returns to the pubis.” explains Céline Hattab Braha, midwife.
Moreover, the appearance of the abdominals will also evolve. “After a caesarean section, there is what is called a rectus diastasis, like abdominal swelling. Abdominal rehabilitation after that of the perineum can be useful, to have a normal belly shape by putting the abdominals back in their place”, adds the professional.
What is the care of the post cesarean scar?
Depending on the gynecologist, there may be threads on the scar, threads under the skin that cannot be seen or staples. Dr. Pénager advocates very simple treatments for his patients.
► Cleansing the scar. “As soon as the dressing is removed, i.e. the day after the operation, I recommend daily washing with soap and water. Then rinse well, then pat dry“, she explains. It is very important to ensure that this area is very dry and that there is no maceration, so that the healing takes place.
► When there are non-absorbable sutures or staples, they are removed 7 days after the cesarean section by a home nurse. After the threads are removed, the mother monitors at home that the scar is not hard or red, that there are no swellings or secretions. “If ever there is a problem, you must see a health professional, general practitioner, midwife or gynecologist“ insists the gynecologist. After 15 days, the scar begins to be very thin.
► Massage the scar. After one to two months, you can start massage the scar with moisturizer to soften it and allow the skin to regain its suppleness. This also helps to avoid adhesions.
“As soon as the dressing is removed, ie the day after the operation, I recommend daily washing with soap and water”.
What are the risks in the days following a caesarean section?
Caesarean section is a surgical procedure that involves risks, even if in the vast majority of cases, everything goes very well. “Immediately, after a caesarean section, we pay particular attention to maternity and in the days that follow. But this is really very short-term monitoring. The main risk is that of infection of the uterus or infection of the scar which can occur up to 7 to 10 days after the operation. It is for this reason that we monitor the temperature of the mothers well and that we make sure that she does not have pain in the belly”, explains Dr Pénager. The latter specifies that the other risk within 24 hours after caesarean section is that of postpartum hemorrhage. The mother is monitored in the recovery room, then in the service, to check that there is no blood loss greater than normal.
What if the scar opens after a caesarean section?
If the scar opens when it was closed, the young mother must go immediately to the hospital. “In case of opening, very strong pain, redness, discharge or swelling at the level of the scar, you must go to the maternity emergency room without delay”, informs Céline Hattab Braha. The doctor will examine the scar and if there is an infection, he can prescribe an appropriate treatment. A nurse can come home to irrigate the wound with saline solution until there is no more infection.
How long does the pain from the scar last?
The duration of post cesarean pain can vary from a few days to a good month depending on each woman and the surgical technique used. Except in the case of a complex caesarean (haemorrhages, infections, etc.), the feelings of tightness and tingling fade after one to two weeks. “The pain is quite severe the first two to three days, then mild to moderate for up to two weeks.“, wants to reassure Dr. Luka Velemir, gynecologist-obstetrician surgeon. A woman who has had an emergency caesarean section often has more pain than a woman who gave birth with a planned caesarean section.because “the woman, in labor, has her uterus contracted, much more irritated and therefore more painful“, he specifies. In the event of discomfort or pain, the patients have sedative protocols adapted to their pain: the paracetamol and anti-inflammatory combo is enough to calm post-operative pain.
When can we do the rehabilitation of the perineum after a cesarean section?
After a caesarean section or vaginal delivery, you have to wait 6 to 8 weeks to rehabilitate the perineum. “This is the time necessary for all the organs to return to their place, for the abdominal wall to return to its place and to resolidify“, explains Dr. Pénager. The perineum will be assessed during the postnatal visit, 6 to 8 weeks after cesarean section. “Following this examination, rehabilitation of the perineum is prescribed, or not. It is not systematic in women who have no sign of weakness of the perineum and good tone on examination.”, adds the doctor. You can also prescribe abdominal rehabilitation performed by a physiotherapist, but this too is not systematic and depends on the clinical examination.
The best position for sleeping after a caesarean is still lying on your back. This makes it possible not to press on the scar if it is painful. Over the weeks and if the healing is going well, you will be able to sleep on your side little by little and then resume your habits.
What is prohibited after a caesarean section?
Having had a caesarean section, the young mother cannot resume her habits overnight. She must pay attention to the gestures and activities she is doing, and this for at least 6 to 8 weeks. Moreover, the day after the caesarean section, it is almost impossible to stand up, the mother walks a little bent, in general during her stay in the maternity ward.
- “During the two months following a caesarean section, it is recommended to do not carry a heavy load, apart from the baby. This avoids using the abdominals, details Céline Hattab Braha.
- Do not do ride too long.
- “Avoid sports that are too intense as long as the perineal rehabilitation is not finished”
- Do not take bath.
- Don’t go to the seanor to the pool.
Can you carry your baby after a caesarean section?
If it is not recommended to carry heavy loads, nature is well done, since it is quite possible to carry your newborn. On the other hand, we avoid carrying the eldest if he is taller and already weighs a lot. “The mother can completely carry her baby.“, reassures Dr. Cécile Pénager, who however specifies that the first day, the pain is more important than during a childbirth by natural means. It is for this reason that it is necessary to accept the painkillers prescribed by the doctor. ‘medical team. “A few hours after birth, the mother can get up with the help of a nurse, and start taking care of her baby. She doesn’t have to worry about the wires breaking, there really is no risk“, says Dr. Pénager. While it is important for the mother to mobilize, she must however work her abdominals as little as possible.
When can I resume intercourse after a caesarean section?
There is no contraindication to resuming sexual intercourse 3 weeks after a caesarean section, the period of time generally necessary for the young mother to recover from childbirth, from the fatigue associated with the baby. “But the patient resumes sexual intercourse especially when she is ready! It all depends on how comfortable she is, how she feels. She must do according to her feelings, wait if she has pain and resume later.“, observes the gynecologist.
When can you resume sport after a caesarean section?
Just like for the rehabilitation of the perineum, it is recommended not to play sports 6 to 8 weeks after the cesarean section. “After two months, when healing has taken place, you can start doing abs and running again. But the intensity of the practice must be dictated by the feelings of the patient..”, recommends Dr. Pénager.
When to get pregnant again after a caesarean section?
This is a question that many women ask themselves. “One year is enough to get pregnant again after a caesarean section : this is the ideal time to avoid increasing the risk of prematurity, hemorrhage in the third trimester, uterine infection or anemia in the mother“, says Dr. Luka Velemir, gynecologist-obstetrician surgeon.
“The latest scientific studies have also shown that we do not increase the risks of a new pregnancy if we wait at least 12 months between delivery by cesarean section and the start of a new pregnancy.“. On the other hand, before 12 months, the risk of rupture of the uterus during vaginal delivery is a bit bigger.
Thanks to Dr Cécile Pénager, gynecologist-obstetrician, Dr. Luka Velemir, gynecologist-obstetrician surgeon in Nice, and Céline Hattab Braha, liberal midwife in Paris.