Cesarean Sections. Understanding Scars, And Helping Them Heal.
- Sam Reynolds
- Apr 27
- 6 min read
This month I have handed over the MBS blog to my incredible friend and past fascia therapist, Jenny Walker. Having had an unexpected c section myself, this area is such an important part of postpartum recovery, but I wanted Jenny to help us realise what c section rehabilitation is all about, without all the medical blurb! Women to women!
Before I retired from being a full time physical rehabilitation therapist, I had latterly enjoyed 15 years helping people recover from traumatic scarring. Mastectomies, hysterectomies, and cesarean scars held specific interest for me, as treating them helped women re-enage with their bodies in new ways, gave them room to talk about their experiences, reduce pain that the scars were producing, as well as giving them the tools to learn how to look after themselves in a positive and healthy manner. To be able to give you a little insight into the subject of cesarean scarring here on Sam’s blog is such fun! I have spared you the technical jargon so that you can understand the subject better, and added helpful links at the end so you can investigate more in your own time.
Why Don’t We Talk About The Scars?
Giving birth through cesarean section is fast becoming the norm, with 42% of all babies in the UK being delivered into this topsy turvy world this way. So why don’t we talk about it more, and why do we shy away from signposting great advice to help Mumma’s after they have had major abdominal surgery, whilst giving birth?
I remember hearing some incredibly painful stories from women in my rehab studio, and one woman vividly stays in my memories. She was expecting triplets, and due to numerous health concerns, she had been advised by her consultant that a C-Section was the best option. She took their advice and had a very healthy birth, and her hands have never been empty since! However, when she attended a new Mums group, she felt shamed by the woman leading it, who told my client that she had not given her children the best start in life as she did not give birth virginally, and had instead ‘selfishly opted for the easier option’.
The truth is that there are still so many pre-conceived ideas and presumptions about cesarean births that it is little wonder there are so many issues around helping Mumma after Babe has arrived. The scars that women carry on, and in, their tummies are so much more than physical reminders of what they have been through; they are psychological battle fields that they have had to win.
Fascia Is Scar Tissue.
When I met Sam, I had the honour of treating her through her cancer journey, so we talked a lot about her cesarean and hysterectomy scars, and we always referred to it as her ‘Icebergs’!
Healthy fascia is a beautiful web made of collagen, elastine, and ground substance that flows through your whole body. Some of it is very thick, like the sheaths of plantarfascia on the soles of your feet, the retinaculum that spans across your lower back, or the wonderful galea aponeurosis that covers the bones of your head like a protective cap. Other fascia is golden and fluffy, and we can see this in different depths all around the body, with older anatomy books calling it ‘a fatty layer’, or as we now correctly call it, your superficial fascia layer. No matter where it is in your body, fascia forms your body, and takes the tension and strain of each movement that you make. Quite simply, it is your matrix.
When we see a scar on the skin after an operation, it tends to look quite neat with the two edges nicely stuck together. However, when we look at the depth of that scar, we can see it spread out like an iceberg. The fascia has thrown out its web to stick to whatever it can find to help pull us back together, and it really does not care if it looks pretty or not, it just needs to be stable!
When superficial and deep fascia have been cut (along with the skin and abdominal muscles), to help get Baby out, it is little wonder that your body decided to lay down some super thick scars. Think about it; your surgeon has had their hands in you to pull your baby out - ‘a little bit of tugging’ can feel more like someone rooting around in your handbag, during your op!
This is why many women say that they feel pulling on their hip bones after they have had a cesarean birth, or if they are experiencing pain during intercourse after giving birth through c-sections, or if the deep lower back pain that they never had before the operation doesn’t go away. Fascia scarring may have webbed its way across muscles, internal organs, and bones to make sure you are knitted back together. Fascia tissue is scar tissue, and instead of being neatly aligned and flowing, it looks dense and unorganised. Your scar needs to become functional and healthy, rather than stuck and unable to offer you freedom of movement.
Sensitisation
Some clients I helped felt their scars were numb, others just hated them and said they felt they were ugly and couldn’t look at them. Scars can be hard to engage with, and that’s totally normal, whether because you can’t feel them due to nerve damage, or psychologically as they are pretty scary.
The thing to remember is that they are doing a wonderful job at keeping you whole. But they do need to be taken care of, as they are part of you, and you deserve to be taken care of as a whole. Massage, physiotherapy, movement therapy, and simple kindness, can help the sensations become more normalised.
Helping Hands
In the studio, I would work through myofascial release and structural integration to help scars release from their anchor sites and allow my clients space to realign; our aim was always to bring freedom of movement, as well as allowing the nerves to either calm down, or speak up, depending on their needs. However, we would always spend time at the end of the session to go through how to massage their scars at home.
The golden rules are:
Only massage your scar after it is free of bandaids, scabs and stitches.
Use a massage oil you love, but preferably one with comfrey and/or rosehip as base oils.
Massage around the scar, on the scar, (and anywhere that your body needs!).
Use your fingers gently on and around the scar in horizontal, then vertical, and then circular motions.
Try to massage your scar once or twice a day for five minutes each time.
At first scars feel thick and unmovable, but the more you massage them the softer they get. You will also learn how to feel them; follow them where they lead, as the edges of them will be wider than the marks you see on your skin.
I would always advise that you work with a physiotherapist that specialises in postpartum, as scars can be helped through movement work that helps to release the tension bound in the pelvis. Physiotherapists can also help you see where the scar tissue may be ‘pulling’, and so creating adverse alignment within your body, and their skill sets are there to help you feel easier within your form.
Working with Doulas like Sam who are trained in postpartum massage can be a wonderful way to restore your body. They will not only help you connect with your inner-self, but also give a safe space to relax, breathe deep and come to a point of release from the trauma that you have been through. Sam concentrates in creative healing touch, and works with gently allowing your pelvis to find its new position after birth through binding and rocking techniques. It’s a deeply nurturing session, and one that I personally feel can only benefit your overall health as you heal from birthing.
Scars do pull you about, they can hurt, and they are 20% weaker than regular fascia tissue, so don’t ignore them or think that just because an arbitrary 6 weeks has passed since you gave birth you should be fixed. (To be honest, that 6 week fiction is total hogswash, as it can take two years for a scar to settle.) It is also never too late to find help with scar management; they can often be coaxed into a healthier space with a little time and gentle healing.
You have been through a lot with a cesarean birth; it is never the easier option. Birth is hard work which requires a lot of healing to follow, no matter how your wonderful babe came into the world. Be kind to yourself, invest in time with your Doula, and cherish this time as you become a new Mumma to your babe.
With many blessings,
Jenny Walker
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