What can cause scarring after having a baby?

During childbirth, you may get wounds from perineal tears, episiotomies or a caesarean section, which can all cause scars.

Perineal tear

A perineal tear is a tear in the skin and/or muscles of the perineum, which is the tissue that separates your vaginal opening from your anus. There are 4 levels of tears that range from a 1st degree tear, which is a small skin-deep tear that heals without stitches, to a 4th degree tear, that extends downwards from your vagina to deeper muscles near your anus or rectum. Most 3rd or 4th degree tears are repaired with surgery.

Episiotomy

An episiotomy is a cut that your doctor or midwife makes to your perineum with surgical scissors. It enlarges the opening of your vagina to help you give birth. Your healthcare professional will always ask your permission before giving you an episiotomy, and explain why they are recommending it.

Caesarean section

A caesarean section is a surgical operation. Your baby is born via a low cut in your abdomen and uterus. Caesareans may be planned or unplanned (for example, in an emergency).

How do I care for my wound?

Care for perineal tears and episiotomies

While you’re in hospital, the nurses will check your stitches daily. They dissolve by themselves.

Hygiene tips to care for your stitches

• Keep the area clean, shower daily and pour water over your wound after using the toilet.
• Change your pad every 2 to 3 hours; avoid touching the part of your pad that touches your wound.
• Keep your wound dry by gently patting it with a clean towel.
• Wash your hands with soap before and after showering, using the toilet and changing pads.
• Wipe front to back.

Tips to reduce wound discomfort or swelling

• Cold pack: Apply for 10 to 20 minutes every 2 hours, for the first 2 to 3 days.
• Positioning and movement: Lay on your side as much as possible, avoid sitting for a long time.
• Pelvic floor exercises: Begin 2 to 3 days after your baby is born, or when your physiotherapist advises you’re ready. Try 4 or 5 squeezes and lifts when feeding your baby.
• Diet and preventing constipation: A high fibre diet is recommended, drink 2 to 2.5L of fluids daily, go to the toilet when you feel the urge and try not to ‘hold on’ or avoid going.
• Compression: Apply 2 stacked pads with firm underwear.
• Pain relief: Take as prescribed.

Tips to support recovery of 3rd and 4th degree tear

• Stool softeners: Take stool softeners for 10 days after giving birth. It’s best if your stools are soft, as straining can cause stress on your wound.
• Pain management: Ask your doctor to prescribe medicine for pain relief that is safe for you and safe during breastfeeding.
• Antibiotics: After birth you will get intravenous (IV) antibiotics, and continue with oral antibiotics (for example, tablets).
• Hygiene: Keep the area clean, for example, by showering daily.

Caesarean wound

Your wound may be closed with staples or stitches. Staples are removed within 3 to 7 days. Stitches dissolve by themselves.

You may have a waterproof dressing for 2 days. Once the dressing is removed you won’t need another one unless your healthcare professional recommends it.

Tips to care for your caesarean wound

• Hygiene: Shower daily, keep your wound dry and clean, ‘air dry’ or gently dry with a clean towel. If a skin fold covers your wound, lift the skin fold and dry the area. If your skin fold becomes damp, ask your health team for absorbent padding.
• Clothing: Wear loose clothing to prevent rubbing. Wear cotton underwear that stretches over your wound. Consider compression shorts that compress your abdomen and pelvis. This promotes blood flow and helps with healing.
• Infection: Look for signs of infection and show them to your healthcare professional immediately.
• Products: Avoid creams or powders on your wound.
• Movement and exertion: Be mindful how you move. Try to roll out of bed, rather than placing strain on your abdomen. Support your wound when you get up by placing your hand over it. Do not lift anything that causes pain or that is heavier than your baby.
• Rest: Rest as much as possible. If you overexert yourself, your wound may swell, causing pain. Ask for support as you need it.
• Pain relief: Take pain relief medicines as prescribed.

What are signs my wound may be infected or not healing normally?

Signs your wound may be infected or not healing include:

• extreme tenderness or pain (after the initial pain has settled)
• bleeding, smelly discharge or oozing
• swelling, redness or warmth on or around your wound
• fever

Seek medical advice without delay from your midwife or doctor if you think your wound may be infected.

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

How long does a wound take to heal?

Perineal tear and episiotomy

It takes 2 to 3 weeks for your perineal tear or episiotomy to heal. You may feel discomfort for up to 6 weeks.

Caesarean

Your incision will heal over a few weeks. While it’s healing you may feel mild cramping, light bleeding, vaginal discharge and pain or numbness around the wound. Most people feel well within 6 weeks.

How do I care for my scar?

You can care for your scars by avoiding the following for 6 weeks:

• soaking in baths
• powders
• creams
• tampons

Care for a 3rd or 4th degree perineal scar

• Ask your midwife or physiotherapist for advice on movements or activities that don’t place pressure on your abdomen.
• Seek physiotherapy to help manage any bowel (poo) or urinary (wee) incontinence.
• Ask your doctor to check that your anal sphincter has properly healed via ultrasound.
• If sex is uncomfortable, lubricant may help.

Caring for your caesarean scar

To help manage any pain, numbness or a feeling of pulling or stretching around your scar during the first few months:

• rest when you feel you need to
• modify your activities, do not lift anything that causes pain or anything heavier than your baby
• take pain medicines as your health team directs
• avoid sex until you are comfortable
• do not drive a car until you are fully recovered and your wound has healed

Massage can help your caesarean scar heal. Here are some tips:

• Massage your scar only once your doctor or midwife has checked it and says it’s safe to do so.
• Use small amounts of oil or cream.
• Apply light pressure over and around your scar for around 3 minutes daily.

Can I do anything to reduce the appearance of my scar?

When your wound has healed, apply Vitamin E cream to help reduce scarring. The colour of your skin over your wound may fade, but it won’t disappear. Check with your pharmacist or GP before using cream.

When should I see my doctor?

• Within the first 6 weeks if you experience constipation, urinary or faecal incontinence and pain when urinating.
• When your baby is 6 weeks old you should have postnatal follow-up where your health provider will assess your wound.
• After 6 weeks postpartum, if you still suffer from incontinence, pain or sexual discomfort, you may be referred to a specialist.
• Following a 3rd or 4th degree tear, your doctor will refer you to a perineal care clinic around 12 weeks after you give birth. Specialist doctors will assess your scar and anal sphincter.
• Following a caesarean, pain and discomfort usually subsides within 3 to 6 months. If pain persists or you have back pain, chronic pelvic pain or sexual dysfunction, seek support from your healthcare professional.

Resources and support

• The Continence Foundation of Australia offers information and support to people with bowel and bladder problems. You can call the helpline on 1800 33 00 66 between 8am and 8pm (AEST), Monday to Friday.
• Visit the Australasian Birth Trauma Association website for information and support, including peer-to-peer support.
• Visit the Perinatal Anxiety and Depression Australia (PANDA) website for information and support after a traumatic birth. You can call the PANDA national helpline on 1300 726 306 (Mon to Fri, 9am to 7.30pm AEST).