A guide to C-section wound healing and how scar massage can help

February 14

A guide to C-section wound healing and how scar massage can help

15 min read By Midwife Cathy Tabner

Healing takes time and occurs in 4 stages. During surgery your abdomen is incised, your wound is repaired and healing commences. Here are the stages of the healing process:

  • The first stage is haemostasis, where clotting factors in your blood stop the bleeding. 
  • The second phase (inflammation stage) is the scabbing over and clearing away of toxins and infections. 
  • The third phase (proliferation stage) is the rebuilding stage and this is when you can benefit the most from massaging your scar. Once healed and formed it can feel itchy and sensitive as the nerve endings within the tissue are actively healing. It may feel numb in places or tingly to the touch or even painful if pressed on. It still looks red at this point but does fade over time to normal skin tone.
  • The fourth phase (maturation stage) is when the scar strengthens. Your body can still be forming scar tissue for more than a year after your C-Section. When scar tissue is no longer being produced by the body, the scar is considered mature. Even at this point, massaging can still be beneficial. 

How to Massage a C Section Scar in 3 stages


Stage 1 - the skin

You can begin gentle massage after your 6 week check-up, or sooner if the scar is considered well healed. Initially, the scar may be quite tender, red, and painful and it may be best to work around the actual scar itself, working the tissues above and below it. As the scar becomes less tender, you can follow this procedure with your fingers directly on top of the scar itself:

  • Wear loose comfy clothes with easy access to the scar area and have your legs out straight and relaxed. 
  • First massage the skin gently around the scar with the oil.
  • Place your fingertips lightly on the skin above the scar and see how mobile the skin is by moving it up and down and side-to-side. 
  • If it moves down more than it does up, that’s normal, try to move it more in the upward direction. Does it move more easily on one side than the other? Are you sore on one side? This is also normal. Discomfort is okay but not too much pain, be conscious about trying to relax, too.
  • If you find a stiff or tight zone, maintain your hold there and breathe – you may feel a release or the tissues relaxing.
  • Use your fingers to move your skin up and down, side to side, and also in little circles. Start by working the tissues around the scar and, later, include those on top of the scar as much as your pain and tenderness allows. Eventually, you will be able to pick the skin of the scar up and roll it between your fingertips.

Stage 2 - muscle layer

Just below the skin and fat is the muscular layer and you may or may not feel your abdominal muscles, but they are there. It is ok to feel slightly uncomfortable during this massage but it should not be painful. 

  • Allow your fingers to melt deeper into your abdomen and check to see how this layer of tissues move. 
  • If one side moves less than the other side this is totally normal. Most people find one side of the scar is more restricted than the other side. It may be that the knot from the stitches finished on that side or that some nerves have been compressed, but there usually is a side which is more sore. 
  • Do the same movements as with the skin, keeping fingers deep and embedded in the flesh, moving them up, down, side-to-side, and small circles around the scar.
  • Have your fingers on top of the scar as much as any tenderness allows. Adhesions where the scar tissue attaches on to your bowel can occur so you can work further out and around from the scar as you would like to. 
  • Focus on any area of tightness to encourage movement in that direction by moving the tissues to where they don’t want to go and then gently holding them there for a few seconds. 
  • You may feel a slight burning sensation, which is normal for stretching tissues. Hold until you feel a softening or melting of the tissues or the feeling that the scar tissue is releasing a little under your fingers. 
  • Do not be too heavy handed with the massage. Go at your own pace - just until you feel some softening and improvement in the area under your fingers. 
  • Do not use extreme force as this can cause tissue tightening, where it will refuse to release. 
  • Most importantly relax, breathe, and massage to the point of tenderness, not extreme pain. 

Stage 3 - deep muscle

In the last stage you are working down at quite a deep level. If you’ve ever been checked for appendicitis or had kidney problems, a doctor would have felt your abdomen this way - it is a massage which is firmly moving the deeper tissues.

  • Bend your knees to slacken your lower abdominal tissues. This helps you to massage the deepest layer.
  • Remember, your fingers need to sink deeper into the tissues around your scar area. 
  • Massage at your scar level on the surface, but also lower near the pubic bone. Try to sink further into the muscles and see if you can move these deeper tissues side-to-side and up and down. 
  • This deeper level massage can prevent you from developing lower back pain or frequency of urination in years to come. 
  • Make sure both sides are massaged well and feel equally mobile. If one side is tighter, then take the massage in the direction it doesn’t want to move in, until you can’t move it any further. Gently hold it there until you feel the tissues melting and releasing under your fingers. 
  • Relax and breathe deeply then recheck the tissue’s mobility to see if it feels the same from side-to-side. 

When to massage

This is a guide to the frequency of massaging, but everyone is different, so develop a routine that feels comfortable for you.

  • Once you are ready to start in the first few weeks after the birth, begin with 5 minutes daily until your tissues are freely moving in all directions with all 3 layers. This may take a few weeks or longer- everyone is different.
  • Then reduce to a weekly massage, noticing any stiff or tight areas and working with them.
  • Then you may want to simply massage the area every so often - maybe monthly. The week after your period finishes is a good time, as you won’t have any additional tenderness or irritation. 
  • This massage routine is a good thing to do monthly to 6-weekly, up until the 2 year mark from the birth. 
  • If you find the tissues getting tight again, slip back into a more regular weekly pattern of massaging.

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