Support for c-section scars
This week I spoke with Dr. Hannah Flammang about C-section scars. We talked about self care and things that we can do to help with recovery and healing after a c-section.
Dr. Hannah is a local chiropractor. She is opening her practice in Rocklin, but she does a lot more than just chiropractic. She really likes to work with women’s health patients, specifically in the prenatal and postpartum periods. C-sections are one of her favorites because she thinks it’s a very underserved population. You get sent home with pretty much no instructions other than: “don’t lift 20 pounds; watch your scar; make sure that it doesn’t have an infection; come back and see me in 6 weeks.” Then they clear you and say you’re good to go.
What are some of the challenges that people have with C-section scars?
Dr. Hannah: A lot of times people want to work on them because they’re experiencing symptoms. They may have numbness in the area of the c-section scar. They may have hypersensitivity where you feel like you can’t put on underwear or wear jeans on that area because it’s just so sensitive to touch. Basically, you’ll have trouble connecting to those lower abdominals because things have been cut and moved around. Someone may come in to work on core work because they may have what we call shelfing: where the scar starts to develop a shelf and above the scar starts to fold over. That can definitely be helped by doing some scar mobilization and working on the area. So when patients come in to me for c-section scar work, it’s normally numbness; hypersensitivity and not being able to wear clothes, or things that are too tight or rub on that area, and having trouble with the abdominal region. That goes hand in hand with diastasis recti, which is the separation that can occur during pregnancy and postpartum. That can be heightened with a c-section because those muscles have actually been cut through and then stitched back together.
What are some of the first things we think about healing after a c-section?
Dr. Hannah: Other than the baby and breastfeeding, this is a major abdominal surgery that unfortunately the medical system doesn’t really treat like a major surgery. I do a lot of sports rehab work as well, so I see people that have had ACL tears or they’re having rotator cuff repair on the shoulder, and they are given pre-hab (pre-rehab) to their surgery, and then they’re set up immediately with a physical therapist afterwards. I wish that c-sections were dealt with in the same manner, because it is a massive surgery.
So I’d say that the initial period should really just be around healing. I won’t work on anyone’s c-section scar, and I don’t recommend that anyone does any scar mobilization, if they are prior to six weeks postpartum. So if you’re in that zero to six weeks and you haven’t gone back for your six-week checkup, if your sutures haven’t healed or if you’re having any infection, then we definitely don’t recommend any scar mobilization at that point.
Once you’ve been cleared and there are no more stitches, then we can start to work on the tissues. First I have to start with, I am not your doctor and this is not medical advice. I highly recommend that you reach out to someone in your area, whether that’s me, or I can help you to find someone. But some of these things you can do at home.
So if you’re at least six weeks postpartum and you’ve got a nice scar, this is something to be proud of, not something to be embarrassed or hold a lot of fear around. I find that c-section scars become very emotional because sometimes it was an emergency c-section or things didn’t go the way that you wanted. You were planning for a natural birth, and it didn’t happen. And when you end up with a c-section, it’s something to be proud of. You birthed your baby.
Practical tips
Scar desensitization:
We’re going to start with something I call scar desensitization. You’re going to use some things that you can find at home. I have an old makeup brush. It’s soft, not rough at all. And I have a little hand towel. C-sections cut through the superficial nerves that supply the sensation to the area, and it can give you all sorts of issues like numbness, tingling, and make that area hypersensitive to where you feel like you can’t put on leggings or jeans, and underwear rubs you. It can be irritating all day long. So with a healed scar and a clean makeup brush and a towel, we’re going to brush along the scar. We’re just trying to get that area used to a new stimulus. You can do it different ways. You can do it side to side. We can use the towel which is a bit rougher. We’re not pushing super hard. We’re not digging in with the towel. We’re just getting the area used to different sensations. If you have a pair of jeans that you can’t wear because of your scar, you can use that jean material just to get used to it. This is something you an do for like 5 minutes a day before you go to bed, just getting it used to different sensations.
Pulling
Another thing that I love to get patients to work on is scar pulling. We’re not yanking. All of this is super gentle. We’re just going to pull in different directions. We’re just trying to get that scar to have mobility. Scar tissue gets a bad rap. Everyone likes to blame all their issues on scar tissue. But scar tissue is super useful because it heals things, and brings you back together. As we pull, we are working on getting all those layers mobilized that were cut through. In a c-section they cut through about seven layers: 1. Skin 2. Fat 3. Rectus sheath (fascia) 4. Separation of the rectus abdominis muscles 5. Parietal peritoneum 6. Loose peritoneum 7. Uterus. You may feel that one side feels tighter than the other, and that’s okay. That’s really normal.
Rolling
Another thing we can do is called skin rolling. That looks like grabbing your skin. And we just want to remind you that everyone has belly fat. That’s normal. We’re going to grab the skin around the c-section scar. If it’s too tender to do over the top of it, we can go either above it or below it. We grab some of the skin and gently pull it and roll it. You can roll slowly over the scar. Most people will find that the edges of the scar have what feels like little knots in them. That is scar tissue from the healing, which is important. But you can use skin rolling to move those around and mobilize them. It may be a little uncomfortable, but it shouldn’t be super painful. If we’re pushing 6 out of 10 pain level then we’re either doing it wrong or there’s something else going on. You can even grab it and go sideways.
Massage
The next step would be to go even a little bit deeper, so I normally recommend that people do this while on their back. It’s great to do at night before you go to bed. We’re going to massage with gentle circles, trying to get things to move a little bit better. You’ll notice again that once side is typically more tender than the other. You may have more of those feelings of scar tissue on one side more than the other side. I’d suggest just 5-10 minutes every day.
Belly Breathing
Belly breathing is something you can do starting in the first few weeks postpartum. It has nothing to do with the incision itself, and we’re not doing any scar work, so you can do this in the first weeks postpartum whether you have a vaginal delivery or a c-section delivery.
There’s no right or wrong way to breathe, but one I like to work on with postpartum moms is working on getting our breath lower into the abdomen. This is easiest to lie on your back on a hard surface like the ground. When we take a deep breath in, I want everyone to see where their breath goes. You can have a hand on the chest and a hand on the belly if that’s helpful. We are going to take a deep breath in, and then let it all the way out. A lot of us are chest breathers, which is not a bad thing, but ideally we’re going to work on getting our breath lower in the abdomen so that we would consider ourselves more belly breathers than chest breathers. If you’re going to start to work on core strengthening, having your breath down low into your abdomen and using that to your advantage is huge.
To practice belly breathing, it’s easiest to be on your back. Put both hands on either side of your abdomen with your fingers on the side so that you can feel both sides of your abdomen. We’re going to take a big breath in, and we’re going to expand all the way around rather than just pushing the belly out. We’re trying to breathe into the outsides and into the back as well, trying to get that breath a little bit lower, helping to expand the area and bring awareness to it after a c-section or abdominal surgery.
Core exercise example
A really good core exercise to work on postpartum is just bringing the legs up into a 90 degree position. We’re going to make sure that the back is flat on the floor, and we want our hips to be as bent as they need to be to help flatten the back so that we aren’t arching. We’re keeping our ribs down and ducked. And as we work on breathing into the abdomen, it’s a bit more challenging but it’s helpful to have the legs out because now you have something to push against. We’re going to breathe nice and low into the abdomen. Then we will slowly bring our feet down one at a time into a heel tap.
Lara’s note: this is good to teach our kids too! Common and Colbie Collait and Elmo have a cute song about belly breathing that you can check out on YouTube.
Hannah’s response: If you have a baby under the age of 2, watch them breathe. They are expert breathers. As life goes on and we get to school, we sit more often, we have more stress, and our breathing patterns start to change. If you watch babies, they are amazing belly breathers.
Cupping
In the clinic I also use a lot of cupping. I use the little silicone cups. It is similar to scar rolling, where we are pulling up on the tissue. The cup is just a way to do that without having to use your hands, and it can get into smaller areas where it’s really hard to pull on the skin. You can use the cups to get the fascia moving better underneath the scar.
How to find Dr. Hannah:
The website may not be up and running yet, but it will eventually be craftedhealthco.com. You can find Dr. Hannah on Instagram at @craftedhealthco. You can email me at Hannah@craftedhealthco.com. If you have a c-section scar or postpartum rehab that you would like help with, please reach out to Dr. Hannah.
