Healing After a Cesarean: My Nine-Month Recovery

The wound, the binder, the keloids and a lump months later

My recovery from my cesarean took nine months, not six weeks. What happened at each stage, what I regret and my plan this time.

Stage 1: The wound

In my first pregnancy, I labored through an induction that didn’t progress, then had a cesarean. I went in knowing I scar badly; my chart calls it a “hx of severe keloid formations,” meaning a history of thick, raised scars. Before delivery, I asked for a plastic surgery appointment for after the surgery, because of that history.

About two weeks after the birth, I wrote to my doctor that pus was leaking from my incision. At my wound check the next day, my stitch was removed and the note says the incision was healing well. I was told I could use over-the-counter steroid tape, 12 hours on and 12 hours off for two days, to help prevent keloids.

A week later, I wrote: “My c-section incision is still leaking pus and a larger hole has opened up causing pain.” The reply gave me the dermatology number and said: “I don’t know who, if any, specializes in keloid so please inquire when you call them.” The next day, the plastic surgery team I’d booked in advance explored the opening, cleaned it, took cultures and packed it with dressing. It grew bacteria, I took antibiotics, and I had weekly wound checks after that.

Stage 2: The binder I didn’t keep wearing

After my cesarean, I wasn’t consistent with belly binding, and I regret it. I don’t know what wearing it consistently would have changed. Those weeks were full. I was home on blood pressure medication, my incision was leaking and then packed, and feeding was hard. Binding was part of recovery I could have planned for, and I didn’t.

ACOG lists an abdominal binder among the options for pain relief after birth. It’s also a tradition in many cultures, with its own wraps and routines. It isn’t a guaranteed way to change how your body looks after birth. If your incision opens, drains or needs packing, ask again whether to keep using it.

Stage 3: The keloids

After the wound closed, painful keloids formed along the scar. I regret not being consistent with scar care once the wound healed. I don’t know whether that would have changed the scar I developed.

What I learned about scar care:

While the wound is healing, follow your team’s instructions for dressings, cleaning and drying. Increasing pain, warmth, pus, a bad smell, a fever or feeling unwell are reasons to call promptly (Cambridge University Hospitals).
After it has fully healed, with no scabs or openings, scar massage and silicone gel or sheets are options (Kingston and Richmond; South Tees). Silicone gel and sheets are sold over the counter; ask your clinician which kind and when to start.
Ask who actually treats keloids at your hospital, and get the referral before you need it.

Stage 4: The lump, nine months later

When my child was almost nine months old, a painful lump formed under my scar. Getting it seen took a cancelled appointment, hours of waiting and a night in the ER with my baby. (“What Postpartum Care Should Include”) A gynecologist finally ordered imaging and asked my surgical team to call me. Questions about what happened in my surgery followed. (“Nine Months Later, I Was Still Asking What Happened in My Surgery”)

Key points

Wound infection follows 3% to 15% of cesareans, and a long labor before surgery is one of the risk factors. Before discharge, ask who checks your incision, when, and who you call if it opens or drains.
In a 2021 analysis of four trials and 601 women, an abdominal binder (a wide wrap worn around the belly) after a cesarean reduced distress at 24 and 48 hours but made no significant difference to pain scores. Ask whether a binder fits your incision, and treat it as comfort and support.
Scar massage and silicone gel or sheets start only after the wound has fully closed; starting too early can reopen it. Ask your clinician to confirm it has healed and to show you the technique.

My plan this time

I’m pregnant again. This is my plan:

Before delivery, tell my surgical team about my keloid history and ask what they’ll do during and after surgery to lower my risk.
Book plastic surgery or dermatology ahead, as I did last time.
Ask before delivery whether a binder is right for me, given my incision and blood pressure history, and have it fitted before I leave, with my partner watching how it goes on. Ask whether my insurance covers one with a prescription.
Look at the incision every day for the first weeks, with photos, so changes are easy to show.
Start scar care when, and only when, a clinician confirms the wound has healed, and keep it up.

Take this back

To discuss with your care team:

Given my scarring history, what will you do during and after surgery to lower my risk?
Who checks my incision, when, and who do I call if it opens or drains?
Is a binder appropriate for me? Which one, and how should it fit?
How will I know the wound has fully healed, and when can I start scar massage or silicone?
Who here treats keloids, and can you refer me now?

To discuss with the people in your life: In the first weeks, will you look at the incision with me every day, help me take photos and help me put the binder on?

Don’t wait if

Contact your care team promptly for increasing pain, warmth, redness, pus, a bad smell or an opening in your incision. A fever of 100.4°F or higher is an urgent maternal warning sign: seek medical care immediately. If you feel very unwell or cannot reach your team, go to the emergency department.

Next in the series: “Your Pelvic Floor After Birth”