What can cause scarring after having a baby?

During childbirth, some people experience wounds that may leave scars, such as:

• perineal tears
• episiotomies
• caesarean section

Perineal tear

A perineal tear is a tear in the skin and/or muscles of the perineum (the tissue that separates your vaginal opening from your anus). There are 4 levels of perineal tears, depending on the severity. A first-degree tear is the least serious type of tear and a fourth-degree tear is the most serious.

Around 4 in every 100 women having a vaginal birth will experience a third- or fourth-degree tear. Most third- or fourth-degree tears are repaired with surgery.

Read more about perineal tears.

Episiotomy

An episiotomy is a cut made to your perineum (the area between your vagina and anus) during birth. Your doctor or midwife may suggest this to make more space for your baby to be born.

Your doctor or midwife may recommend an episiotomy:

• during an assisted birth (when a forceps or vacuum cup are needed to help your baby be born)
• if your baby needs to be born quickly
• if there is a likelihood of a severe perineal tear

Your healthcare professional will always ask your permission before giving you an episiotomy, and explain why they are recommending it. You have the right to ask questions and decide whether or not you consent.

Read more about episiotomies.

Caesarean section

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

Read more about having a caesarean.

How do I care for my wound?

Care for perineal tears and episiotomies

After an episiotomy or perineal tear, the midwife will check your stitches regularly — this may be in hospital, at home or at a follow-up appointment. The stitches will dissolve by themselves after about 3 weeks.

Hygiene tips for your stitches

• Keep the area clean by showering daily and pouring water over your wound after using the toilet.
• Change your pad regularly.
• 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 from vagina (front) to anus (back) with soft toilet paper or wipes.

Tips to reduce wound discomfort or swelling

• Cold pack: Apply for 10 to 20 minutes every 2 hours. Always wrap the cold pack in a cloth or towel — don't place it directly against your skin.
• Positioning and movement: Lay on your side as much as possible and avoid sitting for a long time.
• Pelvic floor exercises: Begin gentle exercises 2 to 3 days after your baby is born, or when your physiotherapist advises you're ready. Try to complete your exercises regularly.
• Diet and preventing constipation: Try to eat a high fibre diet including fruit, vegetables and wholegrains. Drink 2 to 2.5 litres (L) of fluids daily. Go to the toilet when you feel the urge and try not to 'hold on' or avoid going.
• Compression: Wear pads with firm underwear.
• Pain relief: Take pain-relief medicines as prescribed by your healthcare team.

Tips to support recovery of third- and fourth-degree tears

• Stool softeners: Your doctor may recommend that you take stool softeners for the first week after you give birth. Keeping your stools soft is important, as straining can put pressure on your wound.
• Pain management: Ask your doctor about pain-relief medicine that is safe during breastfeeding. Some pain-relief medicines can cause constipation, so your doctor may recommend stool softeners to help prevent this.
• Hygiene: Shower daily and keep your wound dry by letting it 'air dry' or gently patting it dry with a clean towel.

Caesarean wound

Your wound may be closed with staples or stitches. Staples are removed after 3 to 7 days. Stitches will dissolve on their own.

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

Tips for your caesarean wound

• Hygiene: Shower daily and keep your wound dry by letting it 'air dry' or gently drying it 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 and cotton underwear that stretches over your wound. Consider compression shorts that compress your abdomen (tummy) and pelvis. This promotes blood flow and helps with healing.
• Antibiotics: During a caesarean birth, you will receive intravenous (IV) antibiotics to help prevent infection. After birth, your doctor may prescribe oral antibiotics if needed.
• Infection: Look for signs of infection such as redness and discharge. If you notice signs of infection, contact your doctor immediately.
• Movement and exertion: Be careful about how you move. Try to roll out of bed, rather than sitting up straight as this can place strain on your abdomen. Support your wound when you get up by placing your hand over it. Do not lift anything that is heavier than your baby or causes pain.
• Rest: Rest as much as possible. If you exert yourself too much your wound may swell, causing pain. Ask for support from friends or family if you need it.
• Pain relief: Take pain-relief medicines as prescribed by your doctor.

Read more about recovery after a caesarean.

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

Signs of an infected wound or problems with healing include:

• significant tenderness or pain (after the initial pain has settled)
• bleeding, smelly discharge or oozing from the wound
• swelling or warmth on or around the wound
• redness or discolouration on or around the wound
• opening of the wound
• fever (a temperature of 38° or higher)

See your midwife or doctor immediately 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 a perineal tear or episiotomy to heal. You may feel discomfort for up to 6 to 8 weeks.

Caesarean

Your incision will heal over a few weeks. While it's healing you may experience:

• mild cramping
• light vaginal bleeding
• vaginal discharge
• pain or numbness around the wound

These symptoms will usually improve after 6 weeks, but for some women they may last longer.

How do I care for my scar?

For the first 6 weeks after birth, you should avoid:

• soaking in baths
• using powders or creams on your scar
• using tampons

Caring for a third- or fourth-degree perineal scar

Here are some tips to help you care for a third- or fourth-degree perineal scar:

• Attend follow-up appointments in a perineal clinic or with your doctor. During these appointments your doctor will check how your perineal injury is healing.
• Ask your midwife or physiotherapist for advice on how to move to avoid placing pressure on your perineum.
• See a physiotherapist to help manage any bowel (poo) or urinary (wee) incontinence.
• Only return to sex when you feel comfortable. Using a lubricant may help reduce discomfort.
• Avoid heavy lifting — a good guide is not lifting anything heavier than your baby.

Avoid straining while emptying your bowels. If you are having difficulty emptying your bowels, talk with your doctor about taking a stool softening supplement. Your doctor can also review any pain medicines.

Caring for your caesarean scar

In the first few months you may notice pain, numbness or a feeling of stretching around your scar. To help manage this, you should:

• rest when you feel like you need to
• not lift anything that causes pain
• take pain-relief medicines as directed
• avoid sex until you feel comfortable. It's normal for this to take a few months.
• 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 scar may fade, but it won't disappear completely.

Check with your pharmacist or doctor before using cream or oil on your scar.

When should I see my doctor?

See your doctor as soon as possible if you have:

• any signs of infection such as pain or redness around the wound
• heavy vaginal bleeding or
• a dragging feeling in your vagina
• severe abdominal (tummy) pain
• swelling or redness in your legs
• any concerns about how your wound is healing

You should see your doctor 6 weeks after giving birth for your postnatal check-up. At this appointment your doctor will check your wound. You may be referred to a specialist if you still suffer from:

• incontinence
• pain
• sexual discomfort

Perineal tear

Following a third- or fourth-degree perineal tear, your doctor will refer you to a perineal care clinic or a specialist for ongoing care. This will usually happen 1 to 4 months after you give birth. Specialist doctors will assess your scar and anal sphincter.

Some women, particularly those living in regional or remote areas, may need to travel for this care. Your healthcare provider can talk with you about the options available and support you to decide what feels right for you.

Caesarean section

See your doctor if you have:

• ongoing pain
• back pain
• pelvic pain
• sexual discomfort

It's important to remember that recovery following a caesarean is different for all women. If you are concerned about your recovery, talk with your doctor.

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Resources and support

• Continence Health 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 Birth Trauma Australia website for information and support after birth trauma, 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).
• The Australian Commission on Safety and Quality in Healthcare has an Easy Read resource on recovery after a perineal tear.

Languages other than English

The Health Translations page has information from the Royal Women's Hospital on going home after a caesarean birth, in multiple languages.