A cesarean, although a very common type of birth in Brazil, is a major surgery, as 7 layers of skin and uterine tissues are cut during the process. Therefore, some problems can occur during the postpartum period and recovery. Learn more below about cesarean complications, especially about inflamed cesarean section.

How is a Cesarean Performed?

The cesarean birth is performed through an incision in the pelvic area1, right below the bikini line. Next, 6 more layers of tissue, including the uterine wall, are cut in order to allow the baby to be removed.

Of course, before any of this happens, anesthesia is administered and the most common for this medical procedure is the spinal anesthesia, but epidural anesthesia may also be used2. These are the options because both types of anesthesia allow the woman to stay awake and alert throughout the birth to meet her baby as soon as he or she is born.

Anesthesia and Incision

Sometimes, when spinal or epidural anesthesia is not effective, the doctor may resort to general anesthesia, but this is extremely rare. As soon as the baby is removed, the placenta is also removed and the uterus is cleaned. The size of the cesarean incision depends on the doctor and the woman’s body; there is no set rule, but usually it measures about 3 to 4 fingers wide on average.

Sutures or Cesarean Stitches

Closing the incisions takes time and begins as soon as doctors finish cleaning the uterus, which can take about 30 to 40 minutes. The stitches start at the uterine wall and are sewn layer by layer until reaching the skin. It’s worth mentioning that, most of the time, the stitches are not fully exposed, as obstetricians use a different technique to avoid deep, visible scars in the area.

Additionally, the incision in the outermost layer of the skin can be closed using a kind of glue. This type of suture is called a glued cesarean section. However, the internal walls are not glued, just the outer layer, making the incision site much less noticeable.

Removal of Stitches

Stitch removal is no longer always necessary, especially after a glued cesarean. However, doctors who still use traditional suturing will leave one stitch at each end of the incision and one in the middle, which is cut to release the stitches on the ends and remove the superficial suture entirely.

Taking out the superficial stitches brings a great sense of relief to the mother. However, you must wait between 7 and 14 days, and healing of the outside incision and complete internal healing can take up to 18 months!

Symptoms of Inflamed Cesarean Stitches

Not infrequently, one or another cesarean stitch can become inflamed. The main signs of inflammation are redness at the site and burning. It begins as slight discomfort and can escalate to something unbearable in only a few hours. Symptoms of inflammation or even infection after a cesarean include:

  • Redness at the site
  • Scar that’s hot and hard
  • Pain or burning in the area
  • Small watery or purulent discharge at one side of the stitches or on both sides
  • Heightened sensitivity when standing, moving, or sitting

A healthy cesarean scar looks dry, not red, and does not itch. Loss of sensation in the area is common, do not worry—it’s because nerves were also cut along with the skin.

Causes of Cesarean Stitch Inflammation

This can happen for a few different reasons, which may vary from case to case, but the most common are3:

Bacterial proliferation at the site: usually, one or another stitch gets inflamed because it is not being properly cared for, such as remaining damp. In this case, inflammation appears at an isolated spot or along the entire incision. The ideal care is to wash the area with water and neutral soap and dry it thoroughly. Just this process will prevent bacterial growth at the site—always remember to follow your doctor’s or nurse’s instructions when you are discharged from the hospital.

Lack of rest for the new mom: sometimes, the woman feels so well that she starts doing too much. Going up and down stairs, lifting heavy things (often an older child), bending, cooking, ironing… But such exertion pulls on the stitches and can cause inflammation. So, it’s recommended that the woman rest as much as possible for good healing. Remember, you are recovering from surgery!

Allergy to the suture thread: it’s also possible for stitches to become inflamed due to an allergy to the thread used for the internal stitches. In these cases, medical intervention is needed to determine how to proceed. Many times, oral medication or injections are enough to solve the problem without reopening the incision.

Wearing tight clothes: friction from inappropriate clothing can also cause minor inflammation. As with physical exertion, clothes can tug on the area of the incision.

How to Treat and Prevent Cesarean Inflammation

Usually, when the mother is discharged, the obstetrician prescribes medication to prevent problems. In addition to having received specific medicines after delivery, the care must continue at home. It’s important to wash the scar with water and neutral soap and avoid applying any type of ointment during the healing period. For inflamed cesarean scars, doctors usually prescribe:

Anti-inflammatories: ketoprofen, nimesulide, diclofenac or ibuprofen
Pain relief medications: paracetamol, dipyrone, or lisador
Antibiotics: cephalexin (safe for breastfeeding).

Antibiotics help dry out the stitches and prepare the body for proper healing, so the mother must take them exactly as instructed by her doctor.

Pain medicine is also very important, as it will help prevent discomfort at the inflamed stitches. As the medication takes effect, the discomfort will improve and the inflammatory discharge will dry up naturally. Still, women should complete the full proposed course of treatment.

To prevent an inflamed cesarean, mothers must take certain precautions upon discharge. Avoid exertion, be very careful when using stairs and steer clear of certain foods, such as pork, sausage, hot dog, ham, and all processed meats, for example. Also avoid peppers, very spicy foods, and seafood. Learn how to properly care for your cesarean scar in this post.

Important Tip: For breastfeeding mothers, maintaining health during postpartum is crucial, and using a multivitamin suitable for this phase may help. For this reason, Famivita, together with medical specialists, developed FamiGesta. Learn more here.

Also see: Episiotomy – How to Take Care of the Stitches?