How To Manage Tears and Scars from Pregnancy

Scars are story starters. They're a map of our life's story. They are also something we can mindfully care for so they don’t become an adhesion, source of discomfort, or of impeded mobility. 

Scars form from 4 overlapping phases:

1. Hemostasis

This happens when a wound is created. Our bodies constrict the blood vessels to limit bleeding. Blood starts to coagulate and clot 

2. Inflammation

This occurs the first several days (to a week!) following an injury. Mast cells release cytokines (like prostaglandins and histamine). These allow for healing cells to better migrate over and help heal. One of those healing cells is called neutrophils (is this sounding all too much like high school biology?). Neutrophils form the pus around wounds that forms 48-72 hours into healing. They eat bacteria and any dead tissue.

Then, monocytes become macrophages and remove more old tissue. They are like the cleaning crew of your wound.

What do you do during this phase?


Prop your feel up to reduce vaginal pressure.  Keep breathing and pump your ankles to prevalent blood pooling and clots.

You can also use ice to decrease inflammation. Here's a trick my midwife taught me:

Put a water-rubbing alcohol combo in a condom and freeze it. Put it in your undies to decrease inflammation.

1. Proliferation

This phase occurs 3-21 days after the trauma. This is when new scar-like cells form. This is the natural band-aid phase.

What do you do during this phase?

Much of the same as above. You can start walking for slightly longer amounts of time.

2. Maturation. 

This is when the wound starts to remodel. A thinner, less scar-like, and more skin-like collagen is laid down. This process takes a while. The area won’t regain its tissue strength until it’s complete. A wound regains about 80% of its strength 3 months after the trauma (and can last for up to 2 years!)

Behind the scenes, new epithelial cells form for protection against re-injury.

The scar is the end result of the maturation process. Scars usually remain as such for about 6-9 months before flattening and becoming paler.

Scars that are extremely thick and have disorganized collagen. We want the collagen to lay down in fairly neat rows. Visualize a nice neatly braided basket, rather than a pile of cooked spaghetti.

What do you do during this phase?

There's a technique you can use to help organize your collagen. Rub in one direction across the scar very lightly and gently. This can encourage collagen to lay down in an orderly fashion. I recommend 2-3 minutes a few times a day after about 14 weeks. This also helps desensitize the scar. You'll be teaching new nerves not to send alarm bells.

Pregnancy Scars Are Unique

Where it is created can be different depending on a person’s delivery experience. The two most common are:

  • Perineal scarring from a tear or episiotomy
  • C-Section scars.

Approximately 85% of women experience a tear following vaginal delivery. The good news is that most of them are just grade 1 or 2, meaning they don’t go all the way to the anal sphincter.

Risk factors for perineal tearing:

  • Forceps delivery
  • Baby weight over 4000 g
  • Shoulder dystocia
  • Malpresentation of the baby
  • Prolonged second stage of labor,
  • Valsalva pushing (breath-holding b/c that increases the pressure on the pelvic floor)
  • Older age of mother (b/c the tissue isn’t as elastic)

If a scar doesn’t heal in a strong way, it can cause:

  • Urinary or fecal incontinence
  • Pelvic pain
  • Difficulty sitting, nursing, and walking.

What to do for perineal scarring: 

Disclaimer: Before initiating any intervention, be sure the scar or sutures are healing properly and not infected.  Be sure to clear this with your healthcare team first. 

If both criteria are met, gentle scar tissue massage is the next step. Rub horizontally, vertically, clockwise, and even some rolling with a little bit of lubricant (I like fractionated coconut oil).

I recommend starting with 2 minutes a day. Depending on how significant the scar or how sensitive the wound is, applying a vibrator may also improve circulation.

What to do for C-section scarring

Gentle scar tissue massage. Rub horizontally, vertically, clockwise, and even incorporate some rolling. I recommend starting with 2 minutes a day. Gentle cupping around the region can also be helpful.

If a C-section is in your cards, then that doesn’t necessarily mean you won't have pelvic discomfort postpartum. Unmanaged C-section scarring can cause tightness. This can cause you discomfort in the pubic symphysis and within the pelvic floor.

Scar-Healing Basics

For good wound healing to occur, it’s important to make sure the area is getting enough oxygen and blood supply. We want to have good blood flow to the area and avoid things that cause vasoconstriction

Discourage things like:

  • Prolonged cold pain
  • Nicotine and smoking

Encourage things like:

  • Gentle movement- like gentle walking
  • Proper positioning- avoiding prolonged sitting or wide-leg posturing (for perineal scars)
  • Lymphatic drainage- for postpartum care, encouraging the lymph nodes that live in the groin area to train any excess fluid is a good idea. This can be done with gentle cupping.

How could a pelvic health physical therapist help?

  • They can teach you how to perform scar tissue mobilization correctly and safely.
  • They have access to modalities like cupping, low-level laser therapy, ultrasound imaging scar tissue to help prevent the scars from thickening, forming adhesions, or entrapping superficial nerves.
  • They can assess your pelvic floor mobility, abdominal fascia, movement patterns, and global weaknesses and strengths that contribute to your overall function.

Scars are not something to be ashamed or embarrassed about. Scar care can become a 2 minute a day self-care activity you’ll thank yourself for in the future. To learn more, send me an email!

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