Maternal health specialists have cautioned that infections, diabetes, obesity, poor surgical technique, and sustained coughing can lead to wound breakdown after caesarean section, urging women to maintain clean incision sites, avoid strenuous activities, and report warning signs immediately.
While wound disruption after surgery is uncommon, it is more likely in patients with underlying conditions such as uncontrolled diabetes, anaemia, malnutrition, or pre-existing infections, according to seasoned gynaecologists. Proper wound care, adequate rest, good nutrition, and adherence to prescribed medications are essential to prevent complications and ensure faster recovery.
The warnings follow a recent incident in which a man on X, formerly Twitter, posted a picture of his wife’s open surgical scar a few days after she underwent a C-section. The post drew widespread attention, with many attributing the wound breakdown to alleged negligence by the hospital.
A caesarean section is a surgical procedure used to deliver a baby through incisions in the mother’s abdomen and uterus rather than through the birth canal. Previously, the maternal health experts advise new mothers who deliver via C-section to prioritise rest, get adequate sleep, and avoid overexertion to aid faster recovery.
Causes of Wound Breakdown
Professor of Obstetrics and Gynaecology at the University of Uyo, Akwa Ibom State, Aniekan Abasiattai, explained that infections—whether pre-existing, occurring during surgery, or arising postoperatively—are a major cause of wound disruption.
“Infections, either an already existing infection, operating on an already infected environment, or surgical site infection after surgery, can cause wound disruption. Because of the infection, you may have some disruption of the wound,” he stated.
Increased abdominal pressure from persistent coughing or constipation can also compromise wound integrity, he added. Chronic cough and straining during bowel movements increase pressure that may lead to wound breakdown.
Medical conditions such as poorly controlled diabetes, anaemia, malnutrition, obesity, malignant cancers, and HIV reduce immunity and hinder proper wound healing. Diabetes, in particular, is associated with reduced immunity and delayed natural healing.
“Anything that can disrupt the natural healing processes will not lead to a sound wound. Factors like anaemia, malnutrition, diabetes, obesity, where you have a lot of fat and space for collection of fluid or blood after surgery, can predispose you to infection,” Abasiattai noted.
Surgical Factors
Abasiattai emphasised that proper surgical technique is crucial for wound healing. Wound edges must be properly aligned, and appropriate suture materials with good tensile strength should be used. For uncomplicated caesarean sections, surface wounds usually heal by the fifth day, with sutures either removed on that day or absorbed if absorbable sutures are used.
He urged women noticing wound disruption after an uncomplicated C-section to seek immediate medical evaluation. “Once you notice wound disruption, you should immediately go and see your doctor, who would evaluate you thoroughly, determine the cause of the wound disruption and depending on the cause, would now advise on the most proper approach for treatment,” he said.
Treatment may include wound dressing, antibiotics following microbiological studies, or secondary closure of the wound, depending on the severity of the disruption.
Recovery Factors
In an earlier interview, Professor Abubakar Panti, also of Obstetrics and Gynaecology, explained that recovery depends on patient factors, physician factors, and the type of caesarean section performed. Patient factors include immune response to trauma, while physician factors include skill and expertise in preventing infection and complications. Elective C-sections typically have better outcomes than emergency procedures.
Both experts emphasised practical steps for recovery:
- Rest and Avoid Overexertion: New mothers should avoid lifting anything heavier than the baby and refrain from strenuous household chores for at least four to six weeks.
- Nutrition: Consume high-protein foods such as lean meat, eggs, legumes, and milk, as well as fibre-rich foods, fruits, vegetables, and whole grains to prevent constipation. Iron, vitamins, and zinc are also recommended.
- Hydration: Adequate water intake aids recovery and overall health.
- Pain Management: Take prescribed medications regularly rather than waiting for severe pain. Paracetamol and other pain relievers should follow medical instructions for optimal effect.
- Wound Care: Keep incision sites clean and dry, wear loose clothing and cotton underwear to prevent irritation, and watch for signs of infection, including redness, swelling, pus, foul odour, or fever.
- Breastfeeding Positions: Use side-lying positions to avoid putting pressure on the abdomen, and be patient as breast milk flow may be delayed.
- Gentle Movement: Early walking improves circulation and prevents blood clots, but avoid abdominal exercises until cleared by a healthcare provider, usually six to eight weeks post-surgery.
- Emotional Health: Feeling overwhelmed, tired, or emotional after surgery is normal. Women may experience sadness, anxiety, or guilt about not delivering naturally. Emotional support is important.
- Postnatal Visits: Attend all check-ups, typically at two and six weeks after surgery, to discuss pain, bleeding, breastfeeding, mood, and infant immunisation.
Typical Recovery Timeline
- First 1–2 weeks: Pain and fatigue are most prominent.
- Weeks 3–4: Swelling begins to subside.
- Weeks 6–8: Resumption of normal activities, including driving and sexual intercourse, after medical clearance.
Panti warned women against lifting heavy objects, driving too soon, doing household chores prematurely, or having sexual intercourse before bleeding stops and healing is confirmed. He also cautioned against scratching the incision or applying unprescribed products.
Women are advised to report warning signs immediately, including fever, foul-smelling discharge, heavy bleeding with clots, severe abdominal pain, or swelling around the incision, to prevent serious complications.