I personally suffer from keloid scars and as a mother to be have looked into Caesareans and episiotomy. I hope my findings below will be of help.
This piece has been written for pregnant women who have had or are prone to keloid scars, and are concerned about keloid scarring resulting from labour and birth.
Caesareans
Clinical evidence in both the Fast East and West shows that keloid scars often form following Caesarean sections during labour for women who have had or are prone to keloid scars. In the Fast East, in particular, where keloid scar is more prevalent, many such cases have been observed, and the scarring can be quite severe. Keloid scars are commonly found on areas where the skin is naturally dry and tight, and where there are underlying blood vessels. It is believed that these are the main reasons why keloid scars are often found on central chest, the back, shoulders and the ear lobes. The skin area around a Caesarean section has these typical characteristics, and they may be why keloid scars often form there. Therefore, elective Caesareans should be avoided.
Nevertheless, Caesareans may become necessary during labour because of concern for the safety of the mother or baby. In this case, safety naturally becomes a higher priority. I have not researched into the care of Caesarean scars post operation, but currently I believe the normal course and options of treatment for general keloid scars would apply. In the UK, these may include steroid injections, radiotherapy, or laser treatments.
Episiotomy
In short, and contrary to Caesareans, there is no clinical evidence to suggest that keloid scars tend to form following episiotomy. The reasons for this, it is believed, are that:
â– The skin area concerned is not naturally dry or under tension; and
â– The muscle composition where episiotomy takes place is different (though it is not completely understood why it makes keloid scarring less likely)
The clinicians I have spoken to have, reassuringly, not come across any keloid scars following episiotomy. However, in the unlikely event that they become a problem, radiotherapy has been suggested as the best treatment option.
General Care for Wounds
For those who want to take active and preventative steps to minimise the chance of keloid scars forming, the following could be helpful[1].
It is suggested to keep wounds moist and covered during healing, with the application of a lubricant followed by a dressing. For infection-free wounds, a suitable lubricant is plain petrolatum (no aloe) and for dressing non-stick types like Telfa (held in position by tape), DuoDerm, or silicon gel pads (no vitamin-E).
I have also personally found Dermatix, a clear gel that is available at UK hight street pharmacies without prescription and can be very easily applied over scars, to be very effective in reducing pain, itchiness, and redness in scars on the central chest and fingers, though I have not looked into whether it is appropriate for scars resulting from Caesareans or episiotomy.
Sources of information: consultation with GP, plastic surgeons, clinician, and medical publications.
1.Beth G Goldstein, MD. Adam O Goldstein, MD, MPH. 2010. from www.UpToDate.com.