Caesarean wound infection: risk, warning signs and wound care

The NHS describes infection of the wound as a common risk of caesarean, causing redness, swelling, increasing pain and discharge, and says antibiotics are now given before caesarean so infections should be less common. NICE says endometritis, urinary tract and wound infections occur in about 8% of women who have a caesarean birth, and that giving prophylactic antibiotics before the skin incision reduces maternal infection more than giving them after, with no known effect on the baby.

East Kent Hospitals University NHS Foundation Trust gives a higher figure: up to 16 in 100 (16%) of all caesarean births will develop a wound infection. The two numbers measure different things (all infections combined versus wound infections reported from a local source), so treat them as a range rather than a precise rate.

NICE recommends alcohol-based chlorhexidine skin preparation before caesarean birth to reduce wound infections, vaginal cleansing with an antiseptic preparation before caesarean in women whose waters have broken to reduce endometritis, and prophylactic antibiotics before skin incision that are effective against endometritis, urinary tract and wound infections. It also says that using separate surgical knives for skin and deeper tissue, routinely closing the subcutaneous space (unless there is more than 2 cm of subcutaneous fat) and routine superficial wound drains do not decrease wound infection. These are choices for your surgical team rather than you, but they explain why infection rates are lower than they used to be.

If you have diabetes, the East Kent leaflet says maintaining normal blood glucose helps wound healing and reduces infection risk.

The NHS says to gently clean and dry the wound every day, wear loose comfortable clothes and cotton underwear, take a painkiller if the wound is sore (paracetamol or ibuprofen but not aspirin while breastfeeding) and watch for signs of infection. Non-dissolvable stitches or staples are usually taken out after 5 to 7 days, the NHS says. The East Kent trust adds hand-washing with soap and water for at least 40 seconds before and after touching the wound, keeping it clean and dry, getting air to it, wearing loose breathable clothes, showering with a gentle spray, avoiding soaking in a bath until healed, patting dry rather than rubbing, avoiding strenuous activity and swimming pools until fully healed, and eating and drinking well.

Dressing practice varies: the East Kent trust says its dressing is removed on day 5 and that if you have surgical glue you should not scratch, pick or apply lotions. Follow the advice your own hospital gives. The NHS recommends period pads rather than tampons for vaginal bleeding after caesarean.

The East Kent leaflet lists redness around the wound, swelling or hardening, the area feeling warmer or hot, foul-smelling or pus-like discharge, increased pain or tenderness, feeling unwell, fever over 38C, and chills and sweats. It says not to wait, that quick identification and early treatment is of high importance and reduces the risk of developing sepsis, and to contact maternity triage; it adds that you should call if the wound gapes or separates. It says maternity triage can be called up to 42 days after the caesarean.

The NHS recovery page says to contact your midwife or GP straight away for severe pain, leaking urine, pain when peeing, heavy vaginal bleeding, a wound that becomes more red, painful and swollen, a discharge of pus or foul-smelling fluid, a cough or shortness of breath, or swelling or pain in the lower leg, as these may signal infection or a blood clot. NICE says to seek advice without delay for fever, shivering or abdominal, pelvic or perineal pain. If you feel very unwell, confused, or have chest pain or breathlessness, call 999.

A midwife or doctor will examine the wound. The NHS says wound infections may need treatment as soon as possible, and the East Kent trust says you may be advised to take all prescribed medicines, such as anticoagulants, as advised. Antibiotics are the usual treatment for a spreading skin infection, and sometimes a collection needs draining; your clinician decides. Never start or stop a medicine without advice. You can continue to breastfeed.

NICE says to ask about wound healing and symptoms of wound infection at each postnatal midwife contact after a caesarean. The East Kent leaflet says keep all follow-up appointments with your community midwife, as regular check-ups allow early detection.

The NHS says the wound will form a scar, usually horizontal and about 10 to 20 cm long just below the bikini line, red and obvious at first, fading with time. It says to be careful not to overexert yourself, to walk daily to reduce clot risk, and to start driving, exercise, lifting and sex again only when you feel able, perhaps not for 6 weeks or so; ask your midwife or GP at the 6-week check. Local postnatal wound clinics and dressing policies differ between trusts.