Objective To explore the effect of optimized nursing pathway on the healing and aesthetics of maternal surgical incision. Methods A total of 98 primiparas who underwent cesarean section in the obstetrics department of our hospital from September 2022 to May 2023 were randomly divided into control group and observation group, with 49 primiparas in each group. The control group was given routine postoperative nursing, and the observation group was given optimized nursing pathway. The scar characteristics, incision complications, the Patient and Observer Scar Assessment Scale(POSAS), aesthetic satisfaction of surgical incision and nursing satisfaction were compared between the two groups. Results The thickness and width of scar in the observation group were better than those in the control group, and the difference was statistically significant (P <0.05). There was no statistically significant difference in the length of scar in between the two groups (P >0.05). The incidence of incision complications in the observation group was 2.04%, which was lower than 14.29% in the control group, and the difference was statistically significant (P <0.05). The PSAS and OSAS scores of the observation group were lower than those of the control group, and the difference were statistically significant (P <0.05). The social score, self-evaluation and total score in the observation group were higher than those in the control group, and the differences were statistically significant (P <0.05). The satisfaction rate of the observation group was 95.92%, which was higher than 83.67% of the control group, and the difference was statistically significant (P <0.05). Conclusion Optimizing the nursing path is beneficial to promote the healing of incision after cesarean section and improve its aesthetics, reduce the scar condition, reduce the incidence of complications, and can better meet the needs of women and improve nursing satisfaction.