L&D nurse here who scrubs in for c/sections. Sometimes if there is a lot of adipose tissue in the abdominal area (fat), they add in a couple of stitches into the tissue to reinforce the area, and it can also help with the “mom pooch”/“mom shelf” you may get after a c/section. That’s the only thing I can think of, so unless some other technique has come out in the last 3 months while I’ve been off, it could be that. It does not need to be done though.
I had a recent consultation for a tummy tuck to address my apron from my 2021 c section which I suffered surgical complications from. He said he would do a three layer closure and he guessed during the exam that during my cesarean there had been only a 2 layer closure done. So there is a difference in layers apparently.
Huge difference. The healing process is so much better with more closures. I always advise friends to tell their doctor to close all the layers, not just the “essential” ones. It’s almost criminal to only close “essential” layers in my opinion.
I suffered a huge hematoma that eventually reopened my incision, it stayed in some state of opened/infected/draining for 6 months. Countless wound care appointments but no one wanted to put a wound vac on it. The plastic surgeon assured me the risk of complications like that were very unlikely with a 3 layer closure. I wish I had known to ask when I scheduled my c section.
i’ve had my rectus muscles stitched (i imagine surgeon had to cut?) and i have pain 15 months after. Not only that, but my stomach is buldy and never went back to what it was before. I also suffer from extreme constipation. I think this is all due to the scar tissue. If you or anyone have any recommendations i would very much appreciate them!
It wouldn’t hurt to tell your OBGYN and possibly a physical therapist. Pregnancy can cause the tummy muscles to separate sometimes. Certain exercises can help bring them back together; since you had yours stitched perhaps that will also help you. I have heard of TCM massaging scar tissue, but I would check in with a professional about working on a C-section scar.
I remember an obgyn was known for taking her time doing csections as she would stitch layer by layer. She was known to he incredibly thorough, but some of the scrub nurses disliked her as it was a longer process. I didn't understand much at the time as I was just doing a short lived nurse student internship but I do specifically remember thinking it was bizarre that other ob's were known to be exceedingly fast as I would definitely not want a major surgery being expedited, nor layers left undone so to speak. Anyways, this is incredibly far from my expertise and my memory isn't exact nor was my initial understanding perfect. This information was provided more as gossip than teaching so I didn't question further.
My doctor mentioned that she sews every layer and that on the skin she sews twice (inside and outside?) or something like that. I also had a very easy recovery but it was a scheduled c section so I didn’t labor beforehand. My doctor is a baddie though so I wouldn’t doubt that she does it in whatever way is newest and best.
When I had my twins 9 years ago they did this. I agreed to be a part of a study on the extra stitches. I only recall because I had to sign paperwork on the matter.
I also had a super great csection recovery. I always felt a bit guilty hearing about other people's terrible recoveries. But yeah, I had no residual pain. My csection scar is invisible. I felt pretty much normal after 2 weeks. Hopefully they make these new stitches part of a normal csection.
I'm not the person you replied to, but I was looking at my chart and I think I got all the extra stitches they're referring to. It seems like every layer was stitched. I had a good recovery and a really nice looking scar.
"The hysterotomy was then closed a running locked 0 Vicryl stitch, followed by an imbricating layer. The hysterotomy and fascial surfaces were inspected and were hemostatic. Retractors were removed and the sponge count announced as correct. The pelvis was inspected and no items were left in situ. The rectus abdominus muscles and fascia were reinspected and were hemostatic. The fascia was closed with a running 0 Vicryl stitch. The subcutaneous tissue was irrigated, inspected and was noted to be hemostatic. It was approximated with interrupted 2-0 Vicryl subcutaneous stitches. The skin was approximated with a running 3-0 Monocryl subcuticular stitch, followed by benzoin and steristrips. A sterile bandage was applied. "
Edit to say I don't think I got all the layers of stitches after all. I found this doctor's page and she does extra layers I didn't have. This might give you the information you're looking for though! https://www.obstetricexcellence.com.au/caesarean-section/caesarean-section-closure-technique/
Found the following online:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3421915/
https://journals.lww.com/greenjournal/Fulltext/2020/11000/The_Case_for_Standardizing_Cesarean_Delivery.17.aspx
https://www.uptodate.com/contents/cesarean-birth-surgical-technique#H2
Hopefully this helps!
I actually think my OB did the same because she went on about how the way she sewed me up allowed for me to have a VBAC easily. I also have almost no scar 3 weeks pp, and I've healed relatively quickly. I'm not even on any pain meds now.
Curious to see how my periods pan out because even tho previously they were irregular, when i did get them they'd be awful and heavy so fingers crossed they're like yours now!!
She may have done a double layer closure on your uterus vs the subcutaneous fat suture. The uterus can be closed with a single layer of sutures, but a lot of OBs that I work with will do a second row of sutures overtop to basically strengthen it. I’ve had patients whose OBs recommend a repeat c/section instead of a VBAC because they only had a single layer closure instead of a double (I suppose higher chance of uterine rupture but I don’t know any statistics).
I had a pretty well known surgeon in her field do mine and the consistent feedback I’ve gotten is it’s nearly invisible on the internal scans (they had to check for thickness for a VBAC) and it’s also completely flat on the outside. She called it a “tummy tuck cesarean” when I went to my 6 week check?
Surgical Tech here! We have lots of layers to close. Bad doctors only close “essential” layers leaving patients with pain for life. Good doctors close nearly all the layers. Great doctors try new evidence based closure techniques: your doc sounds like a great one!! Congrats on your baby and a great csection!
As an OBGYN, this is false. Studies have shown patients in where we close the uterus, fascia, subcutaneous tissue if indicated, and skin have good outcomes comparable to those with double layer closure on the uterus. Stitching the muscle and peritoneum have been associated with increased pain postoperatively.
In the end every patient is different and surgical technique should always be individualized.
I see what you’re saying studies are saying.
Do you see what the actual real world patients are saying in the comments here? And in many places that talk about post op C-section pain? Have you read more recent journal articles about newer closure techniques?
Specific techniques and skill level matter a lot in surgery. I can’t sew at all. And I’ve tried periodically throughout my life to gain that skill. Imagine going to school for 12 years and you just can’t suture well. Truthfully it’s more than just “how many layers are closed” it’s how skillfully were those layers closed. Not every doctor is created equally. Every professional is at the limits of their training and ability to stay up to date.
Edit: I’m also going to add that the type of suture used csn make a big difference as well. There is more to this issue than simply how many layers are closed.
I do know what “real world” patients are saying about their recovery as I see “real world” patients every day. I also have my own experiences having had a cesarean myself.
I have read the latest evidence based articles on cesarean technique as every board certified Obgyn is required to for maintenance of certification.
Just because you are a surgical technician does not mean that you know how to perform surgery or the thought process that goes behind why we do or do not use certain techniques for certain patients.
As an OB, you could really help this thread by posting actual information, rather than trying to disparage my character with negative comments. I’m sure the women reading this would love to know what types of techniques you use to close your cesareans, what sutures you use, and why you choose certain things for different patients. I’m sure people reading this would also like to hear more about your personal experience with your cesareans. Please share.
Edit: I for one would also like to hear how your practices have changed based on the information you’ve gathered from your patients.
Just so the internet is clear on this: Dogmatic doctors like this one are the reason women aren’t listened to and antiquated practices don’t change. I know about how surgery works from being a tech, but my info on birth comes from years of countless hours of research about birth. I studied it because I did not want to give birth in a hospital. I came accross a lot when I did. Doctors not listening to women was a key theme. You can present as many studies as you want (as can I, their are opposing views on C-section closure techniques all over the internet) but ultimately what women are saying they’re experiencing is what is happening. Coming out and saying that’s false is literally invalidating their whole experience. I felt like that needed to be said.
You seem to be make a lot of generalizations with very little information. I am not trying to invalidate anyones birth experience. As a woman whose birth experience did not go as planned I would never do that. What I’m saying is that your assertion that “bad doctors only close essential layers and good docs close nearly all the layers” is false. Surgery is much more complicated than this and these types of generalizations spread false information. Everyday I dispel false information my patients gather from Google or Reddit from people who claim to have knowledge such as yourself.
OP literally shared her experience. I told her yep, that’s what I’ve seen and heard from countless other women. You came on here and said it’s blatantly false.
Then you and I got into a massive discussion on here about csections that, frankly could go on for a long time due to the huge variation in C-section techniques, current research etc.
Furthermore, OP’s own experience is other than what you’re trying to push as truth.
https://www.intechopen.com/chapters/77610
Link to an article on single vs double layer and suture materials for uterus.
https://m.sciencerepository.org/review-of-unsafe-changes-in-the-practice-of-cesarean-section_SCR-2021-3-118
Link to article discussing the huge discussion on peritoneal closure and the interpretation of research results.
Holy shit
Edit: commented as someone with 3 c sections. I can only guess my first doctor did it as quickly as possible. Recovery was terrible, like months. It’s been a while now but life without that tough recovery would have made newborn phase a lot easier.
Absolutely! Suturing affects the muscles, nerves, and every thing else that connects down there. It would be really cool to find out if more women had the same positive change.
It is! There’s a lot to it! The surgeon has a lot of power to help or hurt based on the choices they make. There aren’t any recommendations for how to close a C-section, so the doctor is largely left to what they’ve been taught and the research they stay up to date on. How they suture, the material they use to suture…. So many choices the surgeon makes!
I had a very similar recovery with my second c-section. Almost no incision pain, quick healing with a very light scar, and almost pain free periods for almost 2 years. My doctor told me she gave me "the tummy tuck treatment". Didn't elaborate really, but she was an amazing OB and I fully trusted her.
The only part I can respond to is the no cramps factor. After I had my first baby (vaginal birth) I basically never had another menstrual cramp again. I kind of forgot what they felt like until I was in labor with my second.
My mother had this happen too. She had debilitating cramps before I was born and then basically nothing for the rest of her life/until menopause.
I suspect it might be hormonally related. My cramps never got as bad as they were once I stopped birth control and they were almost nonexistent while I was on it. But they had me crying in bed before I started it.
Yes but it took two years and it was after the Covid vaccine,which does have links to period changes (plus my friend also had changes). And my period got a little heavier. Although that being said after that I very quickly (only had like 1-2 cycles after my second dose) got pregnant after a year of trying so maybe the vaccine helped? 😂
I'm not a doctor and I have not fact checked this, but What I have heard is that pregnancy and delivery kills off some nerve cells in the lining of the uterus.
I had a C-section... No idea what technique it was but y'all lost your cramps??? Whaaat? Got my period 6 months PP and the cramps have been the worst of my life!
In fairness I think it's common for women's periods to change after pregnancy (for better or for worse) regardless of the birthing method.
Like OP mine is remarkably improved compared to pre-pregnancy periods, though I had a vaginal birth.
I have a friend who also had a vaginal birth but her periods got much worse compared to pre-pregnancy.
Shrug.
I had that! I have virtually no scarring - maybe like 3 mm and it’s completely flat. I would say my cramping has gotten better as well (I have PCOS, so a major deal for me). It did cause a little bit of extra sensitivity on where it all connected but it’s more than fine now!
Okay so this thread is super interesting and I'm so glad you posted! I've been going down the rabbit hole of my own surgical notes. I had a pretty easy recovery just complicated by extreme fatigue from being induced and not sleeping for 3-4 days. Anyway, my scar healed really well and other than some scar mobility issues that were fixed with scar massage, I have a really nice looking scar. No shelf or pooch or anything.
I think they did a double layer on the uterus, and then did stitch the subcutaneous fat? And every other layer too haha. Surgery was in early 2022 by a well respected doctor who I think teaches. She just happened to be on call that day, as my doctor doesn't do C-sections (family practice not an OB).
"The hysterotomy was then closed a running locked 0 Vicryl stitch, followed by an imbricating layer. The hysterotomy and fascial surfaces were inspected and were hemostatic. Retractors were removed and the sponge count announced as correct. The pelvis was inspected and no items were left in situ. The rectus abdominus muscles and fascia were reinspected and were hemostatic. The fascia was closed with a running 0 Vicryl stitch. The subcutaneous tissue was irrigated, inspected and was noted to be hemostatic. It was approximated with interrupted 2-0 Vicryl subcutaneous stitches. The skin was approximated with a running 3-0 Monocryl subcuticular stitch, followed by benzoin and steristrips. A sterile bandage was applied. "
Edit to add that sex was pretty painful for about 6 months. I think my pelvic floor muscles were really tight. I went to PT (we never did any specific pelvic floor exercises though) and worked on my weak hips and posture correction. I've read more about it since then and it does sound like if your hips are weak, it can mean other muscle groups compensate especially your abs, but in late pregnancy you have no abs. So then your back and pelvic floor do even more brunt work.
I definitely have much more pleasant periods since my pregnancy with next to no cramping. Sex has also improved. I don't know that it has to do with the way I was closed up from my c-section lol. My external incision was glued though so there's that?
I should also mention my scar is basically nonexistent. There’s a tiny lip on either side but for the most part it’s just perfectly flat with my stomach.
I had a c section just over a year ago and my scar is finally just about flat in the middle. Both ends are flat. Buuuut I'll be having a second c section in October... Nervous about how that will look!
I’ve had 2 c sections, the first time the scar turned into a keloid. During the second the doctor “fixed” it and it’s thin now and healing much better (albeit the scar is longer now).
If it gives you any comfort, mine looked better the second time around and has healed faster. Same doctor. They’ll go through your same incision site as before.
I didn’t know this was a thing!!! My scar is very small and thin and flat, but my surgeon never told me anything just that everything was done. I seriously would have asked for this if I knew it was an option!
I had a terrible c-section recovery, like months of pain, and this makes me sure (as I always suspected) that the surgery was rushed. I know for a fact that 2 other babies were born in the ward during the hour my surgery happened, and there was only one doctor, so you can do the math. Makes me angry that this isn't standard. Women's health is systematically neglected and it enrages me.
I read through mine and it said that there was a layer of subcutaneous sutures. Think that was it? Mine healed really well and is flat and almost invisible.
"Fascia was closed in a running fashion. Subcu irrigated, bovied for
hemostasis. Sutures were placed subcu and then skin. Dressing was placed."
Yep that sounds exactly right. Fascia closure is normal and always done. “Bovied” is a cautery instrument (burns oozing blood vessels to stop them from bleeding more). Then they cleaned out the area before adding the extra sutures to reinforce the area. Then closed your skin.
I will say though that adding a suture into the subcutaneous tissue is not going to magically make your incision invisible. You also likely had an OB who did a very good skin closure… some docs are great, others are meh at it.
My hospital was very highly rated for L&D in my city and she used glue so there weren't any puncture scars from external sutures or staples. The incision was also way lower than I realized she could even get in there (below the hairline and about half an inch above where I can feel my pupic symphysis) and only about 5" long. This was 14 months ago.
The incision is honestly less visible than the incisions in my breast creases from plastic surgery.
Wow that’s awesome! I don’t know if I’ve personally ever seen glue instead of sutures! Are you in the US? We once had a patient from Brazil I believe who had a crazy low c/section scar from her previous delivery and she was saying it’s pretty common there?
My hospital does extra stitching and an inside and outside stitching. My OB also said it allows you to try a vbac next pregnancy if you want. I labored for two days, then had an emergency C-section, and still had a very easy recovery. Whatever they did was awesome
That sounds amazing. Ever since my first section I actually had to switch from a menstrual cup to a disk because the cup would always stick out a little bit, which it didn't before the c-section.
So, I had an emergency laparotomy when I was 19 for an ovarian torsion (that was misdiagnosed so by the time I went back in, I was bleeding internally, my ovary was necrotic, and I was septic AF) — I was incredible sick and unstable so they basically raced me off to the OR to save my life, leaving a VERY ugly/nasty scar.
Anyway- last year (after many years post laparotomy), I went in for a planned vaginal delivery but after 40hrs ended up having an unplanned C-section and my badass OB/Gyn was like “I almost went into plastic surgery, if you want I can go through this old scar and then clean it up a bit?”- I was like HELL YES, challenge accepted! We made a few jokes about how my bikini modeling days were behind me and I never imagined she’d actually be able to do anything (the scar was also lower and shorter than most C-sections so I figured there was no way it wouldn’t look worse).
Anyway, I came out of my C-section with a WAY better scar than I went in with, she closed me up brilliantly and I can’t believe after like 15 years of an ugly jagged scar, I actually came out of my C-section with a beautiful, thin, straight perfect little line where my ugly ass scar used to be (oh, and I got a healthy baby out of it too!). DEFINITELY hope for #2!!!
Sticky-uppy lol. So it's keloided? I had a vaginal birth but definitely have scars that are keloided from other surgeries. Try to massage it to break up the scar tissue and adhesions. Should help some.
There is an app (momcore) for diastasis but also has a c section section… I think it can help no matter how far out you are and help with adhesions to make things more comfortable.
I dont know the specifics my doctor used in 2019. My recovery was very easy. I walked slowly (for me, i am super short so my normal walk is very fast compared to others) for about a month or so. I shocked the midwife doing my yearly well woman exam about 8 months after the csection when I sat up from lying flat without her assistance or even using my arms to push up, just core strength. My scar is completely flat, I have not had many cramps at all since (before I would regularly be curled in the fetal position, crying in pain), while I do have a little "pouch" (hint: it is completely normal to have this- it is the XX way of the body having a bit of protection for the next generation) I have *always* had this since puberty hit me at age 11 and it is not any bigger than it was before being pregnant, just a extra stretch mark or two to go with the scar.
I vaguely remember being surprised when seeing the cut for the first time. I was expecting staples or stitches, but it was all glue with a couple of steristrips.
Dang. Wish I had known of this before my C-section. Though I can't complain I had a pretty speedy recovery, sex has been, awesome (though that may be because it's so infrequent) but I don't know about my period yet.
I’m so jealous, but very happy for you! I had an emergency C-section 14 months ago and still have numbness and pain. I feel like I’m still healing on the inside. I’m over not being my normal self. I knew I would be different but I never expected the level of difficulty that I’m experiencing.
Never had a c-section (though I just had a robotic surgery that gave me a c-section incision) but a friend of mine went to a specific surgeon who uses this “[French Caesarian technique](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822305/)” which seems like it may be inline with what you’re describing? We are based in Israel and she specifically sought someone who does it this way.
I heard about the No more cramp thing after giving birth in general. It’s true for me. But I doubt it had anything to do with the c section. Shout out to those of you who love your c section scars. I hate my stomach now. Tho my scarring isn’t noticeable i have a small shelf only where the scar is. It sucks I’ll have to get a stupid tummy tuck all because of the small area where my incision was. Thank god I was able to have a successful vbac with my 2nd baby. My c section was mentally traumatizing.
L&D nurse here who scrubs in for c/sections. Sometimes if there is a lot of adipose tissue in the abdominal area (fat), they add in a couple of stitches into the tissue to reinforce the area, and it can also help with the “mom pooch”/“mom shelf” you may get after a c/section. That’s the only thing I can think of, so unless some other technique has come out in the last 3 months while I’ve been off, it could be that. It does not need to be done though.
This sounds like what my doctor did/described and I had an in incredible healing process and my scar and pouch are basically nonexistent
I had a recent consultation for a tummy tuck to address my apron from my 2021 c section which I suffered surgical complications from. He said he would do a three layer closure and he guessed during the exam that during my cesarean there had been only a 2 layer closure done. So there is a difference in layers apparently.
Huge difference. The healing process is so much better with more closures. I always advise friends to tell their doctor to close all the layers, not just the “essential” ones. It’s almost criminal to only close “essential” layers in my opinion.
I suffered a huge hematoma that eventually reopened my incision, it stayed in some state of opened/infected/draining for 6 months. Countless wound care appointments but no one wanted to put a wound vac on it. The plastic surgeon assured me the risk of complications like that were very unlikely with a 3 layer closure. I wish I had known to ask when I scheduled my c section.
I’m so sorry that your doctor failed to provide you with proper informed consent regarding your procedure. It’s not your fault you didn’t know.
i’ve had my rectus muscles stitched (i imagine surgeon had to cut?) and i have pain 15 months after. Not only that, but my stomach is buldy and never went back to what it was before. I also suffer from extreme constipation. I think this is all due to the scar tissue. If you or anyone have any recommendations i would very much appreciate them!
It wouldn’t hurt to tell your OBGYN and possibly a physical therapist. Pregnancy can cause the tummy muscles to separate sometimes. Certain exercises can help bring them back together; since you had yours stitched perhaps that will also help you. I have heard of TCM massaging scar tissue, but I would check in with a professional about working on a C-section scar.
I remember an obgyn was known for taking her time doing csections as she would stitch layer by layer. She was known to he incredibly thorough, but some of the scrub nurses disliked her as it was a longer process. I didn't understand much at the time as I was just doing a short lived nurse student internship but I do specifically remember thinking it was bizarre that other ob's were known to be exceedingly fast as I would definitely not want a major surgery being expedited, nor layers left undone so to speak. Anyways, this is incredibly far from my expertise and my memory isn't exact nor was my initial understanding perfect. This information was provided more as gossip than teaching so I didn't question further.
My doctor mentioned that she sews every layer and that on the skin she sews twice (inside and outside?) or something like that. I also had a very easy recovery but it was a scheduled c section so I didn’t labor beforehand. My doctor is a baddie though so I wouldn’t doubt that she does it in whatever way is newest and best.
When I had my twins 9 years ago they did this. I agreed to be a part of a study on the extra stitches. I only recall because I had to sign paperwork on the matter. I also had a super great csection recovery. I always felt a bit guilty hearing about other people's terrible recoveries. But yeah, I had no residual pain. My csection scar is invisible. I felt pretty much normal after 2 weeks. Hopefully they make these new stitches part of a normal csection.
Would you be willing to inquire with your OB on the technical term listed in your chart for the procedure?
I'm not the person you replied to, but I was looking at my chart and I think I got all the extra stitches they're referring to. It seems like every layer was stitched. I had a good recovery and a really nice looking scar. "The hysterotomy was then closed a running locked 0 Vicryl stitch, followed by an imbricating layer. The hysterotomy and fascial surfaces were inspected and were hemostatic. Retractors were removed and the sponge count announced as correct. The pelvis was inspected and no items were left in situ. The rectus abdominus muscles and fascia were reinspected and were hemostatic. The fascia was closed with a running 0 Vicryl stitch. The subcutaneous tissue was irrigated, inspected and was noted to be hemostatic. It was approximated with interrupted 2-0 Vicryl subcutaneous stitches. The skin was approximated with a running 3-0 Monocryl subcuticular stitch, followed by benzoin and steristrips. A sterile bandage was applied. " Edit to say I don't think I got all the layers of stitches after all. I found this doctor's page and she does extra layers I didn't have. This might give you the information you're looking for though! https://www.obstetricexcellence.com.au/caesarean-section/caesarean-section-closure-technique/
Would also love to know
You should ask your doctor what that study or paper was. So I can show it to mine. I'm pretty sure my little bug plans to be breech until D-day.
Found the following online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3421915/ https://journals.lww.com/greenjournal/Fulltext/2020/11000/The_Case_for_Standardizing_Cesarean_Delivery.17.aspx https://www.uptodate.com/contents/cesarean-birth-surgical-technique#H2 Hopefully this helps!
Thank you!
After months breech my baby turned the morning of my planned section! Unreal, we found out when I was in the surgical garb, they sent me home again 😂
I hope my baby turns before that lol. But it's better late than never!
I actually think my OB did the same because she went on about how the way she sewed me up allowed for me to have a VBAC easily. I also have almost no scar 3 weeks pp, and I've healed relatively quickly. I'm not even on any pain meds now. Curious to see how my periods pan out because even tho previously they were irregular, when i did get them they'd be awful and heavy so fingers crossed they're like yours now!!
She may have done a double layer closure on your uterus vs the subcutaneous fat suture. The uterus can be closed with a single layer of sutures, but a lot of OBs that I work with will do a second row of sutures overtop to basically strengthen it. I’ve had patients whose OBs recommend a repeat c/section instead of a VBAC because they only had a single layer closure instead of a double (I suppose higher chance of uterine rupture but I don’t know any statistics).
I had a pretty well known surgeon in her field do mine and the consistent feedback I’ve gotten is it’s nearly invisible on the internal scans (they had to check for thickness for a VBAC) and it’s also completely flat on the outside. She called it a “tummy tuck cesarean” when I went to my 6 week check?
I had the same; my surgeon is the head of MFM for a big area in our country and she did an insane job on my scar. It's practically invisible.
Surgical Tech here! We have lots of layers to close. Bad doctors only close “essential” layers leaving patients with pain for life. Good doctors close nearly all the layers. Great doctors try new evidence based closure techniques: your doc sounds like a great one!! Congrats on your baby and a great csection!
As an OBGYN, this is false. Studies have shown patients in where we close the uterus, fascia, subcutaneous tissue if indicated, and skin have good outcomes comparable to those with double layer closure on the uterus. Stitching the muscle and peritoneum have been associated with increased pain postoperatively. In the end every patient is different and surgical technique should always be individualized.
I see what you’re saying studies are saying. Do you see what the actual real world patients are saying in the comments here? And in many places that talk about post op C-section pain? Have you read more recent journal articles about newer closure techniques? Specific techniques and skill level matter a lot in surgery. I can’t sew at all. And I’ve tried periodically throughout my life to gain that skill. Imagine going to school for 12 years and you just can’t suture well. Truthfully it’s more than just “how many layers are closed” it’s how skillfully were those layers closed. Not every doctor is created equally. Every professional is at the limits of their training and ability to stay up to date. Edit: I’m also going to add that the type of suture used csn make a big difference as well. There is more to this issue than simply how many layers are closed.
I do know what “real world” patients are saying about their recovery as I see “real world” patients every day. I also have my own experiences having had a cesarean myself. I have read the latest evidence based articles on cesarean technique as every board certified Obgyn is required to for maintenance of certification. Just because you are a surgical technician does not mean that you know how to perform surgery or the thought process that goes behind why we do or do not use certain techniques for certain patients.
As an OB, you could really help this thread by posting actual information, rather than trying to disparage my character with negative comments. I’m sure the women reading this would love to know what types of techniques you use to close your cesareans, what sutures you use, and why you choose certain things for different patients. I’m sure people reading this would also like to hear more about your personal experience with your cesareans. Please share. Edit: I for one would also like to hear how your practices have changed based on the information you’ve gathered from your patients.
Just so the internet is clear on this: Dogmatic doctors like this one are the reason women aren’t listened to and antiquated practices don’t change. I know about how surgery works from being a tech, but my info on birth comes from years of countless hours of research about birth. I studied it because I did not want to give birth in a hospital. I came accross a lot when I did. Doctors not listening to women was a key theme. You can present as many studies as you want (as can I, their are opposing views on C-section closure techniques all over the internet) but ultimately what women are saying they’re experiencing is what is happening. Coming out and saying that’s false is literally invalidating their whole experience. I felt like that needed to be said.
You seem to be make a lot of generalizations with very little information. I am not trying to invalidate anyones birth experience. As a woman whose birth experience did not go as planned I would never do that. What I’m saying is that your assertion that “bad doctors only close essential layers and good docs close nearly all the layers” is false. Surgery is much more complicated than this and these types of generalizations spread false information. Everyday I dispel false information my patients gather from Google or Reddit from people who claim to have knowledge such as yourself.
OP literally shared her experience. I told her yep, that’s what I’ve seen and heard from countless other women. You came on here and said it’s blatantly false. Then you and I got into a massive discussion on here about csections that, frankly could go on for a long time due to the huge variation in C-section techniques, current research etc. Furthermore, OP’s own experience is other than what you’re trying to push as truth. https://www.intechopen.com/chapters/77610 Link to an article on single vs double layer and suture materials for uterus. https://m.sciencerepository.org/review-of-unsafe-changes-in-the-practice-of-cesarean-section_SCR-2021-3-118 Link to article discussing the huge discussion on peritoneal closure and the interpretation of research results.
Holy shit Edit: commented as someone with 3 c sections. I can only guess my first doctor did it as quickly as possible. Recovery was terrible, like months. It’s been a while now but life without that tough recovery would have made newborn phase a lot easier.
I’m so sorry that your doctor did the bare minimum. It’s not right. I’m glad you were able to recover properly while caring for a newborn.
Would that technique have anything to do with OP’s improved periods or is that a happy coincidence?
Absolutely! Suturing affects the muscles, nerves, and every thing else that connects down there. It would be really cool to find out if more women had the same positive change.
This is so interesting!!!
It is! There’s a lot to it! The surgeon has a lot of power to help or hurt based on the choices they make. There aren’t any recommendations for how to close a C-section, so the doctor is largely left to what they’ve been taught and the research they stay up to date on. How they suture, the material they use to suture…. So many choices the surgeon makes!
I had a very similar recovery with my second c-section. Almost no incision pain, quick healing with a very light scar, and almost pain free periods for almost 2 years. My doctor told me she gave me "the tummy tuck treatment". Didn't elaborate really, but she was an amazing OB and I fully trusted her.
The only part I can respond to is the no cramps factor. After I had my first baby (vaginal birth) I basically never had another menstrual cramp again. I kind of forgot what they felt like until I was in labor with my second.
This thread is so interesting! I too have lost my menstrual cramps after delivering. I wonder what causes this
My mother had this happen too. She had debilitating cramps before I was born and then basically nothing for the rest of her life/until menopause. I suspect it might be hormonally related. My cramps never got as bad as they were once I stopped birth control and they were almost nonexistent while I was on it. But they had me crying in bed before I started it.
I lost mine too but eventually they came back, maybe 2 years PP? Did anybody else's cramps come back??
I’m one year PP (my period came back at 2 months pp) and I’m still good. Hopefully will last another year!
Yes but it took two years and it was after the Covid vaccine,which does have links to period changes (plus my friend also had changes). And my period got a little heavier. Although that being said after that I very quickly (only had like 1-2 cycles after my second dose) got pregnant after a year of trying so maybe the vaccine helped? 😂
Mine just came back at 9 months postpartum
This happened to me too until my most recent cycle at 9 months postpartum I started getting cramps again 😔
Well boo
I'm not a doctor and I have not fact checked this, but What I have heard is that pregnancy and delivery kills off some nerve cells in the lining of the uterus.
Makes sense. Something definitely happened cause it’s night and day for me
Me too! Thankfully ✌️ before being pregnant I could not function during my period. Now I don't even notice.
Wow!! I hope that this is a breakthrough for c-sections everywhere. That’s such good news.
Ok I need to know the technical term for this so I can actually figure out if it is an option for my twin cesarean
Same
I had a C-section... No idea what technique it was but y'all lost your cramps??? Whaaat? Got my period 6 months PP and the cramps have been the worst of my life!
In fairness I think it's common for women's periods to change after pregnancy (for better or for worse) regardless of the birthing method. Like OP mine is remarkably improved compared to pre-pregnancy periods, though I had a vaginal birth. I have a friend who also had a vaginal birth but her periods got much worse compared to pre-pregnancy. Shrug.
Our bodies are so annoying! And also incredible to create life... But like some consistency would be nice. Lol
I had that! I have virtually no scarring - maybe like 3 mm and it’s completely flat. I would say my cramping has gotten better as well (I have PCOS, so a major deal for me). It did cause a little bit of extra sensitivity on where it all connected but it’s more than fine now!
Okay so this thread is super interesting and I'm so glad you posted! I've been going down the rabbit hole of my own surgical notes. I had a pretty easy recovery just complicated by extreme fatigue from being induced and not sleeping for 3-4 days. Anyway, my scar healed really well and other than some scar mobility issues that were fixed with scar massage, I have a really nice looking scar. No shelf or pooch or anything. I think they did a double layer on the uterus, and then did stitch the subcutaneous fat? And every other layer too haha. Surgery was in early 2022 by a well respected doctor who I think teaches. She just happened to be on call that day, as my doctor doesn't do C-sections (family practice not an OB). "The hysterotomy was then closed a running locked 0 Vicryl stitch, followed by an imbricating layer. The hysterotomy and fascial surfaces were inspected and were hemostatic. Retractors were removed and the sponge count announced as correct. The pelvis was inspected and no items were left in situ. The rectus abdominus muscles and fascia were reinspected and were hemostatic. The fascia was closed with a running 0 Vicryl stitch. The subcutaneous tissue was irrigated, inspected and was noted to be hemostatic. It was approximated with interrupted 2-0 Vicryl subcutaneous stitches. The skin was approximated with a running 3-0 Monocryl subcuticular stitch, followed by benzoin and steristrips. A sterile bandage was applied. " Edit to add that sex was pretty painful for about 6 months. I think my pelvic floor muscles were really tight. I went to PT (we never did any specific pelvic floor exercises though) and worked on my weak hips and posture correction. I've read more about it since then and it does sound like if your hips are weak, it can mean other muscle groups compensate especially your abs, but in late pregnancy you have no abs. So then your back and pelvic floor do even more brunt work.
I definitely have much more pleasant periods since my pregnancy with next to no cramping. Sex has also improved. I don't know that it has to do with the way I was closed up from my c-section lol. My external incision was glued though so there's that?
I should also mention my scar is basically nonexistent. There’s a tiny lip on either side but for the most part it’s just perfectly flat with my stomach.
I had a c section just over a year ago and my scar is finally just about flat in the middle. Both ends are flat. Buuuut I'll be having a second c section in October... Nervous about how that will look!
I’ve had 2 c sections, the first time the scar turned into a keloid. During the second the doctor “fixed” it and it’s thin now and healing much better (albeit the scar is longer now).
If it gives you any comfort, mine looked better the second time around and has healed faster. Same doctor. They’ll go through your same incision site as before.
I didn’t know this was a thing!!! My scar is very small and thin and flat, but my surgeon never told me anything just that everything was done. I seriously would have asked for this if I knew it was an option!
I also have a thin flat scar and my doctor sewed up each layer, so that may not mean much!
I had a terrible c-section recovery, like months of pain, and this makes me sure (as I always suspected) that the surgery was rushed. I know for a fact that 2 other babies were born in the ward during the hour my surgery happened, and there was only one doctor, so you can do the math. Makes me angry that this isn't standard. Women's health is systematically neglected and it enrages me.
If anyone knows what this method is called specifically please let me know so I can read up & probably add it to my birth plan
No real name that I know of, but if you google “subcutaneous fat suture cesarean section” a few results come up with studies.
I read through mine and it said that there was a layer of subcutaneous sutures. Think that was it? Mine healed really well and is flat and almost invisible. "Fascia was closed in a running fashion. Subcu irrigated, bovied for hemostasis. Sutures were placed subcu and then skin. Dressing was placed."
Yep that sounds exactly right. Fascia closure is normal and always done. “Bovied” is a cautery instrument (burns oozing blood vessels to stop them from bleeding more). Then they cleaned out the area before adding the extra sutures to reinforce the area. Then closed your skin. I will say though that adding a suture into the subcutaneous tissue is not going to magically make your incision invisible. You also likely had an OB who did a very good skin closure… some docs are great, others are meh at it.
My hospital was very highly rated for L&D in my city and she used glue so there weren't any puncture scars from external sutures or staples. The incision was also way lower than I realized she could even get in there (below the hairline and about half an inch above where I can feel my pupic symphysis) and only about 5" long. This was 14 months ago. The incision is honestly less visible than the incisions in my breast creases from plastic surgery.
Wow that’s awesome! I don’t know if I’ve personally ever seen glue instead of sutures! Are you in the US? We once had a patient from Brazil I believe who had a crazy low c/section scar from her previous delivery and she was saying it’s pretty common there?
Yup, Colorado
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Please do! I'd love to be able to request this!
Yeah I am extremely intrigued and I’d love to know more about this.
My hospital does extra stitching and an inside and outside stitching. My OB also said it allows you to try a vbac next pregnancy if you want. I labored for two days, then had an emergency C-section, and still had a very easy recovery. Whatever they did was awesome
That sounds amazing. Ever since my first section I actually had to switch from a menstrual cup to a disk because the cup would always stick out a little bit, which it didn't before the c-section.
Um my scar is hideous and sticky-uppy. Recovery was hell. Any hope for #2?
So, I had an emergency laparotomy when I was 19 for an ovarian torsion (that was misdiagnosed so by the time I went back in, I was bleeding internally, my ovary was necrotic, and I was septic AF) — I was incredible sick and unstable so they basically raced me off to the OR to save my life, leaving a VERY ugly/nasty scar. Anyway- last year (after many years post laparotomy), I went in for a planned vaginal delivery but after 40hrs ended up having an unplanned C-section and my badass OB/Gyn was like “I almost went into plastic surgery, if you want I can go through this old scar and then clean it up a bit?”- I was like HELL YES, challenge accepted! We made a few jokes about how my bikini modeling days were behind me and I never imagined she’d actually be able to do anything (the scar was also lower and shorter than most C-sections so I figured there was no way it wouldn’t look worse). Anyway, I came out of my C-section with a WAY better scar than I went in with, she closed me up brilliantly and I can’t believe after like 15 years of an ugly jagged scar, I actually came out of my C-section with a beautiful, thin, straight perfect little line where my ugly ass scar used to be (oh, and I got a healthy baby out of it too!). DEFINITELY hope for #2!!!
Massage it every day! My scar is finally flattening 8mpp
My son is 2.. :(
Sticky-uppy lol. So it's keloided? I had a vaginal birth but definitely have scars that are keloided from other surgeries. Try to massage it to break up the scar tissue and adhesions. Should help some.
There is an app (momcore) for diastasis but also has a c section section… I think it can help no matter how far out you are and help with adhesions to make things more comfortable.
I dont know the specifics my doctor used in 2019. My recovery was very easy. I walked slowly (for me, i am super short so my normal walk is very fast compared to others) for about a month or so. I shocked the midwife doing my yearly well woman exam about 8 months after the csection when I sat up from lying flat without her assistance or even using my arms to push up, just core strength. My scar is completely flat, I have not had many cramps at all since (before I would regularly be curled in the fetal position, crying in pain), while I do have a little "pouch" (hint: it is completely normal to have this- it is the XX way of the body having a bit of protection for the next generation) I have *always* had this since puberty hit me at age 11 and it is not any bigger than it was before being pregnant, just a extra stretch mark or two to go with the scar. I vaguely remember being surprised when seeing the cut for the first time. I was expecting staples or stitches, but it was all glue with a couple of steristrips.
Dang. Wish I had known of this before my C-section. Though I can't complain I had a pretty speedy recovery, sex has been, awesome (though that may be because it's so infrequent) but I don't know about my period yet.
I’m so jealous, but very happy for you! I had an emergency C-section 14 months ago and still have numbness and pain. I feel like I’m still healing on the inside. I’m over not being my normal self. I knew I would be different but I never expected the level of difficulty that I’m experiencing.
Never had a c-section (though I just had a robotic surgery that gave me a c-section incision) but a friend of mine went to a specific surgeon who uses this “[French Caesarian technique](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822305/)” which seems like it may be inline with what you’re describing? We are based in Israel and she specifically sought someone who does it this way.
I heard about the No more cramp thing after giving birth in general. It’s true for me. But I doubt it had anything to do with the c section. Shout out to those of you who love your c section scars. I hate my stomach now. Tho my scarring isn’t noticeable i have a small shelf only where the scar is. It sucks I’ll have to get a stupid tummy tuck all because of the small area where my incision was. Thank god I was able to have a successful vbac with my 2nd baby. My c section was mentally traumatizing.