Many women who have had a cesarean delivery wonder if doctors make the incision in the same location for a repeat C-section. This is an understandable concern, as minimizing scarring and potential complications are common goals. The short answer is usually yes, doctors do typically make the incision in generally the same spot as the previous C-section. However, there are some factors that can lead to a different incision placement.
Reasons for Using the Same Incision Site
There are several advantages to using the same incision site for a repeat C-section:
Less Scarring
Making the incision in the same location helps limit the overall amount of scar tissue and keeps it consolidated to one area on the abdomen. Every incision will lead to some degree of scarring, but containing it to one site generally leads to a thinner and less visible scar. The more incisions made means more scarring overall.
Easier Procedure
Dissecting through scar tissue can be more challenging than cutting through fresh tissue. Surgeons are familiar with the anatomy and layers of tissue they previously cut through. Making the incision in the same place allows them to follow the same tract they created with the first surgery. This can make the repeat procedure faster and easier.
Less Bleeding
There tends to be less bleeding when cutting through scar tissue compared to fresh tissue that has a robust blood supply. Making the incision in the previous location avoids cutting through additional blood vessels and reduces the risk of surgical complications like hematomas.
Lower Infection Risks
Existing scar tissue has a lower chance of infection compared to fresh surgical wounds. Bacteria has a harder time penetrating and colonizing previously healed incision sites. Reopening the old incision avoids creating a second fresh wound prone to infections during healing.
Less Pain
Nerves in scar tissue tend to be less sensitive and reactive to pain. Patients generally experience less post-surgical pain when the incision is made in the previous site versus cutting through fresh innervated skin again. Healed incisions have fewer nerve endings to transmit pain signals.
Reasons the Incision Site May Change
While doctors usually prefer to reuse the original low transverse uterine incision site, there are some reasons why the location may need to change for a repeat surgery:
Adhesions
Extensive scarring under the skin along the abdominal wall is known as an adhesion. Adhesions that form along the previous incision line can make reopening the same site difficult and dangerous. The doctor may need to make a vertical incision in a different spot to safely access the uterus if severe adhesions are present.
History of Wound Infection
If the prior incision became infected, the surgeon may opt to make the new incision in an uncontaminated area. This prevents reopening contaminated tissue and lowers risks of recurring infection. A different incision site allows them to avoid infected skin and tissues.
Hernia Repair
An incisional hernia may occur when weak scar tissue leads to a bulge or pocket near the old incision site. If a hernia repair procedure is being done concurrently, the surgeon may need to reopen the old wound and then make an additional incision to implant mesh for reinforcement.
Prior Vertical Incision
If a vertical skin incision was required for the first C-section, the low transverse method may be attempted for the repeat surgery if no complicating factors exist. This would provide a smaller and less visible scar.
Extreme Scarring
In some cases, extensive scarring builds up along the old incision causing skin rigidity or decreased mobility of underlying tissues. Trying to reopen the damaged area could increase risks and make the surgery overly difficult. A fresh site may provide better access and outcomes.
Placental Position
The location of the placenta inside the uterus may necessitate a different surgical approach to avoid damaging or cutting into it. An odd implantation spot may preclude using the old incision angle.
Preparing for Surgery
If you are planning a repeat C-section, ask your surgeon at a pre-op visit if they anticipate reusing the original low transverse hip incision site. They will examine the location and check for any complicating factors like adhesions or infections. Review your surgical history and any related concerns about scarring or pain thresholds.
Some key questions to ask include:
– Will you likely make the new incision in the same spot?
– How does any scarring along the old incision look?
– Do you anticipate any need to change the incision site?
– Would a different site mean a longer recovery or extra pain?
– How can I best prepare my skin along the incision area?
Your doctor will inform you if they have any cause to alter the standard practice of reopening the previous low transverse surgical cut line. If the same site will be used again, carefully follow their pre-op instructions for cleansing and caring for the skin over the scar. Ensuring it is healthy optimizes how the existing scar tissue heals after being reopened.
The C-Section Procedure
During a repeat C-section, these basic steps are followed once the abdomen is opened:
Retracting Tissues
The surgeon will use instruments to lift and separate tissues along the existing incision line. This exposes the deeper muscular layers and allows them to be cut along the previous tract. Any adhesions may need to be detached.
Entering the Uterus
The doctor will extend the incision through the abdominal wall and reach the uterus. They will carefully reopen the old cesarean scar using a scalpel or surgical scissors. This allows entry into the lower uterine segment which contains no blood vessels.
Delivery of Baby
With the uterus open, the amniotic sac is ruptured to release the amniotic fluid. The baby can then be gently lifted out, the umbilical cord clamped and cut, and the newborn passed to waiting caregivers.
Removal of Placenta
The placenta is then detached from the implantation site on the uterine wall and removed through the incision. The uterus contracts and bleeds from where the placenta was attached.
Suturing Uterus and Layers
The doctor closes the low transverse uterine incision with dissolvable sutures in multiple layers. Additional sutures then repair the reopened abdominal tissues, from peritoneum to fascia, muscle, and finally skin.
Recovering After Surgery
Post-operative care will be very similar after a repeat C-section versus a first surgery. Follow all discharge instructions closely, including:
Pain Management
Take prescribed medications to manage surgical pain and allow comfortable mobility. Use ice packs to relieve localized pain along the incision site.
Incision Care
Keep the dressing clean and dry. Watch for signs of new bleeding, fluid leakage, swelling, or fresh redness. Report any worrisome symptoms to your obstetrician.
Activity Precautions
Avoid overexerting the incision site and abdomen. Follow lifting, stair use, and driving restrictions until approved by your doctor at follow-up visits. Get help caring for your new baby as needed.
Diet
Restart a normal healthy diet gradually. Drink plenty of water, eat fiber, and take stool softeners to avoid straining with first bowel movements.
Showering
Sponge bathe initially to allow the incision time to seal. Once approved, keep soaps away from the area and pat dry. Change dressings if needed after washing.
Closely follow all discharge instructions to ensure proper healing and recovery. Report any worrisome symptoms promptly like bleeding, pain, redness, swelling, fever, etc. Your doctor will want to check the incision site at follow-up visits after your stitches or staples are removed around 4-6 weeks postpartum.
Frequently Asked Questions
Here are some common questions about incision placement for repeat cesarean deliveries:
Does a second C-section incision heal faster?
Yes, reopening an existing scar usually heals a bit faster than a fresh incision through intact skin and tissues. Less surgical dissection leads to quicker recovery times.
Why do they cut vertically sometimes?
Vertical incisions may be needed due to scar tissue complications, histories of infection, adhesions, hernias or other anatomical factors the surgeon encounters during the procedure.
Do two C-sections lead to more scar tissue?
Yes, each repeat surgery through the same incision site will generate additional scar tissue. But contained to one area, it remains relatively minimal and manageable.
How long after a C-section can you get pregnant?
It is generally recommended to wait 12-18 months after a C-section before getting pregnant again. This allows adequate healing and lowers risks like uterine rupture.
Does scar tissue stretch during future pregnancies?
Yes, the old incision scar will stretch and expand as the uterus grows larger. Regular massaging with lotion can help soften and improve elasticity of the scar tissue.
How soon after delivery can you see the C-section scar?
Initially the incision site will be covered by dressings. After these are removed in the hospital or at follow-up appointments, the closed incision should be visible as a reddish-pink line that gradually fades over the postpartum months.
Conclusion
In most cases, obstetricians will make the skin incision for a planned repeat C-section in approximately the same low transverse location as a prior surgery. This promotes the best cosmetic results, minimizes blood loss, reduces infection risks, and allows efficient re-entry through delicate scar tissue planes. However, certain factors like adhesions or hernias may necessitate a different surgical approach or alternate incision placement. Discuss the likelihood of reusing your old incision site with your doctor prior to a scheduled repeat cesarean delivery. Follow their pre and post-operative instructions closely for optimal recovery results.