Your C-Section: A Step-by-Step Guide

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There are several incisions (cuts) your obstetrician will need to make as part of a C-section. Rest assured that the entire procedure, without complications, lasts a little over half an hour and your body should heal quickly in the weeks that follow.

I prefer to make the horizontal, or "bikini" incision in the lower abdomen. It's called a "Pfannenstiehl" incision, and besides being cosmetically superior to the up-and- down midline incision, it also heals better and hurts less during recovery.

A scalpel is used to make this incision. This is done with a smooth firm pressure of the blade as it moves across and against the skin. The skin is thin and the blade is so sharp that the underlying yellow fat layer almost bursts out. A smaller tract of cutting then takes place in the middle of this fat layer until a shiny, tough, fibrous layer called the fascia is seen below it. The fascia, which lies over the abdominal muscles, also serves as a floor for the fatty layer just cut into. One can push a finger of each hand against this fascia and then rake away the fatty layer to each side, exposing an adequate length of this tough, lower layer. Once again, a scalpel is used to nick an opening in this fascia that's just been exposed. The rectus abdominal muscles (the "abs") are two muscles that run up and down from the upper abdomen down to the pubic bone. They are joined together at the midline, so when a pair of scissors is used to cut this fascia, horizontally toward each side, these muscles are easily seen. Where they meet can be easily separated with a gentle pushing away at the midline. They're fairly pliable, and even though they run vertically compared to the horizontal incisions made thus far, they can easily be pulled apart and away to expose the next layer to open.

This next layer is called the peritoneum, a filmy, flimsy layer that is the actual lining of the abdominal cavity (this is why inflammation of this layer, as with a ruptured appendix, is called peritonitis). It is opened very carefully with sharp thin scissors. It is usually such a thin layer that one can see any bowel underneath it. This is a good thing, because cutting bowel is a very bad idea.

Once a small opening is made in the peritoneum, it is actually opened up and down, which is a departure from the direction of all of our openings so far. It, too, is very pliable, and this up-and-down direction poses no difficulty in spreading it open enough to see the lower abdomen with good visibility.