How many layers of internal stitches are there after a c-section?

[SmallSCREAMCap]

Can't find this on Mumsnet and a very small google gives me too many links with images, no thanks!

I have had 2 standard c-sections, both lower transverse horizontal scars, and very neat and tidy they look from the outside, too.

Obviously there will also be a scar in my uterus, but I'm wondering what else happens in between? I believe that muscles are usually separated, rather than cut, but do they need pulling/stitching back together?

Is the fat stitched back together, or just placed? And what about the peritoneum, does that get cut and stitched back?

Just curious. Feeling all sorts of pulls and prickles, which I know is normal, but a mental map would help me out.

[maybebaby23]

Will be watching this with interest! I have had one section and am booked in for my 2nd in December.

[RenderedSpeechless]

hi. had my first (and last) section recently. think remember midwife saying i should not underestimate rest i will need as they went through 7 layers. dont know how much internal stitching involved though. so also watching this thread with keen interest.

[SmallSCREAMCap]

I was told something similar, Rendered, but I was quite chemically enhanced at the time so I'd like to hear more from anyone who knows...

I must go and check your other thread too, to see if you still have any guests staying with you!

[kitstwins]

This might help. It certainly explains the agony I was in post-section. Felt like I'd been run over by a truck and then reversed over by five trucks. No small potatoes, in spite of what some of the "Oh you're too posh to push" brigade might think. Also, take with a pinch of salt all those who brag endlessly about how they were turning cartwheels/walking four miles three days later as they're talking crap. The level of cutting and tearing and retraction that takes place during this major abdominal surgery means that you're bruised and very tender. It takes around three weeks for the healing to really happen (before that it's very superficial, hence the extreme tenderness/pain following cesarean delivery), which is why most people feel back to normal at around 3 1/2 to 4 weeks as everything has moved beyond initial superficial healing: -

From ican-online
"A horizontal incision is made with a scalpel, just above the pubic bone where the pubic hair begins, slicing through five layers of skin, tissue, and muscle: 1) the derma, or outer layer of skin and 2) fat; 3) the fascia, the tough, thin layer that supports the muscle; 4) the rectus muscle, which is manually separated with the fingers down to the pubic bone; and 5) the peritoneum, the shiny layer that encases the entire abdominal cavity. Suction is applied to absorb excess blood. A metal "spatula" known as a bladder blade is inserted to pull back and protect the bladder. Another "spatula" known as a retractor is inserted at the top of the incision and/or on the sides, and are pulled back tightly to enlarge the incision, usually by two surgical assistants. Another incision is made into a sixth layer, the uterine lining, taking care not to cut the bladder, causing infection. Suction is again applied. Sponges and gauze are used to blot blood and fluid pooling in the abdominal cavity.


The mother may feel intense pulling and tugging to dislodge the baby?s head from the pelvis. If vertex, the baby is pulled by the neck backwards out of the pelvis and then by the head through the incision in the uterus. The baby?s nose and mouth are then suctioned to remove any amniotic fluid, mucous and/or meconium from the airway. The remainder of the baby?s body is pulled from the mother?s uterus through the abdominal incision, taking care not to tear the uterine or abdominal incision wider."

[SCARYspicemonster]

Ooh interesting. So I guess that's 5 layers they stitch back together (including the skin). Or maybe they don't stitch fat? I can't imagine they would.

I had appalling SPD as well as my CS so took so many drugs I felt very little

[JoeyBettany]

Apolgies ahead for TMI

I know that people frequently end up back on the ward after their c-section wound opens up. They have to have it packed and it ain't pretty.

I was worried as 2 weeks after my op, loose stitches began to appear at the edge of the scar, and it was very tender, oozing pus and inflamed.

Foolishly, I pulled at the dangling thread (it was like a scab that I couldn't leave alone) and OMG, it would not come out -it just felt as if I was pulling the end of a drawstring bag! I was in floods of tears.

Luckily, I had some antibiotics and by 7 weeks I was pretty much back to normal. My advice would be-do not ever try and pull any emerging stitches!

[JoeyBettany]

I was told they were soluble stitches btw, I don't know why they emerged They were like a thickish beige cord.

[swampster]

I read something like that while waiting for my third section. It was an elective after two emergencies so I thought I wanted all the info. I didn't really. The idea of manually separating muscles really grossed me out but of course tears heal better than cuts.

I think there are loads of layers of stitches but don't quote me.

I also remember reading some MNer saying her DH had looked over the screen and seen a large organ resting on her abdomen waiting to be put back in.

I think my anaesthetic had started to wear off by the end of the op and I swear I felt something heavy sitting on me...

The biggest plus point of having more than one section is that they tend to take extra special care. My wound and scar were way trimmer and lovelier second and third time round than the first.

[swampster]

Ooooooooh, JoeyB, that sounds awful!

[5inthetomb]

Swampster, when having my 3rd section with ds3, I was getting sterilised at the time afterwards, and I can clearly remember the surgeon saying "I'm going to have to deliver your womb to get to your tubes" and the feeling when he done it was undescribable.

Ass I've already said, I've had 3 sections, and have never thought of the amount of stitching required. This thread is quite interesting.

[swampster]

I knew I should get sterilised while having DS3 but I just couldn't bring myself to. [bangs head emoticon]

[kitstwins]

That would be the uterus. They remove it from the abdominal cavity following delivey to clean it out and stitch it - easier to stich it shut when not rummaging through an opening in your stomach. Obviously it gets put back in before they then stitch up all the other layers. It's why stitching/reassembly after cesarean delivery takes around 30 to 40 minutes. The actual birth of the baby is over in about two or three, depending on how jammed in they are.

Oh, and they can also use cesarean forceps, which are a slightly different shape to vaginal forceps. Caesarean forceps are used to manouvre a baby that is wedged. I know this as they were used on me during my caesarean. As a result I got a haematoma on my pubic bone, a cracked pubic bone and a haematoma behind my scar.

Some caesareans are good, but sometimes they're brutal and bloody awful. If someone had given me a gun when I woke up from the anaesthetic (my epidural and spinal block were bodged/failed so I could feel things and so they had no option but to knock me out) I'd have shot myself. It was that level of pain. Not surprising really as I had no epidural and could feel everything.

According to some people though, the "easy option". It annoys me when people portray it as a walk in the park. It isn't. Not for me anyway.

[AcademicMum]

I think I remember the surgeon telling me during my 2nd section that there were 6 layers of stitches. I guess this matches with what kitstwins already said i.e. 5 layers of internal stitches plus the skin.

DP watched from the business end when I had my 2nd one - said it was very interesting . He did say though they appeared to loose some equipment at one point as they looked worried and started desparately counting their tools.

I was also told by the surgeon who delivered ds1 that another surgeon he knew had stitched his initials into the back of a patient's womb after a section. It was seen and he was sacked when the woman had her next section. Don't know how true that is.

[LissyGlitter]

That is all very interesting...does anyone know a good reliable website where I can see pictures? I want to know what has been done/will be done to me! The worst bit of the first section was having no idea what was going on.

[swampster]

kitstwins!

The worst thing that happened to me was being physically pummled to get everything back into place/knock excess air out? and I felt totally battered and like I was about to shoot off the table and they told me I'd be grateful for it later.

The prepping for the op was pretty weird too, after two emergencies, going in cold. I kept saying to DH: "This didn't happen last time did it?" and: "Did they do this the other times?"

[AcademicMum]

Would also agree that it's in no way the "easy" option. The only ones who think that are people who have never had one. After ds1 the skin on my wound separated slightly and bled a lot. I had to see the doctor to get it checked out. The doctor asked if she should come to me but I said no as the surgery was only at the end of the road (no more than 50 metres away) - by the time I reached to the end of the road I couldn't walk further and was in tears. At the time I was on my full dosage of paracetamol, diclofenac and dihydrocodeine.

[blueshoes]

kitstwins, horrified that your anaesthetic did not work. That must have been awful!

[swampster]

This site was useful - I don't think there are pictures but you really don't need to see any!

[5inthetomb]

Swampster, I ha EMC with DS1, and with DS2 I had elective one. They gave me antacid tablets to take the night before an morning of, and was so embarassed when I farted getting on the operating table . I really couldn't help it!

Kits, that is so sad . I had a drain put in when I had DS3, and when it was removed, it was the worse pain I ha ever felt in my whole life. I begged he MW to get me an epidural as I couldn'tstand the pain.I was in tears, screaming the ward down and the woman in the same room as me had to leave whilst I had it done as she was in tears listtening to me. I know what you meant by what you'd have done if you had had a gun.

[JoeyBettany]

I didn't know that they cleaned your uterus out at the time. I didn't have any bleeding after ds so that makes sense, but loads after dd This is a fascinating thread.

After I had both c-sections I could not rest as I was told to. Even though I was in a lot of pain, I had a really strong urge to get up and do house work and carry on as normal.

My sister said it's an evolutionary thing-something to do with stone age women having to get back on their feet quickly before a sabre -toothed tiger got them, or something.

It was pretty weird though, because normally I am the sort of person who looks after themself when ill, and takes any ailments very seriously!

[5inthetomb]

BBM, I found my CS's were "easier" after my elective ones than my emergeny one. I was able to get up and about sooner, and was in less pain and less tired. Probably because I didn't have 31 hours of labour beforehand. I din find the waiting around pretty hard going, but was lucky both times that I was first on the operating list.

[bibbitybobbityCAT]

Kitstwins - you had a caesarian with no epidural? omg

[slowreadingprogress]

Have never really thought before about the surgical details of what happened to me - fascinating but toe curling at the same time!

I found mine really hard to get over. Reading this does explain just what major surgery it is, and to have that surgery quickly followed by raging hormones, new baby needing looking after, milk coming in, struggling to feed......oh my god. I forgot how hard it all was! However agree with 5 that the labour beforehand plays a big part; I had three days of constant labour followed by a 'crash' CS and that does not put you in the best physical condition for major surgery performed in a tearing hurry