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.

I had an elective (well not by choice but it wasn't emergency - that term really irritates me) and it was pretty okay really - very calm, no pain. I couldn't get up and walk around for a day or so and I had a couple of haematomas which I needed ABs for. Not an easy option at all. I do know someone who's had 3 and her recovery has definitely improved with each one of them. I found the lack of stomach muscles really debilitating.

oh my goodness SCARY I'd forgotten that as well about the stomach muscles!! I remember painfully lowering myself into the bath, gripping on to the handles for grim death, grimacing with the pain, then finally laying down then thinking "I'm not actually going to be able to sit up...."

My DH watched everything with my third c-section. The nurse kept asking him if he was sure he was ok as I think she thought it would be too squeamish for him. He loved looking though! Odd man. The descriptions of my insides and the two people holding my various layers apart so they could take DS3 out made ME feel ill.

I had one proper emergency - 24+ hours labour followed by being whooshed to theatre and holding my baby within minutes - he had been in distress, cord round neck twice so just as well I had a CS.

DS2 was not an emergency in that sense - 24 hours of labour followed be a pragmatic book the CS now as the list fills up.

Elective just made sense after that.

Although I would have preferred natural births, I'm very happy that in each case I was given every opportunity to try have the births hat I wanted. I'm very grateful that for DS1 and DS2 there was a Plan B. All in all, my CS experiences were very positive.

I didn't dare have a bath SRP! I couldn't even get my baby out of his cot. Or put him back in again. I was utterly, utterly useless. My legs worked but without stomach muscles, bending over and picking things up (or putting them down again) is virtually impossible.

Still didn't stop the MW shouting 'what's wrong with you, broken your legs?' at me for ringing the call button when I couldn't get the baby to feed him

Interesting, everyone! Sorry to hear about those who had a horrible time.

My first was horrible. It was elective for transverse lie, but as SCARYspicemonster says above, I hate that word as it implies that you stuck your hand up and said "Ooh, me, me, a section for me!" I was gutted, but tried not to let it colour the experience... It was awful though, I had no idea what was going on, my anasthetist was really nervous and dithery and no-one explained anything that was happening. It took 90 minutes to get the spinal to work and it wore off during the last 5-10 minutes of the procedure, I had gas & air and some painkillers in my drip, they called the anaesthetist's boss person (?!) and she seemed to be furious at the state I was in. Aftercare in hospital was frankly disgusting and I made a complaint, which was upheld and changes were made to a number of procedures, including first-night care after a section and simple things like, y'know, offering food and painkillers.

So when my hopes of VBAC turned to an elective section at 40+1 (was also offered induction but wasn't confident that it wouldn't lead straight to another section anyway), I was pretty upset, but had moved towns and was covered by a different unit. I was very clear in my birth plan that I had had a horrible experience before and wanted better treatment this time. I also decided to MAKE A FUSS this time if anything went wrong. It was a completely different experience, very professional, very comfortable and dare I say, healing. It is never a walk in the park, and this time I (and my DH) knew that I needed to rest a LOT more than I did last time. I spent most of the first week in bed, even though I didn't really feel I needed to. That has paved the way for a really strong recovery. (Birth story is here.

If anyone reading is worried about an upcoming section, my main advice would be to take all the pain relief you are offered, insist on more if you need it, plan for help around the clock for the first week and DO NOT GET CONSTIPATED.

Agree with Scary - the term elective annoys me too. Both mine were so-called "elective" but not because I was "too-posh-to-push" or whatever, but the first because ds1 was transverse and going into labour could have endangered both of us and with ds2 I spent a lot of time researching VBAC versus elective repeat cs and decided that a 0.3% chance of uterine rupture with VBAC was higher than I was willing to take. I do believe I recovered better after ds2 though in part because I "decided" on having a section whereas with ds1 I had no choice (even though it was elective in that I was not in labour when they did it).

Agree re:pain relief! Amazed at how effective Paracetamol is in conjunction with other stuff (Diclofenac, anyone?) I've fallen in love with all three of my anaethetists.

Aftercare after first CS was so dreadful I should have made a complaint - fish midwives didn't realise I'd had a section, no painkillers till I was screaming at 6pm - DS1 had ben born at just before midnight the day before!

Second time round I was ready to make a big fuss but didn't really have to and third time round everyone was lovely!

Having been given NO FOOD first time round, I knew to take plenty with and to send DH for sushi in good time!

I agree that the term elective does not describe it for most and it must be very annoying indeed - when it may have been your dearest wish to have a natural birth and you may have worked damn hard to get that, only to end with it being impossible - elective does not anywhere near describe it.

It is only words, but it is important imo. It was only on here that I heard the term 'crash' CS for what happened to me. And it really, really, helped because 'emergency' section can mean simply unplanned, which is different to the experience I went through. It's part of having your experience valued and understood - it's not just a word.

Lovely story, SmallScrewCap.

Thank you swampster

The Bio Oil website, of all places, has an interesting page about the different phases of scar healing here.

btw I don't work for Bio Oil!!!!

I quite like Lansinoh on my scar - and I don't work for them.

Does anyone else find their scar goes a bit itchy/irritated when they are stressed/tired/unwell? Mine does.

I do feel sorry for women who elect for electives though, the attitudes I encountered were quite enlightening. On a number of occasions I was asked in a fairly antagonistic-verging-on-aggressive way why I was having an elective.

Me: "After two emergencies it seems the wisest course of action to me - I can't bear the thought of going through another 24 hours of labour and ending up with another section."

Cue visible softening and sympathetic noises.

Wonder how they would have reacted if I had yawned and told them that I'm simply far to posh to push.

Oh god, this has put me off ever having any more children.

Oh Megglevache

Just remember that when you're in the thick of it, hormones and so on conspire to ensure that you're not all there... well that's certainly always been the case for me!

Oh dear. I feel sick. Now im panicking about heamotomas, epidural not working/failing half way through, organs being removed from my body then chucked back in, stitches coming out, terrible infections in wound afterwards...i shall add that list to the little one i had already created. Dying during csection, having to have a hysterectomy, having bladder or some other organ sliced, blood clots, adhesions.......

I wish i hadn't read this now!

what organs get put in the fridge on hold whilst baby is being yanked out then?

maybebaby, you have to know the risk of cs to make an informed choice, but not the actual details of the procedure, which perhaps in your case, is not helpful.

Don't ever read up about botched vaginal births ...

To put a positive spin, I had a crash and elective cs and recovered without event and swiftly. Lots of positive cs stories on mn, just to counterbalance things a little.

I'm afraid after having had an emergency C the first time and a crash the second my chances of having a vaginal birth are well and truly over.

Sorry if anyone has been upset by anything on here. I find it all quite fascinating and I am really happy for the chance to share what were, for me, mostly positive birth experiences.

I'm curious, are we not supposed to talk about our CS experiences, good and bad, in case we upset someone who is about to have one or might have one sometime in the future?

no no noooo!!!! Please do talk about your experiences! I chose to keep reading it and will carry on lol! Im a worrier anyway, i already had a list of worries just found some new ones

I am alo happy for the chance to share experiences, jut ignore the worrier in the corner

damn S doesn't work properly, meant "also" and "just"

Ah, we all worry. And awful things do happen. But mostly they don't. Overwhelmingly, in fact. A CS is really a very save procedure, just not without risks.

I'm afraid I couldn't stay away from the gruesome info either when I was waiting for mine. I knew I shouldn't look but I just couldn't help myself.

Very few places now externalise the uterus in the UK as it tends to increase the woman's feelings of being "jumbled around" as a good epidural will take away all pain sensation but still leave you feeling some prodding and pushing (for example as the baby actually leaving the abdomen most women can feel the relief!) The obstetricians generally "mark" the ends of their cut with long stitches that are held outside and then stitch between those two marks feeling in so that it isn't necessary.

In general there is a double layer of stitches on the uterus itself, one starting at each end of the cut to make it as safe as possible, especially for any future pregnancies, then a layer stitching the fascia shut. The rectus muscles which have been moved to each side by hand (and are generally separated slightly by the pregnancy anyway) aren't stitched together as they wouldn't be after any other pregnacy, fat isn't together enough to stich - it would just sort of fray so any little bleeding spots are dealth with then that isn't sticthed then a single long stitch is pulled down through the skin at one end with a bead on the end that sits of the skin, the stitch is then woven backwards and forwards in the layer under the skin and back up through the other end of the cut and another bead placed on the end of that. This keeps the 2 sides of the skin right next to one another to heal without ending up with a load of stitches that need removing or a whole load of little knots that might be palpable under the skin. Generally with that technique 7-10 days later a MW or nurse needs to snip off one bead and pull the whole stitch through and out. Some places use medical staples instead and its really the preference of the obstetrician as both techniques do the job.

It is very rare for a wound truly to "open up" i.e to anything deeper than a cut you might make with a minor accident at home but a few do get bits, often at one end, where are a tiny part of the scar doesn't heal as quickly and the skin parts slightly and has to heal by "secondary intent", that is not by the primary fixation - the stitches - but by the body's own, slightly slower and less neat measures.

Hope that is helpful!