It is easy for doctors and midwives, who live with this common operation in their
daily working lives, to assume that everybody knows what happens. In fact, many women
confront it with no idea as to what it actually entails save for delivery of the
Basically, a cesarean delivery will involve cutting open the abdomen and then the
uterus to deliver the baby. It is therefore an abdominal delivery as opposed to the
usual vaginal delivery.
Cutting open the abdomen
By far the most common incision is the "transverse" one, made just above or along
the bikini line. It is also known by various other names, but the wound and ultimately
the scar will look the same, more or less. (See picture illustrations here:)
Less commonly used is the "midline vertical" (up and down) incision. This extends
from just below the umbilicus to just above the pubis. It accounts for probably less
than 5 per cent of all cesarean skin incisions. Needless to say, the more common
transverse incision gives significantly better cosmetic results.
There is the common term ‘Lower segment cesarean section’. This is likely to be found
on the consent form. If left unclarified, the woman may assume it refers to the skin
incision. In fact, the term refers to the incision on the womb. Its mention is not
an act of mere pedantry on the part of doctors, as it has a very important implication.
We shall see why shortly.
Opening the womb (uterus)
The most common incision is the lower segment transverse incision. This is because
it is an easier approach, bleeds less, is easier to repair and gives the strongest
Historically, the incision used was a vertical upper segment one. It is in the historical
context that this old method has come to be known as "classical cesarean section".
This is used only in exceptional circumstances, such as extreme prematurity (where
it may be easier and safer for the baby).
Another approach used is a lower vertical incision, also used in special circumstances
More than 90% of all cesarean sections are performed through a lower segment transverse