A cesarean section, or C-section, delivers a baby through incisions in the mother’s abdomen and uterus. Concerns often arise regarding the manipulation of internal organs during this surgery. The answer is that organs are moved, but only in a very limited and precise way. Specifically, the urinary bladder is temporarily displaced to allow access to the uterus. Other organs, such as the intestines, are meticulously protected to ensure a safe and successful procedure.
Navigating the Abdominal Layers
The first steps of a C-section involve making an incision through multiple layers of tissue. After the initial cut through the skin and subcutaneous fat, the surgeon reaches the fascia, a strong layer of connective tissue overlying the abdominal muscles. The most common incision, the low transverse or “bikini cut,” is made just above the pubic bone.
Once the fascia is incised, the surgeon manually separates the rectus abdominis muscles by pushing them apart rather than cutting them. This separation technique minimizes muscle damage and aids recovery. The final layer is the peritoneum, a thin membrane that lines the abdominal cavity. Entry into the peritoneal cavity is achieved either sharply or bluntly, granting direct access to the enlarged uterus.
The Role of Bladder Displacement
The reason for moving an organ is anatomical: the urinary bladder rests directly over the lower part of the uterus, the preferred location for the uterine incision. This lower uterine segment is thinner and less vascular, making it the ideal place to cut. The bladder must be temporarily moved to protect it from injury and provide a clear surgical field.
Displacement is achieved by creating a “bladder flap,” which involves incising the vesicouterine peritoneum, the fold of tissue connecting the bladder to the uterus. The surgeon uses gentle, blunt dissection to separate the bladder wall from the lower uterine segment. The bladder is then gently pushed downward and held out of the way with a surgical instrument for the duration of the delivery. This temporary displacement is a standard, careful surgical step.
Protecting Other Internal Structures
While the bladder is temporarily displaced, the remaining organs within the abdominal cavity, primarily the intestines, are carefully managed. The goal is to ensure these structures are not manipulated, injured, or contaminated during the procedure. The intestines naturally shift during pregnancy but are still close to the surgical site.
To keep the bowel out of the way, the surgical team uses sterile laparotomy sponges or moist surgical packs. These packs are placed within the abdominal cavity to gently hold the loops of intestine away from the uterus and the surgical field. This technique isolates the area of operation, maintaining sterility and preventing accidental contact with instruments. Once the baby is delivered and the uterus and abdominal layers are closed, the bladder naturally returns to its original position.