A Cesarean section, or C-section, is a major abdominal surgery involving delivery through incisions in the abdomen and uterus. The common question of how many stitches a patient receives often stems from a misunderstanding of modern surgical practices. Unlike a simple cut requiring a few individual sutures, a C-section requires the surgeon to carefully open and close several distinct tissue layers. Therefore, a single, countable number of “stitches” does not accurately describe the extensive internal repair performed using various materials and techniques designed for optimal healing.
The Multi-Layered Closure Process
A C-section incision requires the surgeon to pass through approximately seven layers of the abdominal wall and uterus to safely reach the baby. Each layer must be meticulously repaired with its own set of sutures, making a simple stitch count impossible. The deepest layer requiring closure is the uterus, typically repaired using one or two continuous lines of absorbable suture. This internal stitching holds the tissue together while the body heals, dissolving naturally over several months.
The layers above the uterus include the fascia, a tough sheet of connective tissue covering the abdominal muscles. The fascia provides the primary strength to the abdominal wall, and its closure is the most important for structural integrity. Surgeons use a continuous, strong, absorbable suture to close this layer, ensuring it can withstand the tension of movement and recovery. The rectus abdominis muscles are generally not cut; they are gently separated and pushed aside, falling back into position without needing repair.
The next layer is the subcutaneous tissue, primarily fat located just beneath the skin. This layer is only sutured if it measures more than two centimeters thick, which helps eliminate the empty space where fluid might collect. Internal sutures are almost exclusively continuous, meaning the thread runs in a long line rather than using many individual knots. This technique provides even tension and reduces the time needed for internal repair. Since these sutures are absorbed by the body, they never need removal.
External Incision Types and Closure Materials
The incision visible to the patient is the outermost layer, the skin. It is usually a low-transverse cut, often called a Pfannenstiel incision or “bikini cut,” made just above the pubic hairline. This horizontal incision accounts for the vast majority of C-sections performed today. The low-transverse approach is preferred because it results in less postoperative discomfort and a scar less prone to tension. A vertical incision is used much less frequently, typically only in emergencies or when access to the upper uterus is required.
There are three primary methods used to close this external skin layer, and the choice influences the final scar appearance and whether removal is necessary.
Closure Methods
- Surgical staples are a fast method of closure, sometimes preferred in emergencies or for patients with a higher body mass index. Staples are non-dissolvable and must be removed by a healthcare provider, usually five to seven days after the procedure.
- Removable, non-dissolvable sutures, such as nylon, are placed individually across the incision. Like staples, these stitches require a follow-up appointment for removal within the first week or two after surgery.
- Subcuticular closure is the most common method, using a continuous line of fine, dissolvable suture material placed just beneath the skin’s surface. This technique is frequently combined with a topical skin adhesive or sterile strips, eliminating the need for removal and often yielding the most cosmetic result.
Caring for the Incision and Expected Healing
Caring for the incision immediately after surgery focuses on keeping the area clean and dry to prevent infection. Patients should gently wash the area with mild soap and water and then pat it dry, avoiding rubbing or scrubbing. Some pain, tenderness, and numbness around the incision site are expected for several weeks, and prescribed pain medication should be taken as directed. A dressing may be applied immediately after surgery but is often removed within the first week, allowing the incision to be exposed to air.
The initial healing phase for the outer skin layer takes about six weeks, the general timeline for significant recovery. During this period, it is important to protect the incision by avoiding activities that strain the abdominal wall, such as lifting anything heavier than the baby or performing strenuous exercise. Gentle movement, like short walks, is encouraged to promote circulation and aid the healing process.
The scar itself will continue to mature and fade over a much longer period, often taking six to twelve months, or sometimes up to two years, to reach its final appearance. Patients should monitor the incision for any signs of complications, including increasing redness, warmth, excessive drainage, or a fever, which may indicate an infection.