What to Expect in a C-Section

Classical C-section

What Is a Classical C-Section?
The classical C-section has been used by physicians as the standard way of performing a C-section, but recently it has been superceded in use by the Low-Transverse uterine incision (see next section).

In a classical C-section, the physician makes an incision or cut in the upper or contractile portion of the uterus. This gives much more access to the baby. It traditionally has been done under emergency circumstances, so many doctors thought this was the quickest and easiest way to deliver the baby. However, as doctors discovered later, this type of incision subjected both the mother and baby to additional risks, as will be discussed later.

While we're on the subject, don't confuse the way your skin is cut and the way your uterus is cut. We're talking about the cutting of the uterus here, not the incision in the skin that you see – confusing, but important differences. Just because a doctor cuts your outer skin up and down or a bikini cut (sideways) doesn't mean that he cuts your uterus that same way. You can't tell from the outer skin incision how your uterus was cut, and it does matter later if you plan on having subsequent births.

The old dictum was once a C-section, always a C-section, which usually applied to the classical Cesarean section and meant that you always had to have C-sections for later deliveries. However, that dictum does not always apply to a low-transverse C-section.

Risks of a Classical C-Section
When a classical C-section is performed, the area that is cut tends to be muscular so that when a scar forms, the scar is found to be weaker when laboring with a future pregnancy. This does not bode well for a mother's attempt at a vaginal delivery in subsequent births, for fear that the scar might tear while in labor. Thus, there is a risk in future deliveries for the uterus to rupture.

If a rupture occurs, the mother could bleed internally, and the baby could work its way through the previous incision or scar. In that case, the placenta would be compromised, and the baby could die. The mother could also die. The overall risk of a uterine rupture occurring is less than one percent in women who have never had surgery of the uterus (for example, a previous baby born by this type of C-section).

However, in women who have had a classical C-section in a previous birth, the risk for rupture elevates to 20-25 percent in subsequent pregnancies and births attempted vaginally. For this reason, most doctors recommend that subsequent births also be delivered via C-section.

In contrast, the risk for rupture in subsequent pregnancies for a woman with one low-transverse C-section is less than one percent. And that's the real reason that OBs prefer the low-transverse C-section procedure.

Uncovering Statistics
How did doctors figure this out? Dr. John said that there is an unfounded story that the difference between these two types of C-sections in subsequent births was first noticed in the UCLA parking lot, of all places! One day the parking lot was literally full of women having babies at the County Hospital because the hospital was full, and there weren't enough rooms. Because many of the women were Hispanic and possibly there weren't enough interpreters or time to get full histories or data before the births, it wasn't until after the births occurred that doctors discovered that many of the women were having a third or fourth child delivered vaginally, but they had previously had low-transverse incisions and C-sections. Bells started ringing and people started asking questions. The result: The discovery that low-transverse incisions are safer for vaginal deliveries after C-sections. (Hey, it's a good story whether it's true or not.)