Making the Cut: Does C-Section Incision Type Matter?

Making the Cut: Does C-Section Incision Type Matter? Blog

Whether a Caesarian section is planned or unexpected, it is a serious and invasive intervention for the otherwise natural biological process of childbirth. For all expectant mothers, pregnancy is disfiguring, and a C-section even more so. While the delivery of a healthy baby is paramount, surgeons who perform C-sections should consider the implications of an abdominal incision on the mother’s wellbeing and quality of life.

Making the Incision Decision

C-sections have been on the rise globally over the past several decades, with one in three women undergoing Caesarian delivery today. Several skin incision and abdominal wall opening techniques have been developed over time, however there is little agreement about which technique is safest and most appropriate.

The choice of the incision technique rests with the individual surgeon alone, and hinges on the surgeon’s experience and preferences.  While the condition of the mother and fetus at the time of delivery are taken into consideration, the patient has little say about her own preferences, nor is she informed of her options concerning how the incision is performed. Yet incision type can profoundly affect the mother’s physical, emotional and psychological health, postpartum.

Some ways in which incision type affect the mother’s health include:

  • Acute and chronic pain post C-Section
  • Damage to neural bodies at the incision site
  • Cosmetic damage to the mother’s abdomen
  • Desire to have subsequent pregnancies

Because a C-section has long term effects on the mother, she has the right to be informed about the procedure, and to have a stake in decision-making about which technique is best. Moreover, surgeons should take the patient’s long-term health into consideration when deciding on an incision method.

Comparing the Effects of Common Incision Types

While there are many techniques for performing a C-Section, two in particular are most commonly performed:

  • The Pfannenstiel incision, also known as the bikini incision, where a transverse incision is made 2 to 3 cm above the symphysis pubis
  • The Misgav-Ladach method using the modified Joel-Cohen incision, which is a straight transverse incision made about 3 cm below the anterior iliac spine

In a recent literature review, Gizzo et al. (2015) sought to compare the outcomes of the two methods in terms of post-surgical acute and chronic pain, and long term effects on the mother’s quality of life, including her desire to have more children.

After reviewing 21 articles that met their research criteria, the authors concluded:

  • The Pfannenstiel skin incision is smaller but made in a lower area of the abdomen, which involves nerve pathways that can become damaged
  • The Pfannenstiel technique accesses all abdominal layers, including skin, subcutaneous tissue, fascia and the peritoneum, while the Misgav-Ladach incision is made only in the midline, and then extended by the surgeon’s fingers perpendicular to the direction of nerve spreading, eliminating or reducing nerve or anatomical damage
  • The Pfannenstiel technique is associated with increased postoperative bleeding, adhesions and fibrosis of the anterior abdominal wall, which may result in long term abdominal pain

The authors suggest that the Misgav-Ladach approach should be considered the gold standard for C-section incisions, since it appears to reduce post-surgical pain and improve the mother’s long-term quality of life. Mothers who had Caesarian deliveries with the Misgav-Ladach approach  were more likely to desire future pregnancies.

Postpartum Care in NYC

Pregnancy, childbirth and C-sections place a great deal of strain on the mother’s body, and can have long-term effects on her physical and psychological health. However, with proper postpartum care and appropriate exercises, many women are able to recover with few long-term repercussions.

The postpartum specialists at NYDNRehab help women to recover from the harsh effects of childbirth, to restore both form and function. If you are planning to become pregnant, are currently expecting, or have recently given birth, let us help you achieve the very best physical condition for the greatest long-term quality of life.


Gizzo, Salvatore, et al. “Caesarean section: could different transverse abdominal incision techniques influence postpartum pain and subsequent quality of life? A systematic review.” PLoS One 10.2(2015): e0114190.


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