There are 3 types of incisions that can be used to perform a Caesarean birth. These are:
- A low, transverse or horizontal incision, in the lower segment of the uterus. This is referred to a Lower Segment Caesarean Section (or LSCS).
- A vertical incision made higher up the middle of the uterus into the upper segment of the uterus. This is referred to as a Classical Caesarean (or CS).
- A low vertical incision, in the lower segment of the uterus, which can be extended into a classical incision into the upper segment if necessary.
A ‘Lower Segment Caesarean Section’ (or LSCS)
Currently the most preferred technique used to deliver babies. This is because the lower segment of the uterus, when compared to the upper segment of the uterus is:
- Thinner, less muscular and has less blood supply, therefore has minimal blood loss when it is cut.
- Structured in a way that after it is sutured heals with less scar tissue.
- Less involved in uterine contractions with future labours, decreasing any chance of the suture line splitting (or ‘rupturing’) with a subsequent pregnancy and labour.
- Situated away from the woman’s intestines, reducing the chances of complications such as infecting the woman’s abdomen and causing scar tissue forming between the abdominal organs (known as ‘adhesions’).
LSCS incision line where the horizontal incision is made in the lower segment of the uterus.
A ‘Classical Caesarean’
This tends to only be used in certain circumstances. A ‘Classical’ or vertical incision may be preferred if:
- It is a true medical emergency situation, because it is quicker to deliver the baby through this incision.
- The baby is in a transverse position (or lying across ways in the uterus). The higher incision may help the surgeon to reach the baby.
- The woman is having Twins or more. Again this higher incision can help the surgeon to reach the babies higher in the uterus.
- The baby is very premature (usually less than 28 weeks). A classical incision is needed because the lower segment only forms in the last 3 months of the pregnancy.
Having a classical incision is not generally the most preferable option, but in some cases it may be necessary. This type of incision cuts through the thicker muscle of the upper uterine segment, usually causing more blood loss and increasing the chances of complications from the operation.
A previous Classical Caesarean can affect the woman’s ability to plan a vaginal birth with a subsequent pregnancy. This is because it weakens the muscles and holds a higher risk of the uterus splitting (or ‘rupturing’) with a subsequent pregnancy or labour (about 10% compared with 0.3% to 0.7%). This will be discussed later in this Class in Vaginal Birth after Caesarean (VBAC).
Image shows where the incision is made with a classical Caesarean.
Low vertical Caesarean
On rare occasions if the surgeon would prefer to do a lower segment Caesarean but is unsure whether a classical incision may be required (for example if the baby is in a transverse position and they are not sure if they will be able to reach the baby). A lower segment vertical incision has the same advantages of a lower horizontal incision (LSCS) and will have the same disadvantages as a Classical incision if it is extended into the upper segment of the uterus.
Image shows where the vertical incision is made in the lower segment of the uterus.
NOTE: In the majority of cases the type of incision made into the uterus is the same as the scar that will be visible on the woman’s belly. Occasionally a woman will have a low scar on her belly but have had a classical incision into their uterus and visa versa.