A patient at her postnatal visit today complimented me on how much better her Caesarean section delivery experience had been with me. I had not looked after her in her previous pregnancy. She also said she had much less postoperative pain, needed fewer painkillers, was mobile much quicker and felt so much better.
While there are many variables that can account for differences, I am “fussy” with closure and take care and, in particular, I close all layers.
I insert eight layers of stitching inclosure with a Caesarean section. These are:
- Uterus muscle in two layers of continuous suture. With the first layer, I avoid stitches going into the endometrium (called decidua in pregnancy) and so can minimise the risk of placenta accreta (placenta morbidly adherent to or embedded in the uterine wall) in the next pregnancy.
- Visceral peritoneum (skin over uterus) with a continuous suture.
- Parietal peritoneum (inner skin of abdominal wall) with a continuous suture.
- Muscle layer (rectus abdominus or ‘abs’) with interrupted sutures to help give a ‘flat tummy’.
- Rectus sheath with a continuous suture.
- Subcutaneous fat with a continuous suture.
- Skin with a continuous subcuticular absorbable suture.
I know that extra time and care with closure is worth it!