April is Cesarean Birth Awareness Month, and I want to take a moment to talk about something that affects a significant portion of the people I support. The cesarean delivery rate in the United States reached 32.4% in 2024 CDC, meaning roughly 1 in 3 babies born in this country arrives via cesarean.
Whether you’re currently pregnant, planning to become pregnant, or already on the other side of a cesarean birth, I believe you deserve clear, honest information about what this surgery involves and what your body goes through in the process. So let’s talk about the layers.
What Happens During a Cesarean Birth
A cesarean birth is a major abdominal surgery. The baby is delivered through incisions made in the abdomen and uterus, which means the surgeon works through several distinct tissue layers to reach your baby. Here’s what that looks like:
1. Skin + Fat: The first incision is typically made horizontally just above the pubic hairline, commonly called a “bikini cut.” This goes through the skin and the fat tissue underneath.
2. Fascia: Beneath the fat lies a strong, fibrous connective tissue layer called the fascia, which wraps and supports the abdominal muscles. This layer is carefully cut horizontally to allow access to deeper structures.
3. Abdominal Muscles Here’s something many people don’t know: the rectus abdominis muscles, your “six-pack” muscles, are typically not cut. Instead, the surgeon separates them by hand down the midline to create a pathway to the uterus.
4. Peritoneum: This is a thin, delicate lining that surrounds the abdominal organs. It is opened to expose the uterus.
5. Uterus: The uterus itself is then opened, usually with a horizontal incision in the lower segment - known as a low transverse incision. This is the final layer before your baby is reached.
6. Amniotic Sac: Once the uterus is open, the amniotic sac is broken if it hasn’t already ruptured, and your baby is gently lifted out.
Closing: What the Research Says
After your baby is born, the surgeon closes each layer carefully on the way back out. The uterine closure technique is an active area of ongoing research. Current evidence suggests that certain uterine closure techniques may be a risk factor for long-term complications, including niche formation in the uterine scar - which has been associated with gynecologic symptoms and complications in future pregnancies. The Enhanced Recovery After Surgery Society recommends double-layer closure because it is believed to potentially reduce the risk of uterine rupture, though current guidelines acknowledge that optimal technique continues to be studied (AJOG). This is a great conversation to have with your care team.
Why This Matters for Your Recovery
Each of these layers - skin, fascia, muscle, peritoneum, uterus - needs time, circulation, and support to heal properly. This isn’t just about the incision you can see on the outside. The deeper tissues are intimately connected to your core strength, your pelvic floor function, and how you move and feel in your body for years to come. A common misconception is that because a cesarean bypasses the vaginal canal, the pelvic floor is unaffected. In reality, the pelvic floor, diaphragm, abdominal muscles, and back muscles all work together as part of the deep core system, and when one part is affected by abdominal surgery, the entire system can be impacted.
Compared to vaginal delivery, cesarean delivery is not completely protective against pelvic floor dysfunction. Pregnancy itself loads the pelvic floor for months regardless of how birth happens. Research also shows that awareness of available support is strikingly low: despite pelvic floor dysfunction significantly detracting from participants’ daily life, nearly 67% of postpartum women in one U.S. study reported having no awareness that pelvic floor rehabilitation was available to them. You deserve better than that.
Ways to Support Your Body After Cesarean Birth
- Gentle movement and breath work to reconnect with your deep core and begin restoring the pressure system in your abdomen
- Scar tissue care to promote mobility, reduce sensitivity, and prevent restriction in the surrounding tissue
- Pelvic floor awareness, even if you didn’t birth vaginally, pregnancy and abdominal surgery both affect pelvic health
- Professional pelvic health rehabilitation if you’re experiencing discomfort, weakness, heaviness, scar sensitivity, pain with movement, or any other postpartum concerns
If you have questions, are preparing for an upcoming cesarean, or are navigating recovery and want support, please don’t hesitate to reach out. This is exactly the kind of support I’m here for. You carried and birthed a baby. Your recovery matters.
Book a Consultation
With peace and love,
Dr. Ellyn Halley, DC, Doula, Coach
Doc Halley Solutions
Key references for the clinically curious:
- Osterman MJK, Hamilton BE, Martin JA, et al. Births: Final Data for 2023. National Vital Statistics Reports, CDC/NCHS, March 2025.
- Verberkt C, Stegwee SI, Van der Voet LF, et al. Single-layer vs double-layer uterine closure during cesarean delivery: 3-year follow-up of a randomized controlled trial (2Close study). Am J Obstet Gynecol. 2024;231:346.e1-11.
- Creason M, et al. Pelvic Floor Dysfunction After Childbirth: Occupational Impact and Awareness of Available Treatment. PubMed, 2020.
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**Disclaimer: The content in this email is not intended to be medical advice. The content here is for informational purposes only. Please consult with your healthcare provider regarding any medical or health related diagnosis or treatment options.
