A low, horizontal skin incision is made in the abdomen at or just above the pubic hairline. Rarely, a vertical incision is required. This is sometimes used in an emergency situation as it may be slightly faster.
After the abdomen is opened, the bladder is protected from injury, and the uterus is opened. The incision in the uterus is usually horizontal and low in the uterus. Or it may be vertical. A vertical incision is preferred when a larger uterine incision is needed, or if the lower part of the uterus has not developed or stretched enough to permit a low horizontal incision. A vertical incision is often needed to perform a preterm cesarean delivery. The bag of waters is broken, the baby is delivered, and the umbilical cord is clamped and cut.
The time from the beginning of surgery to delivery of the baby generally is less than 10 minutes, but may be longer if it is not a first cesarean and there is scarring from a past procedure, or if a woman is particularly heavy. Once the baby is delivered, it can take another 30 to 40 minutes to remove the placenta and close the uterus and abdomen with stitches or staples. The entire surgery usually takes just under an hour.