C-section options

Sutures or staples? How to decide which is the best method for you.
Sep. 13, 2010 | By:

Nearly two years after my first C-section my scar was dark pink and rose about a centimeter above my skin. Until my OB-GYN looked at the scar just prior to delivering my second child I had no idea this was not normal.

My C-section line was hypertrophic, or a thickened scar. Instead, a C-section scar should be flat and only mildly pink six weeks after surgery. By six months all that should be left is a flat, barely visible, pale line.

I had opted for absorbable sutures for my first C-section and, upon viewing my scar, my OB advised using staples the second time around. It appeared that my skin type did not respond well to sutures. She was right.

Three weeks post surgery with staples and my scar already looked better than my first had at the 21-month-mark. By two months the line was barely visible.

“Unfortunately, there is no way of knowing ahead of time how your skin will respond to staples or sutures,” says Dr. Gareth Seaward, head of Obstetrics and Gynecology at Mount Sinai Hospital in Toronto, ON. There are studies that seem to favour one over the other, but even they are inconclusive.

According to a recent study in the American Journal of Obstetrics and Gynecology the overall scar rating at two months and six months is the same for sutures and staples. Other studies, such as a review published in the British Medical Journal, have found that absorbable sutures yield a superior cosmetic result. Here is some advice on how to choose which one is right for you.

Staples

Staples tend to be the preferred closure method by many doctors because they are easier to do, faster, and reduce the overall operating time.  “Also, if you have a focal hematoma or an infection, it’s easier to open a section of the staples,” says Dr. Seaward. With sutures the only way is to open and re-close the entire wound.

Of course the downside to staples is that they can be uncomfortable to remove. Personally, I barely noticed most of my staples coming out. However, I highlight the word MOST. A small film of skin had formed over two of the outer staples and I knew it was a bad sign when the nurse gave me her hand and told me to squeeze hard before their removal. Yes, a few profanities were uttered, but the pain was over in a few minutes and, for me, staples produced the fastest and best healing.

Sutures

“Some doctors think that sutures have better cosmetic results, but I haven’t seen that in my practice,” says Dr. Seaward. Some studies have also found that sutures may have lower infection rates and result in less postoperative pain, but nothing is conclusive. If a woman has a history of keloids, is obese or requires a vertical incision, research does tend to favour sutures. And, of course, absorbable sutures don’t require any potentially painful removal after surgery.

Your decision

“Everybody heals differently,” says Dr. Seaward. And, unfortunately, in most cases the only way to know which method your skin will respond most favourably to is through trial and error. There are, however, a few exceptions so it’s best to discuss both options with your OB-GYN beforehand and come to a decision you both agree on before entering the operating room.