The Mark of Love

The idea of this project is to illustrate the different layers of skin where incisions will be made during a cesarean section. A cesarean birth occurs by an incision in the abdominal wall and uterus rather than through the vagina. A cesarean section is required for a high risk pregnancy, complications, and certain sexually transmitted disease. The STEAM project consists of seven different zipper bags, varying in size, one inside another representing the different layers of skin where incisions are made. During a cesarean section, six separate layers of the abdominal wall and uterus are opened individually to allow access to the baby. The seventh zipper bag represents the amniotic sac. The six layers of skin that are cut during a cesarean section are the skin (epidermis), subcutaneous tissue, fascia, rectus abdominal muscles, peritoneum, and the uterus. Of these 6 layers, the rectus muscle is often the only layer that isn’t routinely cut because it is separated vertically. “The only muscle that is always cut during a c-section is the uterus” (Robles, 2022). During the procedure, the mother is given either a general or local anesthetic. The procedure last about an hour and the baby can be taken out of the womb within 10 to 15 minutes, and faster during an emergency.

The first incision is made to the skin, which can be a vertical incision just below the navel and above the public bone or a transverse incision (bikini incision) just above the mons pubis (the most common). The incision is approximately ten centimeters wide. The second incision is made to the subcutaneous tissue (lipid layer), which is usually a yellowish color. The subcutaneous tissue stores energy, insulates the body and connects the dermis layer to muscles and bones. Third is the fascia which is a sheet of connective tissue found below the skin (hypodermis). The connective tissues provide protection, support, stability, and strength. The fascia also separates muscles, maintains vessel patency, and encloses different organs. Next is the rectus abdominal muscle which is not usually cut, but separated vertically. “The muscle tissue is excitable, responding to stimulation and contracting to provide movement” (Anatomy and Physiology, OpenStax 2017, pp 136-147). According to Dr. Brittany Robles, 2022, cutting the abdominal muscle is rare, but can occur when the anatomy doesn’t allow easy access to the uterus. If the rectus muscle is cut, then they will be stitched back together. The fifth layer is the peritoneum, and it’s often separated vertically without cutting. The peritoneum is the serous
membrane that surrounds several organs in the abdominopelvic cavity and provides cushion to reduce friction on internal organs when they are moved, such as lung inflation and heart beating. Finally, the uterus, which receives a fertilized egg and protects the fetus as it grows and develops
inside the womb. The uterus consists of three layers; the perimetrium, myometrium, and endometrium. The uterus is made of smooth muscle which allows for contractions to push the baby out during birth. “The only muscle that is always cut during a c-section is the uterus” (Robles, 2022). Last but not least, an amniotic sac which is a thin-walled sac surrounding the fetus during pregnancy. The sac is filled with amniotic fluid produced by the fetus and the amnion (a membrane that covers the fetal side of the placenta). The amniotic sac protects the fetus from injury and helps to regulate the fetus temperature (John Hopkins Medicine, 2023). The amniotic sac will be punctured and amniotic fluid suction out prior to delivering the baby through the incisions. The baby’s head will be delivered first so that the mouth and nose can be cleaned of fluids to allow it to breathe. In 2011, 1 in 3 women gave birth by cesarean delivery in the United State (PubMed, 2014).