Why is it that obstetricians now cut in this seemingly more damaging direction?

Question

The rectus abdominus muscle is the main muscle of the abdominal region. Until the early 1980's, women who gave birth via Caesarian section were opened up with a longitudinal cut down the midline of their abdomen. Since then there has been a shift for C-section incisions to cut across the bottom of the belly (i.e. right to left). Cutting a muscle perpendicular to the “grain” is much more damaging to it than a cut along the length of the muscle (“with the grain”).

Answer 1

Actually, the so called "bikini" incision is the safest incision for many reasons:
1. it bleeds less
2. it forms very strong scars
3. less chance of dehiscense if subsequent pregnancies

The bikini or low transverse incision also causes far less pain to the mother. It also results in a smaller incision. Another benefit to the mother is that the scar ends up hidden.

Nowadays, the "up and down" or vertical incision is used only when the baby must be removed in an extreme hurry (incision is much, much larger allowing for fast access). However, it has a high chance of rupturing open (dehiscence) during future pregnancies. This incision also has a high risk of excess bleeding. Recovery is painful as well.

As for your concern over the muscles, the abdominal muscles in a female are accommodating for a pregnancy. Did you know that they develop a gap during pregnancy? Well, the muscles form this gap to accommodate the pregnancy and the labor process. Also, the muscles are NOT cut during a low transverse c-section...they are separated manually (by hand) and then spread to allow access underneath.