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Next, the surgeon opens the uterus with either a horizontal or vertical incision, regardless the direction of the skin/abdominal incision. A vertical incision on the uterus causes less bleeding and better access to the fetus, but renders the mother unable to attempt a vaginal delivery (must have another repeat C-section) in the future.
If you end up with a horizontal incision, you will have the option of either going through a trial of labor (TOL) or electing a repeat c-section.
The reason for the differences between the two is that patients with vertical uterine incisions have a much higher chance of rupturing the uterus (8% to 10%) in the future pregnancies, compared to only 1% in those with horizontal incisions.
Review Date 5/29/2026
Updated by: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
