We appreciate Drs Gordon and Welch’s interest in our study. They reflect on the potential benefits of the “Sokol” incision in which the transverse skin incision is located in the supraumbilical area to avoid the abdominal pannus. Unfortunately, the Maternal-Fetal Medicine Unit Network cesarean delivery registry did not include the exact location of the transverse skin incision on the maternal abdomen, so we could not assess this clinical question.

It is plausible that the potential benefit of a transverse skin incision (compared with vertical) may be offset by a surgical incision that is located underneath the pannus, with a higher potential for infection. In addition, maternal body mass index and habitus do not always correlate; 2 women with the same body mass index may have substantially different abdominal fat distribution and may benefit from different incision locations. We agree that these questions should be tested in a randomized clinical trial.