OBJECTIVE: To compare subcuticular sutures with staples for skin closure after cesarean delivery in a randomized trial in which each woman was her own control. METHODS: Women undergoing cesarean delivery (primary, n532; repeat, n531) were randomized to side distribution of skin closure methods with one side of the skin incision closed with staples and the other side closed with subcuticular suture. The primary outcome was the overall preferred side of the scar 6 months postoperatively. Additional outcomes were women's preferred method of closure and cosmetically preferred side of the scar, difference in objective cosmetic scores (assessed by two plastic surgeons), and pain between the two sides of the scar and infection rate. RESULTS: Significantly more women preferred the stapled side, both overall (odds ratio [OR] 2.55; 95% confidence interval [CI] 1.18-5.52) and cosmetically (OR 2.67; 95% CI 1.24-5.74), and reported staples as their preferred technique (OR 2.00; 95% CI 1.10-3.64). There were no significant differences in pain scores at any time. One plastic surgeon preferred the stapled side (OR 2.8; 95% CI 1.01-7.78) and scored it significantly higher on a cosmetic visual analog scale (P5.031); the other found no significant difference. There were four (6.8%) cases of infection-three on the sutured side and one bilateral. CONCLUSION: Staples were preferred to subcuticular suture for skin closure by women after cesarean delivery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; www.clinicaltrials.gov; NCT01217567.