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How Many C-Sections Can A Woman Have Safely?

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“How many C-sections can you have?” is a common question many parents may have when the obstetrician suggests a C-section delivery, especially if they would like to have more children. However, it is difficult to say how many C-sections you can have since each woman’s risks and complications vary. In general, there is an increased risk of complications with subsequent C-sections (1).

Read through the post to learn about the safety, advantages, and side effects of repeat C-sections.

When Is A Repeat C-Section Advisable Over A Vaginal Delivery?

Some of the indicators to go for a repeat cesarean section are (2):

Some incisions from a C-section may limit further vaginal birth and indicate a repeat C-section. They are (3):

  • ‘J’ or Inverted ‘T’ shaped cesarean incisions
  • Low vertical cesarean incisions
  • High vertical cesarean incisions

How Safe Are Repeat C-Sections?

According to the expert advice, there is a high risk associated with more than three C-sections (1). The British Journal of Obstetrics and Gynecology (BJOG) says five or more cesarian surgeries are associated with increased complications and longer surgery time (4). The study also finds that the associated risks of having three to four repeat C-sections are similar to five to nine repeat C-sections (4).

What Are The Side Effects Of Repeat C-Sections?

In addition to the complications associated with first time C-section, some additional effects of multiple C-sections are (5), (6):

  • Prolonged hospitalization time
  • Prolonged operation time
  • Frequent prenatal medical visits
  • Dense adhesions
  • Urinary bladder or intestinal injuries
  • Placenta previa (the placenta lies in the lower segment of the uterus)
  • Abnormal placental invasion (the placenta attaches abnormally to the myometrium in Accreta, invades through the myometrium in Increta or may perforate through the outermost uterine wall of serosa to invade the urinary bladder in Percreta)
  • Due to previous surgical scars, it might be challenging to perform a surgical incision
  • Myometrial thinning

Are There Any Advantages Of Repeat C-Sections?

Some benefits of multiple C-sections include (7) (8):

  • Less anxiety is involved with a repeat C-section since you are familiar with the procedure.
  • Better planning and scope of preparation to avoid a last-minute rush.
  • Lower risk of uterine rupture as compared to vaginal birth after cesarean delivery (VBAC).
  • You do not have to go through the labor pain.
  • Lower risk of fetal morbidity and mortality

What Are The Factors To Consider For Subsequent Pregnancy After A C-Section?

Some concerns might run in your mind during pregnancy after a C-section. It is important to bring them to your doctor’s notice and get relief from your worries.

Some factors you should consider in consultation with your doctor before a second pregnancy are (9):

  • Wait for the scars to heal before attempting another pregnancy. It may take up to 18 to 24 months to heal the scars completely.
  • Maternal age is an essential factor in determining a safe delivery. With a higher age, the risks associated with birth also increase.
  • A longer gap can reduce the risk associated with placenta previa and placental abruption.
  • A longer gap can help you achieve a VBAC delivery and avoid complications from multiple C-sections.

According to the national vital statistics report of 2019, 13.8% of births were VBAC (10). VBAC can be practiced with one previous C-sections. However, it is not recommended for everyone to have a VBAC. A committee of doctors will decide if you are fit enough to undertake a vaginal delivery.

Frequently Asked Questions

  1. Can I have a natural birth after five C-sections?

According to BJOG, vaginal delivery is not recommended after two C-sections (11). It is difficult and risky to undertake the trial of labor after cesarean delivery (TOLAC) post five C-section deliveries.

  1. Will my C-section scar hurt when I get pregnant again?

Usually, a doctor will recommend a gap until the scar from a C-section heals entirely, not hurting anymore. In case of pain during pregnancy in the previous scar site, there is a risk of uterine rupture (12). Further, there is also a risk of rupturing the scar during pregnancy (13).

Multiple C-sections bring risks and complications with the increasing number of deliveries. It is essential to take advice from a doctor before planning for pregnancy after a prior C-section and maintain a healthy gap. A doctor can guide you on the number of safe C-sections you can undertake.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
  1. You Asked: How many C-sections can a woman have?
    https://vitalrecord.tamhsc.edu/asked-many-c-sections-can-woman/
  2. Birth After Previous Caesarean Birth.
    https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf
  3. Multiple C-Sections.
    https://healthcare.utah.edu/womenshealth/pregnancy-birth/multiple-c-sections.php
  4. Higher order repeat caesarean sections: how safe are five or more?
    https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.2004.00244.x?sid=nlm%3Apubmed
  5. Is it safe to have multiple repeat cesarean sections? A high volume tertiary care center experience.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673710/
  6. Repeat cesarean section in subsequent gestation of women from a birth cohort in Brazil.
    https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-017-0356-8
  7. Planning a repeat caesarean birth.
    https://www.nct.org.uk/labour-birth/different-types-birth/caesarean-birth/planning-repeat-caesarean-birth
  8. Weighing the Pros and Cons of Planned VBAC and Repeat Cesarean Section.
    https://www.lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/weighing-the-pros-and-cons-of-planned-vbac-and-repeat-cesarean-section
  9. Pregnancy and giving birth after a caesarean section.
    https://www.tommys.org/pregnancy-information/giving-birth/after-caesarean-section
  10. Births: Final Data for 2019.
    https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf#tab17
  11. Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections.
    https://pubmed.ncbi.nlm.nih.gov/19781046/
  12. Incomplete Cesarean Scar Rupture.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719360/
  13. What About Uterine Scar Ruptures?
    https://www.contemporaryobgyn.net/view/what-about-uterine-scar-ruptures
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Anshuman Mohapatra

Anshuman Mohapatra is a biotechnology scientist with more than six years of research experience in analytical chemistry and biotechnology. He has submitted his Ph.D thesis at the Indian Institute of Technology Guwahati (IIT Guwahati) and served as a research fellow (JRF/SRF) during his Ph.D tenure. His research interest includes analytical chemistry, neurobiology and lipid disorder diseases. Three of his research... more