How Many C-Sections Are Safe to Have?

By
Robin Elise Weiss, PhD, MPH
Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor.
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Robin Elise Weiss, PhD, MPH
Medically reviewed by
Medically reviewed by Brian Levine, MD, MS, FACOG on August 01, 2020

Brian Levine, MD, MS, is board-certified in obstetrics and gynecology as well as in reproductive endocrinology and infertility.

 

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Brian Levine, MD, MS, FACOG
on August 01, 2020
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As the cesarean section (C-section) rates soar and the number of vaginal birth after cesareans (VBACs) fall, there are more women having multiple cesareans. The science behind the safety of multiple cesareans says that the more cesarean surgeries you have, the riskier the subsequent surgeries become for you and your baby.

The National Institute of Health (NIH) advises that you probably shouldn't choose a cesarean if you want more than two or three kids.

Risks

Among the risk factors for multiple cesareans includes a risk of placenta previa, placenta accreta, and hysterectomy. These risks to pregnancy go up with each cesarean and have health ramifications on the life of the mother and baby.

"I guess it wasn't explained well to me," said Amanda, after three cesareans. "I knew having a baby after a C-section had increased risks, but I didn't realize that it went up after each surgery."

There are maternal problems directly related to cesarean surgery, like bowel injury, ICU admissions, post-operative ventilator use, cystotomy, and more. These risks also increase as the number of cesareans increase. The surgery is also technically more difficult to do with scar tissue, meaning subsequent surgeries take longer to do.

Risks to Pregnancy

  • Placenta previa

  • Placenta accreta

  • Hysterectomy

  • More difficulty for cesarean surgery

Surgical Risks

  • Bowel injury

  • Post-operative ventilator use

  • Cystotomy

  • ICU admissions

  • Adhesions, bleeding

  • Bladder injury

Future Pregnancies

This increase in risk has an impact on the health of mom, the health of the baby, the rates of future pregnancies as well as the health of future pregnancies. If the risk goes up with each pregnancy that there will be another complication, then the life of the baby and mother may be at risk.

This certainly doesn't mean that you will not be treated if you are pregnant after three cesareans, but it does mean that you may have a higher risk of pregnancy and may need special care.

The decision for a primary or first cesarean section should not be taken lightly or without a medical reason, according to the American College of Obstetricians and Gynecologists (ACOG).

Some researchers have gone so far as to suggest that a tubal ligation be recommended for mothers who have had more than three cesareans to help encourage them to avoid these additional risks.

Amanda also remembers this: "My last doctor tried to get me to have a hysterectomy after I had my last baby. He said that it was simply too dangerous to get pregnant again. I got a second opinion from a high-risk doctor. He said that I was healed well, had never had an infection, and was a fine candidate for another baby, even with the increased risks."

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