How Many C-Sections Are Safe to Have?

By Robin Elise Weiss, PhD | Medically reviewed by a board-certified physician | Updated June 10, 2019
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As the cesarean 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 multiples cesareans says that the more cesarean surgeries you have, the riskier the surgeries are for you and the baby. Risky enough that the National Institute of Health (NIH) said that you probably shouldn't choose a cesarean if you wanted more than two or three kids.

What Are the Risks of Multiple Cesareans?

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 increase as the number of cesareans increase. The surgery is also technically more difficult to do with scar tissue, meaning the surgery takes 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 OB/GYNs.

Some researchers have suggested that a tubal ligation is 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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Article Sources

  • Gasim T, Al Jama FE, Rahman MS, Rahman J. Multiple repeat cesarean sections: operative difficulties, maternal complications, and outcome. J Reprod Med. 2013 Jul-Aug;58(7-8):312-8.
  • Maternal morbidity associated with multiple repeat cesarean deliveries. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O'Sullivan MJ, Sibai B, Langer O, Thorp JM, Ramin SM, Mercer BM. Obstet Gynecol. 2006 Jun;107(6):1226-32.
  • Multiple cesarean section morbidity. Makoha FW, Felimban HM, Fathuddien MA, Roomi F, Ghabra T. Int J Gynaecol Obstet. 2004 Dec;87(3):227-32.
  • Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No. 1. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:693–711.