A C-section is something every expectant mama has to think about, whether it’s simply an option or she’s had one before and is anticipating another. But how many C-sections can a person have safely? Is there a limit? With each procedure, risks for complications for both mom and baby do go up, according to experts.
Timothy J. Rafael, M.D., board-certified OB-GYN at Long Island Jewish Forest Hills in New York City, told Romper that there is no easy answer to this question. What is considered safe differs for every mom and baby and should always be discussed in detail with doctors.
“The take-home point is that, regardless of number of C-sections, the best practice is to try and avoid the first C-section. There’s no safe number, and there’s increased risk with every successive C-section,” he says. “A Cesarean is a major abdominal operation. Most women can have two to three C-sections uneventfully; however, even after the first C-section I’ve seen patients have complications in a second pregnancy. In general, if the repeat C-section is done after 39 weeks, the risks of complication for the baby are very small.”
OB-GYN Jessica Shepherd, M.D. agrees, telling Romper that repeating C-sections does increase the risk of complications every time, and your recovery can take longer with each surgery, too.
“There is no set number for a patient, however we do know that as the numbers of Cesarean sections increase, there are more risks for complications for bladder and bowel injuries, heavy bleeding or hemorrhaging, or even problems with the placenta.”
Rafael adds that repeated C-sections up the risk of scar tissue formation, infection, blood clots, need for blood transfusions, placenta accreta or placenta previa, and uterine rupture. “The majority of patients can have multiple C-sections uneventfully, but I’ve seen patients on their second pregnancy who need a hysterectomy at the time of their second C-section to prevent hemorrhage. Sometimes it’s just unavoidable.”
Does opting for a vaginal birth after Cesarean (VBAC) (also known as a trial of vaginal delivery, or TOLAC) reduce that risk? Both OB-GYNs agree that vaginal birth reduces recovery time for moms and is preferable to a repeat C-section in a perfect world. However, whether it’s right for you is a personalized decision that you should make with your partner and physician.
“Each patient and situation might differ, and there should be a very intentional discussion with your health provider about the potential risks involved,” says Shepherd. “Women requesting a trial of vaginal delivery after two caesarean sections should be counselled appropriately, as there is a success rate of 71.1%, and also knowing the uterine rupture rate is 1.36%.”
“After one prior C-section, if the C-section was full-term and the incision on the uterus was low, the uterine rupture risk is less than 1%,” says Rafael. “Especially if a patient has had a vaginal delivery before that C-section, she may be an excellent candidate for a TOLAC. After two Cesareans the rupture risk is still low — between 2% and 2.5% — and depending on the type of uterine incision it’s still reasonable to offer these women TOLAC, but they have to find a provider that would be comfortable providing one.”
VBACs should only be performed at locations ready to offer emergency surgery, says Rafael, because they can sometimes end in needing a repeat C-section. For this reason, he encourages hospital births rather than birth center or home births for VBAC mamas.
“This has to be in a hospital setting where an emergency delivery via repeat C-section can be carried out very quickly,” he says. “Patients in labor are watched with continuous fetal heart rate monitoring, and sometimes with TOLACs there may be indications by the fetus that there is a uterine rupture, in which case providers need to take the patient into a repeat C-section.”
Rafael recommends using a free online TOLAC/VBAC calculator to more accurately predict your rates of risk versus success before meeting with your OB. It can help predict your outcomes more accurately, and then you can run those numbers past your doc to see what they think.
“It takes things into account such as indications for the prior C-section, the patient’s weight, and a number of other factors that can give her a more accurate prediction of successful VBAC. We generally say it’s about 60% to 80%, but this is more accurate.”
Jessica Shepherd, M.D., board-certified OB-GYN at Baylor Scott & White Health in Texas