A Cesarean section is something every expectant parent has to think about, whether it’s simply an option or they’ve had one before and are anticipating another. But how many C-sections can you have safely? Is there a limit? With each procedure, risks for complications for both parent and baby do go up, according to experts.
C-sections are one of the most common surgeries that OB-GYNs perform, and there are several reasons someone might have a C-section over vaginal birth. “Probably the most common reason is a repeat C-section after having a prior C-section in an earlier pregnancy,” board-certified OB-GYN Dr. Barbara McLaren, M.D., tells Romper. “After having one C-section, patients are typically given the option of either having another C-section or trying for a vaginal birth after C-section, also known as a VBAC.” With VBACs (also known as a trial of vaginal delivery, or TOLAC), the risk of uterine rupture during birth is doubled, compared to someone who has never had a C-section before. Your doctor can go over the risks with you and help you assess the best option depending on your specific situation.
For those who choose a repeated C-section, there is no easy answer to the question of safety. What is considered safe differs for every parent and baby and should always be discussed in detail with doctors.
How safe are multiple C-sections?
“The best practice is to try and avoid the first C-section,” Timothy J. Rafael, M.D., board-certified OB-GYN at Long Island Jewish Forest Hills in New York City, tells Romper. “There’s no safe number, and there’s increased risk with every successive C-section.” Of course, sometimes C-sections are medically necessary, and it’s not always possible to avoid them altogether.
“A Cesarean is a major abdominal operation,” Rafael notes. “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.”
Repeating C-sections does increase the risk of complications each time, and it can take longer to heal with each surgery. And according to McLaren, after three C-sections, the procedure becomes more complex with increased risk. “The surgery is also technically difficult to perform the more scar tissue that is present,” McLaren tells Romper. So, how many C-sections you can have safely will vary person to person, depending largely on how much scar tissue is present.
The risks of repeated C-sections
“After a C-section, you face a higher risk of potentially serious complications in a subsequent pregnancy than you would after a vaginal delivery,” McLaren tells Romper, adding that it’s tough for a doctor to predict how much scar tissue a patient will have. “Some people produce more scar tissue than others,” she says. “One hint can be to look at your scars on the skin for keloids, which can indicate the propensity towards forming scar tissue, but this is not foolproof.”
There is no set “safe” number of C-sections for a patient. “However,” says Jessica Shepherd, M.D., board-certified OB-GYN, “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 more 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,” he says. “Sometimes it’s just unavoidable.”
Are VBACs safer?
Does opting for a VBAC reduce that risk? Shepherd and Rafael agree that vaginal birth reduces recovery time and is preferable to a repeat C-section in a perfect world. However, McLaren also warns that the more C-sections a person has had, the higher their risk of placenta previa — a condition where the placenta becomes attached to the wall of the uterus. “The risk of your uterus tearing open along the scar line from a prior C-section (uterine rupture) is also higher if you attempt a VBAC,” she says. Whether a VBAC is right for you is a personalized decision that you should make with your 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 counseled appropriately, as there is a success rate of 71.1%, and also knowing the uterine rupture rate is 1.36%.”
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 parents.
“This has to be [done] 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.”
The most essential takeaway is to talk in detail with your doctor when you are making this decision. There is no hard-and-fast rulebook for how to approach a delivery, and the best choice will depend on your unique situation.
Jessica Shepherd, M.D., board-certified OB-GYN at Baylor Scott & White Health in Texas
Dr. Barbara McLaren, board-certified OB-GYN and co-founder of Kushae feminine wellness products
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