“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):
Previous uterine rupture Presence of classical cesarean scar Placenta previa Increased risk of uterine rupture Any coexisting high risk condition in the pregnancy along with a previous cesarean section (eg: twins, pre-eclampsia) Having two prior C-sections
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 cesarean 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 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). No need to go through 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-section. 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.
