How many C-sections can women safely have?
Answers from Yvonne Butler Tobah, M.D.
Each repeat C-section is generally more complicated than the last. However, research hasn't established the exact number of repeat C-sections considered safe.
Women who have multiple repeat cesarean deliveries are at increased risk of:
- Bladder and bowel injuries. The risk of a bladder injury increases to greater than 1 percent after a third cesarean delivery. The increased risk is likely due to bands of scar-like tissue (adhesions) that develop after a previous C-section, binding the bladder to the uterus. Postoperative adhesions can also cause small bowel obstruction.
- Heavy bleeding. Heavy bleeding is possible after any C-section. Research suggests that after a third cesarean delivery, the risks of needing a blood transfusion and surgery to remove the uterus (hysterectomy) to control life-threatening bleeding each increase to greater than 1 percent.
- Problems with the placenta. The more C-sections you've had, the greater is your risk of developing problems with the placenta — such as the placenta implanting too deeply into the uterine wall (placenta accreta) or the placenta partially or completely covering the opening of the cervix (placenta previa). If you've had a prior C-section, your health care provider might recommend an ultrasound to determine the location of your placenta during subsequent pregnancies.
Both vaginal and cesarean deliveries have risks and benefits. Deciding how you will deliver your next baby after a previous C-section can be a complex decision. Talk to your health care provider. He or she can help you weigh the risks of a repeat C-section against your desire for future pregnancies.
Yvonne Butler Tobah, M.D.
June 08, 2018
- Berghella V. Repeat cesarean delivery. https://www.uptodate.com/contents/search. Accessed May 21, 2018.
- Berghella V. Cesarean delivery: Postoperative issues. https://www.uptodate.com/contents/search. Accessed May 21, 2018.
- American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Committee Opinion No. 559. Cesarean delivery on maternal request. Obstetrics & Gynecology. 2013;121:904. Reaffirmed 2017.