How many C-sections can women safely have?
Answer 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:
- 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). Both conditions increase the risk of premature birth, excessive bleeding, and the need for blood transfusion and the surgical removal of the uterus (hysterectomy).
- Complications related to adhesions. Bands of scar-like tissue (adhesions) develop during each C-section. Dense adhesions can make a C-section more difficult and increase the risk of a bladder or bowel injury and excessive bleeding.
- Incision-related complications. The risk of incision-related problems, such as a hernia, increases as the number of previous abdominal incisions grows. Surgical repair might be needed.
The number of C-sections you've had can also affect your future delivery options. A trial of labor isn't recommended after three or more prior C-sections.
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 03, 2022
- Berghella V. Repeat cesarean delivery. https://www.uptodate.com/contents/search. Accessed Feb. 17, 2020.
- American College of Obstetricians and Gynecologists. Committee Opinion No. 761: Cesarean delivery on maternal request. Obstetrics & Gynecology. 2019; doi:10.1097/AOG.0000000000003006.