How many C-sections can a woman safely have?
Answers from Yvonne Butler Tobah, M.D.
Each repeat C-section is generally more complicated than the last. Studies show that the risks increase after a third cesarean delivery, and vaginal deliveries aren't recommended after three cesareans. However, research hasn't established the exact number of repeat cesareans considered safe.
Women who have multiple repeat cesarean deliveries are at increased risk of:
- Scar tissue on the uterus and nearby organs. Bands of scar-like tissue (adhesions) develop after each abdominal surgery, though the extent of their formation after a C-section varies. Dense adhesions can make a C-section more difficult, prolonging the time to delivery.
- Bladder and bowel injuries. Bladder injuries, which are possible but uncommon with initial C-sections, are more likely with repeat C-sections. The increased risk is likely due to adhesions that developed after a previous C-section, binding the bladder to the uterus. Adhesions can also cause small bowel obstruction.
- Heavy bleeding. Heavy bleeding is possible after any C-section. The risk of excessive bleeding increases with the number of repeat C-sections. The risk of needing a hysterectomy — removal of the uterus — to control life-threatening bleeding also increases with the number of repeat C-sections. Heavy bleeding might also require treatment with a blood transfusion. One study showed that the risk of hysterectomy increased from 0.65 percent after the first cesarean to 2.41 percent after the fourth cesarean.
- Problems with the placenta. The more C-sections you've had, the greater the risk of developing problems with the placenta — such as when the placenta implants too deeply into the uterine wall (placenta accreta) or when the placenta partially or completely covers the opening of the cervix (placenta previa). One study showed that the risk of placenta accreta increased from 0.24 percent after the first cesarean to 2.13 percent after the fourth cesarean.
Both vaginal and cesarean deliveries have risks and benefits. Deciding how you will delivery your next baby after a previous cesarean can be a complex decision. Talk to your health care provider. He or she can help you weigh the risks of a repeat cesarean against your desire for future pregnancies.
June 25, 2015
- Berghella V. Repeat cesarean delivery. http://www.uptodate.com/home. Accessed June 1, 2015.
- Berghella V. Cesarean delivery: Postoperative issues. http://www.uptodate.com/home. Accessed June 1, 2015.
- Lyell DJ. Adhesions and perioperative complications of repeat cesarean delivery. American Journal of Obstetrics and Gynecology. 2011;205:S11.