The safety of multiple cesarean births (more commonly known as C-section) is an important factor for doctors and expectant parents when making decisions about future births.
Although the number of C-sections performed each year in the United States is not as common as vaginal births, it might surprise you. The Centers for Disease Control and Prevention reported that in 2018, 31.9% of births occurred by cesarean section.
If you come across this statistic, you may be wondering how safe it is to have more than one C-section.
Every pregnancy is different, so it's difficult to give a single answer on how many C-sections can be done safely. And of course, there are circumstances in which multiple C-sections are medically necessary.
However, if you may have more than one C-section, here's what you need to know about the safety, risks, and other options available.
If you have had a cesarean section, will it be necessary for future pregnancies?
No, you will not need a C-section for future pregnancies as long as your previous C-section was a low transverse (roughly horizontal) incision in the uterus, says Robert O. Atlas, MD, FACOG, chair of the department. of Obstetrics and Gynecology at Mercy Medical Center.
You may wonder why the location of the incision is important. According to the American College of Obstetricians and Gynecologists (ACOG), the type of uterine incision you had during a previous cesarean section may affect future births because some uterine scars are more likely to lead to rupture during a vaginal birth after cesarean delivery (VBAC). ). ).
A low vertical incision and a high vertical incision carry a higher risk of rupture than a low transverse incision of the uterus.
According to ACOG, people with a history of cesarean delivery have two options for future births: planned cesarean delivery, or VBAC. If your previous C-section was a low incision, your doctor may talk to you about an attempted labor after cesarean (TOLAC), which is an attempt at a VBAC.
“TOLAC will work most of the time,” says Atlas. The answer, he says, depends on why the first C-section was performed.
“For example, someone who had a breech C-section has an 80% chance of success compared to someone who was fully dilated, pushed for three hours, and then had a C-section; their chances of success are less than 33 percent,” he says.
Therefore, a VBAC is not always possible and yes, sometimes subsequent pregnancies need to be delivered by cesarean section. And this possibility raises the question of how many C-sections are considered safe.
How many C-sections are safe?
When it comes to how many C-sections can be performed safely, Atlas says there's no real answer to that question.
“There are people who have had six or seven C-sections without any problems, and others who have only had one C-section whose next pregnancy is associated with a very difficult problem like placenta accreta spectrum disorder or terrible adhesions (things stuck together),” he says.
But to quantify things a bit, the Mayo Clinic says TOLAC is not recommended after three or more C-sections.
Risks of multiple C-sections
- uterine rupture
- bladder complications
- bowel adhesions or lacerations
- omentum adhesions
- blood vessel complications
- excessive bleeding
- need for blood transfusions