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Having multiple caesarean sections

It is a fact that many mother are now having repeat caesarean sections either out of choice or because the alternative is not available to them. Issues the mother needs to consider include:

Increasing surgical difficulty: The bigger the number of abdominal surgical procedures you have, the more difficult technically the procedure is likely to be. This increases the risk of injury to adjacent structures such as the urinary bladder and bowel. The consequences of such injuries can be quite dire and sometimes long lasting.

Increased risk of serious haemorrhage: Caesarean sections increase the risk of placenta praevia (low lying placenta) with possible severe haemorrhage during pregnancy and before term. Such bleeding can endanger the life of the baby and sometimes the mother. The risk of placenta praevia after 3 caesarean sections is as high as 40%.

Placenta accreta: This means morbidly adherent placenta. Presence of a scar on the uterus increases the risk of abnormal adherence of the placenta to the uterine wall. This is a major potential problem as it can lead to severe postpartum haemorrhage, requiring emergency hysterectomy. Maternal death can result from this.

The usual risks associated with major surgery including risk of anaesthesia, increased risk of thrombosis and embolism and risk of infection, all of which are either absent or much lower with vaginal delivery.

Recovery time: When you are mother with a newborn baby, you want to be able to look after him/her. A caesarean section means you are not able to fully do that for days, even weeks on end as you recover from the surgery. With vaginal delivery, in most cases all you have to recover from is the exhaustion associated with the efforts in the second stage of labour. This takes hours at most.

Number of caesarean sections

Any woman aiming to have a large family of, let’s say, more than 3 children, needs to think carefully about having caesarean section. If it was necessary to have a caesarean section in the first pregnancy, then she should explore the possibility of having a vaginal birth in a subsequent pregnancy or pregnancies. If this is feasible and safe, then that will be the ideal way to proceed. This is for all the reasons detailed above.

The potential for complications increases the more caesarean sections a woman has. It is the case that there is no such thing as a safe number of caesarean sections. Major complications can occur with a second caesarean section. By the same token, a woman may coast through a fifth caesarean section without any problem. It is all a matter of degree of probability. Most obstetricians will advice a woman who has had three caesarean sections to think very carefully before embarking on a fourth. However, this number is plucked mainly out of convention rather than scientific evidence. If it was necessary for a woman to have multiple caesarean sections, she needs to think about having sterilisation done at the time of her last one. Most obstetricians would advise that to be the third one. However, this advice is usually individualised. If the obstetrician performing the caesarean section finds worrying conditions which makes a future pregnancy risky, he/she may advise sterilisation, even if this was only the second delivery.

Important Points:

Last update: October 07, 2012