What is the major concern in a case of previous caesarean section?
A previous caesarean section means the focus is on whether the scarred uterus will be able to withstand the rigours of labour or whether it could give way. the fact is, the risk of uterine rupture is small quoted at 0.35%. Moreover, under good supervision on a modern labour ward, that risk is minimized further.
It is therefore unfortunate that many more mothers do not get the opportunity to try for a vaginal delivery after a previous caesarean. This may partly be because they are not given adequate information to allay their concerns. There is no doubt, however, that, overall, vaginal birth is safer for these mothers, just like all mothers.
What if a woman has had two caesarean sections?
Once a woman has chalked up two caesarean sections, she should always have a caesarean section: That was the conventional ‘wisdom’ for a long time. Since the early part of the 21st century, opinion has gradually but steadily shifted. Many experts now agree that, in carefully selected cases, a trial of vaginal delivery can be attempted after two caesarean sections or even three. In fact, this has been successful in a substantial number of cases and guidance from professional bodies in the UK is now that a trial of vaginal delivery can be considered even for a woman who has had four caesarean sections in the past. In practise, this doesn’t happen that often mainly because the women in question are not usually too keen on the idea, nor, it has to be said, are many obstetricians who have to look after them. However, the dogma of ‘once two sections, always a caesarean section’ which was never based on evidence is now well and truly banished.
What is the acceptable interval following a caesarean section before trying for another baby?
There is no evidence that any time is too soon to conceive, following a caesarean section.
However, if she happens to conceive within three months of having a caesarean section, the chances are that she will end up with another caesarean delivery. This is because many obstetricians are anxious about the strength of the scar after such an abnormally short interval. This is doubly so if there had been post-operative complications, such as infection of the womb. Cases of such rapid conception following caesarean section are uncommon.
How many caesarean sections can a woman safely have?
There is no definite number. There is a myth among many people that anything beyond three caesarean sections is life-threatening! This is certainly not true. What is true is that each subsequent caesarean section makes the next one potentially more difficult. There may be so much scar tissue and distortion of the normal anatomy that chances of injury to other structures, especially the bladder, ureters and bowel, are increased substantially.
There is also the issue of increasing risk of the placenta abnormally adhering to the old scar. This may be so serious as to lead to severe uncontrollable haemorrhage requiring a hysterectomy. Every individual's circumstances are different and the obstetrician will give advice regarding future fertility on the basis of those unique individual circumstances. What is common to all is that the potential for serious complications increases with each subsequent caesarean; it is the extent that differs from person to person.
Last update: February 26, 2013