Health risks increase with each subsequent cesarean, yet some women are able to have 6 or more c-sections without complication. Here's why.

By Whitney C. Harris
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Having a C-section is not a decision that doctors or laboring women take lightly. Thankfully, in the United States, the surgeries are performed by highly qualified professionals, so mothers and babies are in good hands to help navigate any associated risks. Most moms who have a cesarean will also go on to birth their future children via the same method. But how many C-sections can you have?

C-Section Risks and Recovery

Every woman is different. Some recover at a similar rate after each cesarean, while others experience a longer, more difficult post-op period after subsequent surgeries. Still others bounce back faster after each C-section, according to David Ghausi, D.O., department chair of obstetrics and gynecology at Los Robles Hospital in Thousand Oaks, Calif.

While it's hard to say definitively how many cesarean sections is too many, it is generally accepted that certain risks increase as the number of repeat cesarean sections increases. Such risks can include blood transfusion, injury to the bladder, and hysterectomy at the time of delivery—all of which rise to more than 1% chance after a woman's third cesarean. In fact, the chances of needing a hysterectomy soars to nearly 9% percent after the sixth surgery.

There's also no set rule when it comes to the number of C-sections you can have. "I have performed a woman's sixth C-section with virtually no complications or difficulties, and I have performed second cesarean sections with many adhesions and potential complications," says Jason S. James, M.D., chairman of the Department of Obstetrics and Gynecology at Baptist Hospital of Miami.

Potential problems that rise with each subsequent C-section include the placenta implanting abnormally, injury to the bowel or bladder, and the uterine scar opening. What's more, abdominal surgery can lead to adhesions that develop with increasing thickness each time a new C-section is performed on the same woman, and they can make for a more difficult delivery.

More notable risks are developing hernias, diastasis recti (when the stomach muscles separate and the abdomen protrudes), and numbness and pain at the incision site. James notes that endometriosis in the incision can also occur.

VBAC: The Other Options

Women who want to avoid another C-section will often consider attempting a vaginal birth after cesarean (VBAC). In most of the U.S., this is a totally acceptable option after the first cesarean; however, most medical societies don't recommend this route for those who've had two or more, when the risk of uterine rupture during labor rises to 2 or 3%.

To help prevent any complications, Ghausi recommends waiting at least 6 months after giving birth by cesarean before getting pregnant again. Though he's had patients get pregnant 1, 2, and 3 months after a C-section and be just fine. "There's no magical number," he says.

To get a better idea for your situation post-C-section, talk to your doctor about how your surgery went and whether there were any adhesions, or scar tissue that may cause problems.



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