Is having a third C-section risky?

Q: What are the risks of having a third Caesarean section?

A: A primary C-section or a first C-section that is scheduled (meaning you walk in to the hospital with a C-section already planned) has a 2-3% complication rate. The most common complications are infection, excessive bleeding, and injury to other surrounding organs, namely the bladder and/or intestines. Each time a C-section is done, the risk of having a complication increases, such as the risk of injury to the bladder and intestines. Plus, there is always scarring that occurs with surgery, which can make having it a second, third, or fourth time a lot trickier. And a few more complications can occur as the number of C-sections in a particular patient increases. Below is a list of what the complications are, with a brief description of each one.

Placenta previa - the placenta implants over the cervix instead of along the wall of the uterus. This can lead to bleeding during pregnancy and a preterm delivery.

Placenta accreta/increta/percreta - an abnormal attachment of the placenta to the uterine wall. Instead of the placenta detaching and coming off nicely after delivery, it is sticky or has grown into the wall of the uterus, which can result in excessive bleeding.

Uterine atony/excessive bleeding - it becomes more likely that the muscle of the uterus won't contract down after each subsequent delivery, which leads to excessive bleeding that requires medication and, occasionally, additional surgery to stop the bleeding.

Uterine dehiscence or rupture - each time an incision is made in the uterine wall, a scar forms and the scar is weaker than the surrounding muscle. Multiple incisions can create quite a bit of scar tissue, leading to a separation of the uterine muscle as the pregnancy progresses and the uterus grows. This happens especially if labor occurs prior to the date of the scheduled C-section.

It’s best to talk to your doctor about all the possible risks so that you are educated and informed. But, before you panic, know that most third C-sections go just fine -- so looking at this list certainly isn't a reason to avoid having a third child if you really want one!

Answered by Dr. Michele Hakakha

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