How Many C-Sections are Safe?

epiphany · Jul 6, 2008

You have to ask yourself what they mean by safe. Usually they are talking about uterine rupture & adhesions.

The more c/s's the higher the risk of either. When we do a c/s of a women with a prior history even of one c/s, the adhesions you see are pretty scary. If we consult a mother about a VBAC we usually asks if she wants more children, and if so we highly recommend VBACS for those reasons.

Women with c/s's are asked to wait a year before getting pregnant again to give the scars a chance to heal.

Strange that you should your questions here. Midwives do antepartum care, but we don't consider even one c/s to be safe.

Nicky30, BSN, RN · Jul 7, 2008

Sorry if I have caused confusion. In Australia only midwives can be responsible for the care of pregnant women. Our nursing degrees do not cover anything to do with pregnancy at all. In rare circumstances a nurse may be asked to assist in the midwifery department (but this is very rare. In small country hospitals (such as where I work) a midwife may be the only one on duty and look after antenatal, intrapartum and postnatal all on the same shift.

I asked here without thinking that there may be a better place to ask.

Nicky.

beckinben, CNM · Jul 8, 2008

Of the women I know, the most any one has had is 9 (yes, nine) c-sections. Her last was a planned section at 36 weeks due to the increased risk of uterine rupture. The baby did have some problems related to preterm birth.

In the last month, I've first assisted on the c-sections of two women having repeat sections. One was the woman's fifth c-section, the other was the woman's sixth c-section. Both had placenta accreta. In case you don't know, this is where the placenta starts to grow into the uterus, which can make it very difficult to remove. This is a known complication in women having repeat c-sections because the placenta has an easier time growing into a scarred uterus. In the one case, we were able to remove it after some time. In the second, we ended up doing a total hysterectomy.

One of the OBs I work with strongly prefers women not have more than 3 c-sections. I think what I take from this is that I really do my very best to avoid performing that first c-section. When I talk to women about c-sections (especially people who express the desire to have one rather than a lady partsl birth), one thing I like to say is that the first one is relatively easy and safe, but they also have to think down the road, and will they be OK with limiting the size of their family due to the risks of the third or the fourth or the fifth c-section, when the risks are much greater?

JMHO.

sunshyneB · Oct 22, 2009

I have had 6 pregnancies, all resulting in single births. All 6 of my children were delivered by c-sections. They are now ages: 22, 20, 19, 17, 16 & 14. They came out healthy and still are to this day. My 1st c-sec came from swelling of my cervix...

It was a wrap after that...

I haven't ever experienced any complications before, during or after any of my pregnancies. In fact, I didn't gain weight or have problems with stubborn belly fat until my youngest was 11 years old.

Many people are surprised that I even have 6 children, but they are in shock when they hear they were all delivered by c-sections. I have scar tissue, of course, but nothing major. Again, no complications!?!

I did have my tubes tied, by choice, after my 6th one. Enough children for me!

I didn't take any hormone pills/injections before or after to conceive. Call it fertile by nature, I guess. But I can't say, and I'm speaking for myself, from my own experiences, I didn't have any more soreness after the 6th one than I did with the 1st one. Honestly, I was so prepared by the time I had the 6th one, that I was up and walking within the 1st 12 hours after surgery.

My abdominal area went back down as well. In fact, when my youngest was 2, I was in a size 9/10 and weighed maybe 145 at 5'4". But I wouldn't encourage anyone to get excited due to my experiences and think that their body could handle just as many if not more. We are all different and our bodies react differently to different things.

Just know that it's not impossible, because I've been there, done that...

rbytsdy · Nov 21, 2009

Depends on the mom and depends on how she heals. Author Kimberly Hahn had 6 c-sections. When I was having my 2nd baby, I asked my midwives' back up doctor how many c-sections I could have (in case my VBAC was not successful). One of the nurses in the hospital had 7 c-sections and he said he hated doing them since it was like trying to cut through concrete.

Long Term Care Columnist / Guide · Nov 21, 2009

I've had 3 of them and never had any problems that I'm aware of, even when I had my VBAC in 1988 after TWO C-sections. And if memory serves me correctly, Ethel Kennedy had 11 children, all by cesarean.......no one evidently ever told her to stop getting pregnant. I think it all depends on the woman and her overall health.

akilgorefl · Jun 10, 2010

I am glad to be reading these posts. I am creeping up to my delivery date and am starting to terrify myself. I will be getting my 5th c-section done to deliver my baby.

I never had any complications with my c-sections that I know of, and as a matter of fact, they always were able to get in quick and get me stitched up quickly as well. However, I am sure if anything looked bad, the doctors wouldn't be screaming it out! ?

Reading this and seeing that I am not the only mother who wanted more children even after 4 c-sections, makes me feel much better. I love a big family.

We all take care of each other and it's so beautiful. Although we did not really plan this one, I really wanted to have a daughter with my husband, and here she comes! I just feel so blessed.

I was not given the option to do VBAC on my second child as my doctor said there were new regulations (right at 39 weeks he told me this) and he told me that he would have to be in the hospital while I was laboring (the whole time in case anything went wrong). I watched both my sister and my cousin VBAC successfully, so I was definitely bummed out! More than bummed, I was devastated and hurt.

My doctor at that time even told me that if I came in and was in labor and dilated to about 6, he might let me labor. I thought that was so awful. It made me want to stay home and labor on my own and just not call anyone...I think that would have been more dangerous, so I did not try it. I went with what the doctor told me and just did the repeat c-section.

When I got pregnant with my third, I went to another doctor who would let me labor if I wanted to. She told me the risk and said that it was my choice. Just having the choice made me feel so relieved.

I did not feel trapped or scared. It was beautiful. Then, towards the end of my pregnancy, she said "I would much rather do the c-section, but I understand how you feel" I told her that I wanted more children (maybe) and she reassured me that if I wanted them, I could have them. She said that she would take the baby at 37 weeks if I decided to do the c-section. I said "ok" and we went ahead and did it.

Looking back, she was such a great doctor and I am glad she talked me into it. Although I wanted VBAC, I think I lost that opportunity with the last child. If I had lost my son due to my selfish need to deliver lady partslly, I would have never forgiven myself. So, although I am scared now (as I really want to be there to raise my children), I know that everything happened the way it was supposed to and c-section at this point is not totally unheard of. I am tying the tubes though.

I feel so blessed and don't want to push it! Thank you for all of these posts! They have eased my mind a bit. I still realize there are risks, but I just feel better knowing that I am not alone! ?

klone, MSN, RN · Jun 13, 2010

It depends on the individual woman. Some women have dangerously thin uterine walls after only one or two, and some can handle several. Most of the time, scar tissue is removed from the previous incision.

rbytsdy · Jun 13, 2010

akilgorefl said:
Although I wanted VBAC, I think I lost that opportunity with the last child. If I had lost my son due to my selfish need to deliver lady partslly, I would have never forgiven myself.

I think that as nurses, we need to get over this idea that VBAC is selfish. It is selfish to leave your other children without their mother??? Is it selfish to want what's best for your baby? Unless there is a medical indication, lady partsl birth is better for babies, especially when they get to choose their own birthdate rather than risk being born too early. There are risks either way but if a VBAC is selfish, then so it a repeat c-section.

The risk of losing your baby during a uterine rupture is 6%. Not 100%! Not 50%! Just 6%. The chance of a uterine rupture following a spontaneous labor after 1 c-section is 0.4% (Landon study published in 2004 in the NEJM looking at nearly 18,000 women). The chance of a uterine rupture following multiple c-sections is 0.9%. So your chance of losing a baby in a VBAC attempt is 6% of 0.4-0.9%. A planned c-section does not guarantee you either a live or a healthy baby.

I respect every woman's to make her own decision regarding her birth. If a c-section made you more comfortable, then go for it! But please don't refer to VBACs as selfish. There is just as much chance of an adverse outcome with a planned c-section.

akilgorefl · Jun 13, 2010

Do you think that if I have had no complications in previous ones that I am possibly ok? I just feel so worried. I had a friend who had only 3 c-sections and at 37 weeks she had Pre-eclampsia so severely that she showed blood in her urine and had to at that point go in for an emergency c-section. She also had severe scarring where the Fallopian tube had adhesed to her uterine wall. I explained to her that this could have been why she had such difficulty getting pregnant with this child. Other than that, I do not think she had any issues with the other two. I do know that my scar tissue had been removed from previous c-sections, but I also hear the doctors explain how it is still difficult to cut through a previous incision. I guess I just won't know until they are in there huh? Anyone feel like saying a prayer for us? :-)...please feel free. Thanks for the great discussion thread here. It's great.

akilgorefl · Jun 13, 2010

That was so great to hear. I remember learning about the percentages a few years ago too. I was shocked at learn how low they were and yet doctors, in 2003, where told that they now had to be present during the entire labor while a woman chose to do VBAC. I went through a lot of grief back then and struggled with the fact that my doctor would not let me chose for myself. Especially after watching both my sister and cousin successfully VBAC. What he did was wrong, but I did heal from my mental anguish since then. Your message was very informative and I think should be sent to every woman who is told that she is not allowed to VBAC. I would have loved to hear that when getting ready to do my first repeat. I would have told my doctor to shove it! I just really enjoyed your post. Thanks so much!