Cesarean section is a surgical procedure performed when vaginal delivery could pose a risk to the mother or the baby. Sometimes, cesarean delivery is the only solution for the birth of a healthy baby, and therefore it should only be performed when necessary, assessing the risks and benefits in each case.
But if a woman gives birth by caesarean section once, will the following deliveries also be by caesarean section? How many caesarean sections can a woman have?
Vaginal delivery after cesarean section (VBAC)
When the first delivery, for some circumstance that the doctor determines, is by caesarean section, it does not necessarily mean that the second delivery must also be by caesarean section.
It is perfectly possible to have a normal delivery after a cesarean section. In fact, vaginal delivery should be attempted for women with a prior cesarean section if medical conditions permit. According to data from the General Society of Obstetrics and Gynecology (SEGO), in 72-76% of women with a previous cesarean section, a successful vaginal delivery is possible afterwards.
What is the maximum number of cesarean sections that can be had?
As for the number of cesarean sections that can be safely performed, most medical professionals consider three .
According to words in Abc de María Benedicto, gynecologist at the USP San José Hospital in Madrid, “most doctors do not advise performing more than three caesarean sections on the same woman .”
However, she explains that although that is the recommendation of doctors, each woman is free to assume the risks that a fourth cesarean section can entail.
Complications of repeated cesarean sections
This recommended maximum number of caesarean sections is due to the great risk of uterine rupture to which the woman is exposed if she becomes pregnant again.
Cesarean section scars weaken the tissues of the uterine walls, increasing the chances of a spontaneous tearing of the uterus. According to the specialist, the rate of ruptures after two previous cesarean sections is quadrupled.
Uterine rupture is one of the most serious obstetric complications as it is accompanied by high maternal and, above all, fetal mortality.
This implies an increased risk of serious complications such as:
- Risk of uterine rupture: it involves the loss of integrity of the wall of the uterus. In the most serious cases (complete or catastrophic uterine rupture) it can cause the death of the mother and the fetus.
- Placental complications: that the placenta is abnormally attached to the uterus (attached placenta or placenta accreta ) or that it is abnormally implanted over the internal cervical os ( placenta previa) . Both conditions increase the risk of preterm labor, excessive bleeding, and the need for a blood transfusion and surgical removal of the uterus (hysterectomy).
- Adhesions: Adhesions are scar-like tissues that affect not only the uterus but also the abdominal muscles and connective tissue and neighboring organs. Dense adhesions can make a caesarean section difficult and increase the risk of injury to the bladder or bowel, as well as bleeding and maternal or newborn death.
- Problems with the incision : with successive cesarean sections, the risk of complications derived from abdominal incisions, such as a hernia, also increases.
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