C-section birth: how many caesareans can you have?
If a woman's previous pregnancy, for some reason, was resolved by caesarean section (commonly referred to as "caesarean section"), when planning the next child, parents often wonder how many cesarean sections can be had, what do doctors say?
Is it possible to deliver a child naturally after the first or even the second delivery by caesarean section? Is the third C-section a big risk to the health of the mother and child? Fourth C-section - is it possible, what do doctors say, what are the recommendations?
How many caesareans can you have?: is there an upper limit for the number of caesarean deliveries?
As we have already mentioned - "Caesarean" is a colloquial, but often used by women, term for surgical delivery, called by medics caesarean section (CC). How many cesarean sections can you have and why do women even ask doctors this question?
Caesarean section delivery is a serious surgical procedure, which, although currently performed in a routine and safe manner, according to the position of the Polish Society of Gynecologists and Obstetricians, should be performed only for clear medical indications in the woman and/or fetus [1].
Expert advises
The decision to perform caesarean delivery (first or subsequent) in a pregnant woman should always be made by an experienced obstetrician, guided by the good of the patient and the fetus, consulting other specialists if necessary. The woman must also give written consent to the cesarean section.
Caesarean section delivery carries the risk of many complications that may occur during the procedure itself, after delivery, as well as during the next pregnancy and the next delivery. Therefore, the answer to the question of how many cesarean sections can be had is not unambiguous. This is an individual matter, depending primarily on the patient's health condition. Theoretically, there is no upper limit that would determine the maximum permissible number of caesarean sections performed in a given woman - what do doctors say?
The upper limit for the number of caesarean deliveries and doctors' opinions
Obstetricians agree that the scar that forms in the uterus after a cesarean section makes each subsequent pregnancy or delivery more risky for the woman , including complications that threaten the life of the patient and the fetus [2].
Expert advises
One of such complications is the risk of placenta praevia and is 1% after 0.8 cesarean section, and over 4x more after 10 cesarean sections. Another very important complication is placenta accreta, which may grow into the surrounding organs, e.g. the bladder, and require perinatal hysterectomy (it is a consequence of implantation of the embryo in the scar after a previous caesarean section). The incidence of this complication also increases with each cesarean delivery. The relative risk after one caesarean section is 1, but after two caesarean sections it is 4.5, and it increases further after the next one. Each opening of the abdominal cavity is also associated with the formation of adhesions - after 2 cesarean sections, they affect 11.3% of women, and after 2 - 21%.
The patient's second or even third cesarean section: risks
Sometimes, doctors' offices ask: what are the risks of a repeat operative delivery? Is it possible to have a vaginal birth after a cesarean section? Vaginal birth after cesarean section ( VBAC ) is possible and reduces the risk of complications associated with a repeat cesarean section in a given patient [2].
The greatest chance (over 80%) for a “successful” vaginal delivery is in women with spontaneous onset of contractions. Women who have already given birth vaginally, apart from surgical delivery, have a nearly 90% chance of natural childbirth.
VBAC is recommended for women whose obstetric or non-obstetric indications for cesarean section from a previous pregnancy have resolved. However, VBAC also carries risks (including uterine rupture in the scar from a previous cesarean section). Therefore, a trial of vaginal delivery ( TOLAC ) in women who have had a previous cesarean section should be performed:
- after a thorough analysis of the health of the patient and the fetus;
- after obtaining the patient's written consent to TOLAC;
- only under the supervision of a medical team that is adequately prepared to perform a possible CC if any complications are observed during an attempt to perform a natural delivery[1, 2].
Is the second and third empress they are safe as is risk?
Just getting pregnant after a cesarean section is associated with an increased risk of complications, primarily related to the scar tissue from the cesarean section, which places significant strain on the uterus, weakening its walls. Each subsequent pregnancy after a cesarean section carries a higher risk of pregnancy and perinatal complications, including:
- the placenta may grow into the CS scar or detach prematurely;
- the CC scar itself may separate as the fetus grows, leading in extreme cases to rupture of the uterine wall.
The patient's second or third caesarean section means more scars appearing on the uterus, which indisputably and significantly increase the risk of complications during each subsequent pregnancy and childbirth [2]. However, this does not mean that a third caesarean is not possible.
Expert advises
Despite the increased risk of serious complications during pregnancy and childbirth, for many patients, the third delivery by caesarean section is very easy. The case of each woman is analyzed individually by the doctor. The history of previous births and the current health status of the patient and fetus are taken into account.
Fourth empress: is it possible, what do the doctors saywhat are the recommendations?
Until recently, there was a widespread belief that a woman should avoid getting pregnant again if she has already had 3 caesarean deliveries. The fourth pregnancy and cesarean section is a very high risk of complications for the very course of pregnancy and then childbirth. What do doctors say, what are the recommendations for women in whom a possible fourth pregnancy for medical indications would also have to end in the so-called "fourth emperor"?
The position of doctors in this regard is clear - the case of each woman and each possible pregnancy in a given patient should be considered individually. Although the fourth caesarean is associated with a significant risk of complications, many women manage to complete their fourth pregnancy and fourth cesarean delivery without major complications, both for the woman giving birth and the fetus. Fourth caesarean, what do the doctors say?
A woman who has already had three cesarean sections should consult with an experienced gynecologist before deciding to become pregnant for the fourth time . A doctor, aware of the woman's previous birth history and taking into account her current health, will certainly answer all questions thoroughly and analyze the risks for a subsequent pregnancy and delivery with the patient.
Źródła:
Recommendations of the Polish Gynecological Society 2006–2011, Printed in: Ginekol Pol. 2008, 79, 378-384 (https://www.ptgin.pl/sites/scm/files/2021-09/05.2008) [access: July 25.07.2023, XNUMX];
Wojciech Rokita, Jakub Młodywski, Vaginal delivery after caesarean section - qualification, results and complications, Practical Gynecology and Perinatology 2018 volume 3, number 1, pages 1–9
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