Repeat C-sections: Is there a limit?

In general, when a person has more than one cesarean delivery, also called a C-section, each procedure is likely to be linked to more health concerns than the last. But research hasn’t found the exact number of repeat C-sections that’s known to be safe.

People who have more than one C-section are at higher risk of health issues related to the following.

The placenta
The placenta is an organ attached to the wall of the uterus during pregnancy. It gives oxygen and nutrients to a developing baby, called a fetus, and removes waste.

The more C-sections, the higher the risk of problems with the placenta, including:

• The placenta implanting too deeply into the uterine wall. This condition is called placenta accreta.
• The placenta partly or completely covering the opening of the cervix. This condition is called placenta previa.

These conditions raise the risk of:

• Serious bleeding.
• The need for blood transfusions.
• The need for surgery to remove the uterus, called hysterectomy.
• Health issues related to surgery, such as organ and tissue damage.
• The need for an emergency delivery.
• Preterm delivery.

Scar tissue
After a C-section, bands of scar tissue, called adhesions, may develop. Each C-section can make adhesions thicker. And thick adhesions make a C-section harder to do. Thick adhesions also raise the risk of a bladder or bowel injury, as well as serious bleeding.

Incisions
Incisions are the cuts made during surgery. The risk of health issues linked to C-section incisions goes up as the number of incisions goes up. One example of a health concern that can happen due to multiple incisions is a hernia. A hernia develops when an organ or tissue bulges through a weak spot in the wall of muscle.

The number of C-sections a person has also affects the delivery choices that may be offered in future pregnancies. Trying to have a vaginal delivery after C-section typically isn’t an option after three or more C-sections.

Deciding how to deliver a baby after a C-section can be complicated. Talk to your healthcare professional about the risks and benefits to help decide what’s right for you.