Expert: Catherine Beier MS CBE - 1/4/2009

Question
I have had 3 previous c-sections without any complications, and i would love to have another baby who would be born by my 4th c-section(I don't want to VBAC!) My youngest baby was born premature, and is now going to turn 3 years old. I think that I have given enough time for my uterus to heal! Do you think I should go on to have my fourth c-section? How much risks am i putting myself and my future unborn baby in? Is it life threatening? Thank you in advance!

Answer
Shati,


It is possible to have 4 c-sections in most cases. I believe the record for most c-sections is over 10 (which would be very unusual and not typically recommended).


There are benefits and risks you'll have to weigh in your particular situation.  


The risks are greatest when the c-sections are less than 2 years apart, which isn't an issue in your case.  However, it's impossible to say in your particular case whether it's recommended without more information.  Much will depend on the scar tissue you have, the location of the incision, the thickness of the uterine wall, etc, which your doctor should be able to discuss with you.


The risks of complications do increase with each subsequent c-section.   In contrast, they decrease significantly with every successful VBAC you have, but that is probably not even an option in your case.


In a 2006 study, Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries Obstet Gynecol 2006 107: 1226-1232, it was found that the risks of placenta accreta, cystotomy, bowel injury, urethral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with the increasing number of cesarean deliveries.


The study looked at 30,000+ women over 4 years and included women who'd had from 1-6+ c-sections.


Overall, the risks for mothers increased the most with the more previous c-sections, meaning the most complications were in 6+ c-sections, then 5, then 4, etc.  At 4 c-sections, most of these complications were still only seen in about 2.5% of cases (for a first c-section they averaged about 0.25%).  The risks at 6+ c-sections averaged about 8%. So, the highest jump was after 4 c-sections.


The risks of any c-section for the baby include respiratory difficulty, poor feeding, more crying, less consolability, jaundice and increased risk of requiring time in the NICU.


C-sections are major abdominal surgery and do carry risks.  In most cases, though, the risks are highest for the conditions above and not life-threatening, but could prevent you from having further children.


So, talk to your doctor about your history and whether it's advisable to have more children.  That will help you balance the risks to make an educated decision in your situation.



Best,
Catherine