How Many Cesareans Can You Have?

statistics on cesareans
How Many C-Sections Are Safe?

In America the rate of cesarean section deliveries has soared to 32 percent of all deliveries in recent years, compared to less than 5 percent in the 1970s. There are many reasons for this, one being health practitioners adoption of the mantra 'once a c-section, always a c-section'; another being hospitals reluctance to offer the service of a vaginal birth after cesarean delivery (VBAC) for fear of lawsuits if anything goes wrong. Studies show that 92 percent of women who have a c-section delivery go on to do so with the next baby. Yet, it appears that multiple cesareans can be risky for both mom and baby. Risky enough to prompt the National Institute of Health (NIH) to state that you should not choose a cesarean if you want 2 or more kids. The risk of hysterectomy and delivery complications like placenta previa and placenta accreta increases with each c-section you have. Many doctors fail to point out that a cesareans is a major surgery and the cesarean section recovery process can be drawn out.

The Alternative: Trial Of Labor
Trial of labor is a planned attempt to try a VBAC by a woman who has had previous cesarean deliveries. Many women (and doctors) are put off a natural delivery because of the associated risk of uterine rupture. Yet, the success rate of women who try trial of labor is consistently high - about 60 to 80 percent manage a vaginal birth. Those who don't, simply go onto to deliver by c-section. Some hospitals are now actively promoting trial of labor for women in low risk categories. If you have had a previous c-section and would like to try a vaginal birth, then it may be worth calling several hospitals or consultants to see who would support you in this decision.

Statistics: How The Risks Increase With Repeat Cesareans
Source: 2007 US National Center for Health Statistics data.

Death Rates in Women
Trial of labor after previous c-section: 4 deaths per 100,000 live births.
Elective repeat c-section: 13 deaths per 100,000 live births.

Risk of Hysterectomy

Trial of labor after previous c-section: 157 per 100,000 births.
Elective repeat c-section: 420 per 100,000 births after one previous c-section. This figure rises to 900 with 2 previous c-sections, 2,400 with 3 previous c-sections, 3,500 with 4 previous section and 9,000 with 5 or more section deliveries.

Risk of Placenta Previa
The risk increases with each cesarean delivery. With one prior c-section delivery the risk is 900 per 100,000 women. With 2 previous sections this rises to 1,700 and 3,000 with 3 or more previous sections.

Other Issues

There is shorter hospitalization time overall for trial of labor compared to elective repeat c-sections (excluding morbidly obese women). One study also suggests women undergoing trial of labor have lower rates of deep venous thrombosis (DVT) compared with elective repeat cesareans (40 vs. 100 per 100,000).

Bottom Line: While there is no limit to the amount of c-sections you can have, it makes sense to educate yourself about the risks and to investigate the alternatives. If you are not happy with your pregnancy medical team because they do not support your wishes, look for a new one.

Related Childbirth and Pregnancy Questions
How do I know if I'm in labor?
Is an epidural safe?
What are pelvic floor exercises?
How do you do pelvic floor exercises?
How many pelvic floor exercises should you do a day?

• Need more information about delivery and childbirth? See: Guide to Childbirth
• Got another question? See: Womens Health Questions

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