How Many C-Sections Is Too Many?

Image via Kelly Sue/Flickr
Image via Kelly Sue/Flickr

A good friend of mine dreams of expanding her family by just one more; she longs to hold another baby in her arms and watch her children grow up together in a fulfilled, happy brood.

But there's just one problem—her doctor doesn't want her to have another c-section. 

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According to the Center for Disease Control and Prevention, 32.8% of all births since 2011 have been via cesarean section—a number that is fast on the rise again, after reaching an all-time high of 60% in 2009. Following that unprecedented surge in the surgical mode of delivery, the American College of Obstetricians & Gynecologists (ACOG) cracked down on the rules and guidelines for c-sections in an attempt to lower the rate. 

However, the c-section continues to be a popular form of delivery, especially as women are delaying childbearing until older ages, which brings with it increased complications during pregnancy and a higher likelihood of necessitating a c-section delivery. 

Additionally, some women and doctors are simply advocating for c-sections on demand for those who choose it. 

“The medical field now acknowledges a patient’s right to actively participate in her choice of medical treatments, including [the] method of delivery. We have accepted that a patient is entitled to cosmetic surgery, assuming that she is providing informed consent. We should follow the same principle for cesarean section on demand,” writes Dr. Louise Duperron

But knowing the risks that come along with a c-section, is there a cut-off for women giving birth surgically? Is there such a thing as too many c-sections? 

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Because a c-section slices directly into a woman's uterus, the surgery itself inherently weakens the uterine muscle, and the scar tissue that will grow over the incision can simply never be as strong as whole tissue. In fact, the weakening of the uterus muscle places a laboring mother who has already had a c-section at a higher risk for her uterus literally ripping open—a condition called uterine rupture. The risk for uterine rupture after one c-section is relatively rare, about 1 in 100 for mothers who had a low transverse incision (most doctors do those routinely now), according to the Mayo Clinic

The experts at the Mayo Clinic also explain that, in general, most doctors set the “limit” of c-sections to three. After three subsequent c-sections, the risks just get to be too high for the mother. The risks include the weakened uterine wall, of course, but multiple sections can also cause problems with the pregnancy itself, as allowing the placenta and embryo limited space to land on the damaged walls of the uterus. Furthermore, bladder and bleeding problems are common as the number of c-sections goes up. 

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Additionally, doctors advise that women who wish to have more children and have had a c-section wait at least 18-24 months after their c-section before becoming pregnant again in order to allow the uterine tissue ample time to heal. A pregnancy too soon may further weaken the uterus and place the mother at a higher risk for rupture as well.  

Have you had multiple c-sections? Has your doctor discussed these risks with you? 

What do you think?

How Many C-Sections Is Too Many?

Chaunie Brusie is a writer, mom of four, and founder of The Stay Strong Mom, a community + gift box service for moms after loss. ... More

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12 comments

  1. Jacqui says:

    I just want to say that when you write an article like this, you should include a wider variety of risks involved with having repeat c-sections. There are placenta disorders that can be harmful and fatal to the mother and child such as placenta previa and placenta accreta. Placenta previa is when the placenta either partially or completely covers the cervix, and when left undiagnosed, can be fatal. Placenta accreta varies in severity. The form I had is known as placenta percreta. My placenta had grown completely through my uterus and if I would have continued the pregnancy beyond 34 weeks, would have began to attach itself to my bladder. Fortunately I had my daughter whom was very healthy for a preemie and I only needed one unit of blood. However I did need a hysterectomy. I am so glad we survived this horrible condition, as I was not informed of the amount of risk associated with repeat c sections (i had 3 prior to percreta). I just wish every woman would know the risks of repeat c sections. If i had I might have pushed harder for a vbac.

  2. Kaitlyn says:

    I had one vaginal and one csection. I preferred the vaginal. My experience giving birth to my daughter was awesome with hardly any problems. I ended up having a cesarean with my son due to gestational diabetes and they thought he was big. My daughter was 7lbs4oz and my son was 8lbs4oz so only one pound more. I had a lot of excess fluid so my Obgyn told me I wouldn’t dilate past a certain point so we went ahead with the cesarean. I loved seeing my son faster but the recovery was HORRIBLE. The worst pain I’ve ever been in. Not sure if I ever want to go through that again… If I do it’ll only be one more time!

  3. ryl65 says:

    I had 5 1983, 1986, 1987,1991, 1994 And i also had a surgery in 92 to remove my ovary and tube. and still had my son in 94

  4. Kelsey says:

    I feel like I’m screwed either way. I labored for 39 hours before they did a c-section (my son was very large and his head was not fitting, not remotely), and I had a brutal recovery and have a terrible scar from it, I would never want another one, but I’ve heard from my friend who does labor and delivery that a VBAC could cause a uterine rupture as well.

  5. gfeld says:

    Never knew there was a limit. I have not had any of my children so far via c-section. My aunt had 7 kids through c-section with no problem. I guess that is why it never crossed my mind that there is a limit to how many one can have before a dr deems it unsafe.

  6. Member says:

    I’m an OB/GYN & I’ve had 3 C sections myself. It’s very rare for me to recommend that someone stop having babies because of the number of C sections that they’ve had. There are some that have a very thin uterine wall that are more likely to have a rupture with subsequent pregnancies. I simply discuss the possible risks & let them decide. I have done patients 4th & 5th C sections. I’ve known one patient that had 7 C sections. There are risks & benefits to everything – and rarely should there be absolutes in medicine. I didn’t get a tubal with my last C section even though I have 4 children (in 5 years with a set of twins) just in case I decided to have another.

  7. KITTYNOLAND says:

    I had an elective C-section, although I did have pre-eclampsia at 36 weeks. I so regret having had one. I am pregnant again and by the time my next son is born, it will have been only 21 months between two. I am terrified of labor! I wish women would do one another the favor of not overly exaggerating their labor experience. Granted, their are some who have been in horrid and dangerous situations, yet as a whole, most were likely to have labored in a healthy and safe fashion. Let us encourage one another and not unduly terrify each other when it is not necessary. Most who have truly had a traumatic labor do not enjoy reminiscing the terror of it.

    • Kim Shannon says:

      Hi KITTYNOLAND! I agree with you. I did not enjoy my laboring experience, but I choose to not share my experience with anyone that is pregnant. Plus, everyone has a different experience; just because my labor went a certain way, that doesn’t mean someone else’s will go the same way. There is no reason to add to anyone’s worry! Some people have effortless and wonderful laboring experiences!
      Good luck with your pregnancy!

      • gfeld says:

        It’s all too true that some women scare other women about labor and they therefore opt to have a c. In the five labors I have gone through, there was only one that was truly traumatic for me but that was because my baby had a wide build and it was my first child. I guess his position may have played a part in that as well. All the other labors were normal and uneventful thank g-d. I don’t know why women would scare other women based on their experiences. Where is the thrill in that?

  8. Rochelle says:

    Personally, I just underwent a cesarean surgery almost two weeks ago. The reason for this was because my baby wasn’t getting enough nutrients from my placenta. The doctor mentioned to me that my placenta was “old.” Now knowing that the cutoff limit to a cesarean is three, it makes me wonder whether or not I can have another baby via cesarean. My hospital does not even allow VBACs. Decisions Decisions

  9. LLand says:

    I have had 4 c-sections. First was an emergency, second was partially planned in case baby went into distress and the last two were due to doctors not wanting me to try for vaginal. I waited at least 2 years in between each pregnancy except last who was a surprise. Doctors were not worried about my incision sites and all pregnancies were low risk. None of my doctors discussed the risks with me, I did my own research online and felt safe. Everyone’s body and pregnancy are different though so don’t take my experience as what could happen with you.

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