Caesarean births or C-sections are becoming more and more popular all around the world, but especially in the United States. In the past few decades, C-section rates have risen dramatically from 5 percent in 1970 to 20 percent in 1996. In 2015, one in three births happened by C-section in the US. There are a number of reasons why the rates have risen so drastically.
One of the reasons is due to the amount of technology available, especially in regards to fetal monitoring. As soon as a woman in labor is admitted to the hospital, the baby is under constant monitoring. While this can be a great thing, it also means that doctors take more precautions if they see that baby’s heart rate is abnormal at all. With so many medical advances, it’s better to be safe than sorry. If baby seems like they are in distress at all, most doctors will resort to a C-section.
Another reason is that women can now elect to have a C-section. Some women choose to have a C-section because they don’t like going through the pain of labor and birth. Other women prefer C-sections because it can be much more predictable. They can choose their doctor, the date, and even the time. This can help a woman feel like she has more control over a situation that is usually unpredictable. However, women who plan to have several children should think twice about electing to give birth via C-section. While it’s hard to say how many C-sections is too many, it’s proven that each is more complicated than the last. Here are 13 risks you might not have known about with multiple C-sections.
13 Difficult Delivery
With every additional C-section, the chance of delivery being difficult increases. Studies have found that the rate of difficult delivery can raise as much as 5.1%. A difficult delivery can mean several things and can happen for a variety of reasons. One of the things that define a difficult delivery is how long the surgery takes. One reason that a C-section might take longer has to due with the amount of scar tissue. A woman gets more scar tissue with each C-section. After three or more C-sections, there could be so many adhesions that it would take up to an hour for a surgeon to cut through them. Other things that make a C-section difficult is inflammation of the lining of the uterus, if mom needs advanced monitoring, or if mom requires an additional operation. There is no magic number of C-sections that make your next one difficult, but it’s found that the percentage does increase with each surgery.
12 Additional Operations
There is a risk of an additional surgery with any C-section, but the rate increases with each additional C-section. There are many reasons why women may need an additional surgery after a C-section, and there are also many causes. With each C-section, the amount of adhesions on a mother’s uterus grows. These adhesions make it difficult for a surgeon to perform each additional C-section and increases the time of the surgery. These adhesions can also stick to other organs, making it possible to an organ to get cut. Adhesions are a big culprit for many women needing an additional operation, and the more C-sections a woman gets, the more these adhesions increase. Other additional surgeries could be bowel surgery, hysterectomy, cleaning out an infection, or stopping any additional bleeding. There is not a set numbers of C-sections that doctor’s would say is safe or unsafe, but it’s important to listen to your doctor.
11 Longer Recovery
In general, recovery from a C-section takes longer than recovery from a natural birth. You will be kept in the hospital for 3-4 days and will then require additional help once you get home. You will probably be advised not to lift anything heavier than your baby. For women who opt to get a C-section because they are nervous about the pain of labor and delivery, be aware that you will still feel pain of your own during the recovery period. It’s also likely that the recovery period will get longer with each C-section. With each C-section, your doctor will need to cut you open again to get your baby out. This can be hard on your body and will create additional scar tissue. It’s not uncommon for your recovery period to last longer than your previous C-section. If your body doesn’t feel completely healed yet, don’t push yourself.
10 Bladder Injury
A bladder injury is another risk of a C-section. The bladder is the most frequent organ damaged during a C-section, making bladder injuries one of the more common risks of the surgery. Fortunately, bladder injuries are easy to recognize at the time of surgery. This means the surgeons can diagnose and repair most, if not all, of the damage. A bladder injury is possible with your first C-section, but it is highly unlikely. However, that risk increases with each subsequent C-section. This increased risk is due to adhesions that develop after each C-section. The adhesions can bind the bladder to the uterus and can cause a bladder injury during the C-section surgery. The adhesions can also cause a small bowel obstruction as well. So while bladder injuries are one of the more well known risks, they are generally easier to fix than some of the other risks.
9 Pulmonary Embolism
Blood clots are a well known risk with any C-section. It is possibly the most feared complication as it is the leading case of death among pregnant women in most developed countries. These blood clots are most common in the mother’s legs and pelvic area. The dangerous part of these blood clots is that they can break off. When they do break off, they travel to the lungs — which is called a pulmonary embolism. These blood clots usually cause swelling and pain in the legs. This makes it easy for the mother or doctor to recognize and diagnose before the blood clots travel to the lung. If the blood clot is found early, is it easy to treat with blood thinners. These blood clots are most common when the operation is long and complicated, or when the mother has long periods of bed rest after surgery. With each subsequent C-section, the delivery can get harder and recovery longer, thus making pulmonary embolisms more common.
8 Placenta Previa
A pregnant woman’s placenta usually grows in the upper part of her uterus. Placenta previa is a complication of pregnancy in which the placenta grows in the lowest part of the uterus and covers all or part of the opening to the cervix. There are several forms of placenta previa. As described by PubMedHealth, "marginal is when the placenta is next to the cervix but does not cover the opening. Partial is when the placenta covers part of the cervical opening. Complete is when the placenta covers all of the cervical opening." The risk of placenta previa increases when the uterus has been damaged — for instance, from a previous C-section. The risk of placenta previa is 2.3% with a woman’s fourth and fifth C-section, and 3.4% with a woman’s sixth. If a woman is diagnosed with placenta previa in one of her pregnancies, there is also a greater risk of the mother also having placenta accreta.
7 Placenta Accreta
Placenta accreta occurs when the placenta attaches itself too deeply and too firmly into the wall of the uterus. In a normal pregnancy, the placenta attaches itself to the uterine wall, away from the cervix. Placenta accreta is most common when a woman’s embryo implants itself in the area of her previous C-section scar. While this complication is rare, doctors have been seeing placenta accreta more often due to the increase of C-section deliveries being performed. The percentage for placenta accreta is less thank 1% for a woman’s first three C-sections, 2.13% for her fourth, 2.33% for her fifth C-section, and it drastically jumps to 6.74% in a woman’s 6th. One interesting fact is that if a woman has placenta previa, they are very likely to have accreta. If a woman has one cesarean and is diagnosed with previa in her next pregnancy, her risk of having accreta is 11%. That risk jumps to 40% in the third pregnancy, 61% in the fourth pregnancy and 67% for the fifth and sixth pregnancy.
6 C-Section Endometriosis
Endometrial tissue is usually present inside a woman’s uterus and is there to support their pregnancy. This tissue is also beneficial to your fertility when you’re trying to get pregnant. However, it can be extremely painful if it starts growing outside a woman’s uterus. Women who have endometrial tissue in other places in their bodies have a condition called endometriosis. Less than 1.6% of women report endometriosis after a C-section, making it very rare. This happens when the endometrial tissue grows in the incision site of a woman’s stomach after a C-section. It’s so rare, that a doctor may have a hard time diagnosing endometriosis and may even have to take samples from the incision to confirm the diagnosis. Depending on the situation, treatment can be as easy as taking medication. However, it’s possible that the doctor will recommend surgery to remove the area as it can be painful.
5 Risks To Baby
Multiple C-sections pose several risks to the baby. One of those risks is that the baby can be accidentally cut by the surgery tools. While this is rare and happens in less than 2% of C-sections, it’s still a risk. Even then, the cuts are usually very shallow and easy to repair making the recovery time very short for the baby. The more common risk, while still rare, is that the baby will have breathing problems. One study found that babies delivered by repeat C-sections were nearly twice as likely to be admitted to the neonatal intensive care unit. They were also more likely to have an increased chance of breathing problems that require oxygen. Other complications are low AGPAR score or being premature, but these are all due to the fact that mom was given a C-section because of a complication with the baby and not an additional risk of C-sections.
4 Increased Bleeding
The average amount of blood loss for a C-section is twice the amount of that during a vaginal birth. The pregnant uterus has one of the greatest blood supplies of an organ in the body and the surgeon cuts the large blood vessels while performing a C-section. Most of the time the amount of blood loss can be tolerated. However, sometimes there can be greater blood loss due to postpartum hemorrhaging, atony, lacerations, and placental accreta. Excessive bleeding is possible after any C-section, but the risk increases with each subsequent C-section. Excessive blood loss occurred in 3.3% of women with two C-sections but went up to 7.9% with a third cesarean delivery. Heavy bleeding also comes with risks of it’s own. If it’s heavy enough, mom might require treatment with a blood transfusion. In extreme cases that are life threatening, a woman will need a hysterectomy.
3 Emergency Hysterectomy
One of the risks of any C-section is a hysterectomy. However, the chance of needing an emergency hysterectomy goes up with each additional C-section. The percentages are under 1% for the first three C-sections, 2.4% on the fourth C-section, 3.5% on the fifth, and then the risk of an emergency hysterectomy jumps drastically to 9% on the sixth C-section. The reason for an emergency hysterectomy varies, but is usually due to rupture of the uterus or more commonly because of severe bleeding. The doctor may remove the whole uterus or just part of it, depending on the issue. Regardless of the reason, an emergency hysterectomy is usually performed because it’s the only way for the doctor to save the mother’s life. It’s also important to note that there is also a risk of an emergency hysterectomy with a natural birth, but the percentage is extremely low.
2 Post Surgery Infection
After the membranes have ruptured, the uterus is especially susceptible to infection. The bacteria that normally inhabit the vagina can easily spread to the uterus, resulting in endometritis. It’s also possible for women to develop an infection at the site of the incision on the outer skin layers, leading to post-cesarean wound infection. This would result in fever and abdominal pain. This is usually easily treated with antibiotics. Very rarely, the infection can spread to other organs, but even then they can be cured. According to HealthLine, "up to 8 percent of women who have a C-section delivery develop a bacterial infection called puerperal fever... If it spreads throughout the body, it is called sepsis." Infections like urinary tract infections or mastitis can be a sign of this complication. A fever in the first 10 days after the C-section is a warning sign for puerperal fever. This can also be treated easily with antibiotics if it is caught early.
1 Surgical Adhesions
Another risk of multiple C-sections in the increase in surgical adhesions. Surgical adhesions, as described by Livestrong, "are bands of scar tissue that develop on organs as a result of handling during surgery." These are most common in women who have had multiple C-sections. "Every time another C-section is performed, more adhesions are created. After three or more C-sections there could be so many adhesions that it would take up to 60 minutes for a surgeon to cut through them all." It’s very possible that these adhesions could also cause abdominal pain and even cause organs to stick to one another or to the abdominal wall. In extremely rare cases they can result in infertility. These adhesions can also increase the risk of bladder injury or even small bowel obstructions. It has been found that the bowel has twisted around a band of adhesions in 10% of small-bowel obstructions.