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Repeat C-Section.....or not?
Nowadays 25% or more of newborns are born via Cesarean birth in the United States. So it's very common for me to counsel second-time moms regarding the risks of repeat c-section. They want to know the risks to themselves to their babies, and they want to know how many c-sections a woman can safely have. Here's what I tell them:
Sure there are risks. A Cesarean Section is a major surgery, and there is potential for untoward outcome with any major surgery... The good news is that the risk is very small, generally because c-sections tend to be done on healthy women, and healthy women rarely have complications.
The major risks of c-sections include hemorrhage (requiring blood transfusions), infection, and damage to intraabdominal organs such as the bowel, bladder, blood vessels, and ureters. Wound healing problems can occur afterwards. Rarely there are life-threatening complications such as anesthesia complications, blood clots, pulmonary embolus, or even death.
As for the baby, the major risk is prematurity. If the c-section is scheduled (without labor), the date should be chosen conservatively, so as to be sure the little one's lungs are ready. Most doctors do not schedule c-sections before 39+ weeks just to be sure.
As far as multiple c-sections, the party line is to recommend no more than three, because of concern about the integrity and strength of the uterine scar. The concern is that multiple surgeries could weaken the wall of the uterus and lead to a higher chance of uterine rupture. But, I'm not sure that there's good research to back up this recommendation, and many women choose to become pregnant again and have more than three. There's probably a higher risk of bowel injury (due to scarring from previous surgeries) or placenta accreta the more you have, but these risks are low.
Obviously, in every case, you must balance the risks of another c-section vs. the risk of VBAC, because you have already taken on some increased risk by becoming pregnant again. The risks of a trial of labor and VBAC are extraordinarily low, but many argue nowadays that the risks of repeat c-section are lower. You'll have to consider your options and make a decision based on your unique circumstances and preferences. Either way, the odds of coming through the birth without complication are very high.
Related Topics: Vaginal Birth after Cesarean, Labor and Delivery
Sure there are risks. A Cesarean Section is a major surgery, and there is potential for untoward outcome with any major surgery... The good news is that the risk is very small, generally because c-sections tend to be done on healthy women, and healthy women rarely have complications.
The major risks of c-sections include hemorrhage (requiring blood transfusions), infection, and damage to intraabdominal organs such as the bowel, bladder, blood vessels, and ureters. Wound healing problems can occur afterwards. Rarely there are life-threatening complications such as anesthesia complications, blood clots, pulmonary embolus, or even death.
As for the baby, the major risk is prematurity. If the c-section is scheduled (without labor), the date should be chosen conservatively, so as to be sure the little one's lungs are ready. Most doctors do not schedule c-sections before 39+ weeks just to be sure.
As far as multiple c-sections, the party line is to recommend no more than three, because of concern about the integrity and strength of the uterine scar. The concern is that multiple surgeries could weaken the wall of the uterus and lead to a higher chance of uterine rupture. But, I'm not sure that there's good research to back up this recommendation, and many women choose to become pregnant again and have more than three. There's probably a higher risk of bowel injury (due to scarring from previous surgeries) or placenta accreta the more you have, but these risks are low.
Obviously, in every case, you must balance the risks of another c-section vs. the risk of VBAC, because you have already taken on some increased risk by becoming pregnant again. The risks of a trial of labor and VBAC are extraordinarily low, but many argue nowadays that the risks of repeat c-section are lower. You'll have to consider your options and make a decision based on your unique circumstances and preferences. Either way, the odds of coming through the birth without complication are very high.
Related Topics: Vaginal Birth after Cesarean, Labor and Delivery
