Over the last 30 yrs in the UK, there has been a dramatic increase in the number of babies born by Caesarean Section. Numbers have increased from 10 percent to almost 30 percent in some units. At least one third are planned, the others are performed as emergencies in labour or in late pregnancy. With improvements in anaesthetic, operative and post operative care the procedure is safer than it was 30 years ago, however, after 3 Caesarean Sections there are increased risks of complications in late pregnancy and in relation to labour and delivery.
There is no absolute max number of Caesarean Sections, but a sensible number is 3 or 4. Repeated Caesarean Sections are occasionally associated with abnormalities of the placenta which may cause excessive and dangerous bleeding in late pregnancy and at the time of delivery. In particular, the incidence of Placenta Preavia tends to increase with the number of Caesarean Sections. This is where the placenta lies abnormally low in the uterus, sometimes over the neck of the womb. This may cause recurrent bleeding throughout the pregnancy and may require frequent admissions to hospital. Delivery by Caesarean Section is always required and is often done 2 or 3 weeks before the due date to try and prevent unexpected heavy bleeding. If labour occurs before the planned date, bleeding may be excessive. Sometimes a blood transfusion may be necessary and if bleeding is heavy and there are clotting disorders then sometimes emergency operations or even a hysterectomy can be required as a life saving procedure. Even a planned Caesarean Section can be difficult and be associated with excessive bleeding and difficulty in delivering the baby safely. Occasionally there may be damage to the bladder or bowel if these structures are stuck onto the front of the uterus.
There is an additional rare and serious complication of repeated Caesarean Section which is called Placenta Accreta or Percreta. This is where the placenta may be abnormally stuck to the womb and may even invade through the wall of uterus and get stuck to the bladder and adjacent tissues. It is associated with a high incidence of hysterectomy either as a planned or emergency procedure.
If you are planning more babies and you have already had 2 or more Caesarean Sections you should have a careful consultation with your GP or obstetrician so you can be fully informed of possible risks to you and your unborn baby.
If you are already pregnant and planning a 3rd 4th or 5th Caesarean Section and you know that you do not want to have any more babies, you might like to talk to your consultant about the pros and cons of a sterilizing procedure called tubal ligation. This can usually be done safely at time of Caesarean Section. This is only done if the baby is well and you have given prior consent after detailed discussion. It is important to understand it is not reversible and you must be absolutely sure you do not want any more babies.
This procedure does not effect breast feeding, menstruation, your future hormone balance or sex life.