How many times Cesarean

This search term somebody used to find my website is the inspiration for this post: How many times can a woman have a C-section?

This is something that really needs to be understood, and possibly there needs to be more research. Because of ACOG’s change of guidelines, many doctors and hospitals are now refusing to allow a woman to have a VBAC, insisting instead on an “elective” repeat Cesarean. (How elective can it be, when that’s the only choice given her??) But some women have medically-indicated repeat C-sections, and some women actually freely choose repeat surgery (sometimes thinking they must, because “their bones are too small” or some such thing).

Someone I met once said that her doctor said it was okay to have up to five C-sections. My question (which I suppose I’ll have to get answered sometime) is, what happens if she gets pregnant after that? [innocent smile] Well, she’d have to have yet another C-section, or have a VBAC. But the real question isn’t “how many CAN you have?” but is more “how many is it SAFE to have?”

I argue that if it’s not medically necessary, then it’s not safe to have one at all, because of the higher risk of complications to both baby and mother from this major abdominal surgery, as well as the risk of future problems related to a pregnancy in a scarred uterus — and the risks go up with every surgery. However, C-sections in America are fairly safe — they carry only 5-7 times the risk of death to the mother as vaginal birth. (That fact and others are listed here.) The risk to the mother and any future babies is also increased, usually exponentially, with every additional C-section. These risks generally are related to the placenta and include accreta (the placenta grows through the uterine lining), previa (the placenta grows over the opening of the uterus), and abruption (the placenta detaches from the uterine wall partially or completely, prior to the birth of the baby. Maternal hemorrhage and hysterectomy are also increased.

So, the best way to avoid a repeat C-section is to avoid a primary one! Not all doctors and not all hospitals are created equal — you need to make sure that your doctor and hospital both have low C-section rates — I cannot stress enough that your care provider and labor support team (including L&D nurses at the hospital) will greatly affect your labor and birth. Having a doula is also proven to reduce the incidence of C-sections, while improving your labor experience. Keeping yourself healthy and low-risk will also reduce the likelihood of having a C-section. Educating yourself is necessary.

But, if you’ve had one C-section, then here’s the abstract of a recent study about the likelihood of a successful VBAC. It shows that the rate of complications related to VBACs (including uterine rupture and dehiscence) went down after the first successful VBAC. So, if you’ve already had a successful VBAC, and now all of a sudden your doctor or hospital won’t allow another one, you may need to ask for the medical reasoning, especially in light of the latest evidence. Here is a link to a listing of research done on VBACs. It is a “sound bite” version, if you will, of the research — provided so that you can get the name of the study and the journal it appeared in, so that you can look up the full article with greater ease.

But what if you’ve already had more than one C-section? Can you still have a vaginal birth? Yes! Check out the following links (in no particular order):

  • a blog post written by a woman after her first vaginal birth… which was after four C-sections (it’s the last story on the page, written Feb. 2005
  • a website from the UK, with some stories of vaginal birth after two or more C-sections, plus links to other research on VBAMCs (vaginal birth after multiple Cesareans)
  • a birth story of a VBA3C (vaginal birth after three Cesareans)
  • an excellent website, with a very long page on C-sections, including VBACs, VBAMCs, etc.

Check out my other posts about C-sections, for more information, as well as links to some really cool videos!

Update: — this article features a mother who had seven Cesareans with no complications, and mentions a doctor who performed thirteen C-sections on one woman in the 1970s. Wow.


22 Responses

  1. My dumb friend who is french and has a huge forehead says you can only have up to 3 c-sections please tell him his a ******* retard.

    [Edited to delete an objectionable word.]

    It’s possible that different doctors have different preferences and protocols when it comes to this question. A doctor may have told him that he will do no more than 3 C-sections. The risk to the mother, and to any future offspring, is definitely greater the more C-sections you do, so it is wise to avoid them unless necessary. In fact, many doctors take that into consideration when recommending a C-section — if they know the woman wants a large family, they will apprise her of the risks involved.

    Now, whether or not your friend is dumb, is an entirely different matter; but I am not the one to pass judgment on his mental abilities, regardless of his appearance or background. 🙂

  2. I have had 3 c-sections before and am going to try for a vba3c next time around. It is good to know that there are others out there who are helping spread the word about the risks of c-sections. It is time we start educating women about how wonderful our bodies really are and how we can birth naturally without major surgery.

  3. i had three caesarean section and i want to get pregnancy with my new hushand i would like to know is it safe to get pregnancy and have caesarean section again i want to give him a child my children are three years apart and the third one is four years apart so can i have another baby and it is safe to have another caesaren

    • Nancy,

      The risk of having any complications after three c-sections is low, but higher than if you had never had any C-sections at all. You may have individual risks, depending on how healthy you are and the skill of your doctor. In addition to whatever risks are inherent in any C-section, because of your multiple C-sections you will be at a higher risk of maternal hemorrhage and/or hysterectomy (removal of your uterus). You and your baby are also at higher risk of having problems with the placenta (the organ that nourishes and provides oxygen for your baby). These problems include a greater incidence of the placenta growing over the opening of the uterus, and the placenta growing on and into the scar of the uterus (which increases your risk of hemorrhage, hysterectomy, and other complications). “Increased risk” does not mean that you will definitely have these problems — most women don’t — but it is something to seriously consider and balance your desire to have a child with your new husband, with the risks involved.

  4. Linked to you, after you made a comment on my blog. Seems like you and I are on the same page.

    I sent your link for this post on to someone considering a VBAC after 2 c-sections. Just thought you’d like to know.

    I’ll be writing a follow-up to the husband/doula debate soon. Should be fun!


    • Both vaginal birth and Cesarean are generally very safe procedures. The biggest risk of VBAC is a uterine rupture, and that is more likely to cause problems for the baby than you — but the overall risk of uterine rupture is very small, particularly if you avoid drugs which induce or augment labor (although the risk may rise with every repeated incision). C-sections tend to cause several problems for the baby (the exact reasons are unknown — perhaps some babies are born a little too early, even if they’re at “term”; elective C-sections do not have any labor contractions which may benefit the baby — perhaps by stimulating his breathing skills and ability; and there is benefit to being squeezed through the birth canal — the fluid in the lungs is more effectively drained). One of the big problems with C-section is that the risk of certain problems occurring in a future birth are increased, and these problems include the placenta growing into the uterus, particularly at the incision site, which may cause maternal hemorrhage and necessitate a hysterectomy.

      The relative risks of C-section are much higher than vaginal birth, and this goes up with every repeated C-section; but the absolute risk remains low. Most women do not suffer long-term effects from C-sections, but of course, if it happens to you, it’s 100%.

      You said you are very scared — it may be your intuition telling you something is not quite right, and I would urge you to explore that possibility, and try to get to a place of peace before you proceed with your plans. There are women who have had successful vaginal births after having had multiple Cesareans, and if you feel led to go that way, while being fearful of a repeat C-section, you may have good reason for that, even if you can’t quite put your finger on why. Stories abound of people listening to their intuition, or having a miraculous or near-miraculous intervention that saved their lives. Just recently, I read the story of a man who was working in some factory by a furnace, and had a sudden and overwhelming need to go to the bathroom; right after he walked away from the furnace to relieve himself, the furnace exploded, killing several people and injuring even more. He would have been one of the dead ones, had he not “happened” to walk away.

      I cannot make the choice for you — I can only give you information to help you make your choice. It may be that you do need a C-section, but perhaps not quite on the day that it is scheduled. Perhaps you may need to wait until you go into labor naturally, or even just wait a week or two to let your baby mature more. Quite likely, everything will go just fine, regardless of what you choose. Explore your options and then choose which one is best for you.

  6. I really appreciate this site and its boldness for spreading truth.
    I have had 6 unnecessary c-sections. They have all been low-transverse and healed well. My first was due to malposition which could have easily been changed if I would have been “allowed” to move. I was dilated and effaced completely with no induction. My 2nd c-section was due to the nurse “accidently” rupturing my membranes when I was only dilated to 7 and the baby not coming right away. How stupid of me to allow them to cut me again and not just wait. I had this baby over four years after my first. There was no reason at all to operate. My doctor was distressed!
    My 3rd c-section was about 2 years later and was elective due to scare tactics. With my fourth pregnancy I was much more educated in the field of child birth and VBAC and was completely prepared to have this baby naturally. Everything went great until I went to the hospital. I was treated like a criminal preparing to commit murder. I dilated to 10 on my own, but was still harassed and harassed until finally forced to have a c-section. During this operation my fascia was not put back together and I had a bulge the sixe of a small water balloon below my navel. I still suffer from this operation that was performed over 8 years ago. My 5th c-section was performed after finding a doctor who I felt supported me. I dilated again to 10. The baby was even descending into the birth canal. I had a nurse that was extremely nervous and told me I was taking too great of a risk. She frightened the dr and he demanded that I have another c-section. During this c-section the doctor nicked the main artery that connects my left fallopian tube to my uterus. I almost died from blood loss in this operation. I needed at least 2 or more transfusions and I had to spend the entire night in the ICU without my baby boy. It was horrible!!! That was considered the “safe” option….a c-section! My 6th c-section was in April 07. It was planned and I had a wonderful birthing experience. The doctor treated me human and cared very much for me. He told me that my uterus looked great and I was ready for baby #7. He knew we wanted a big family. That was in Germany.
    So, here I am now…I am in TN. I am almost 30 weeks pregnant and still have not even seen a OBGYN. This is the first time I feel very frightened about the medical system. I have been in contact with a Dr. via phone and email. She is a Dr/Midwife and we are seriously considering a Home birth. This is where I am now thanks to the abuse I have received in the hospitals. I am a woman wanting to have a baby. I want to be treated like a human not like an atomic bomb waiting to go off. I have read and read and read both sides…I know the risks. I am concerned about the safe delivery of my baby. But I have been frightened away from medical staff…There is so much more to my story. But, it would be too long to write here. I have been abused emotionally and physically. I feel I have been violated and have lost my body to a system…an evil system that believes that having a baby is a medical condition. Having a baby is not a medical condition. It is a normal, natural, God-given process that man has perverted and taken control over. Allow woman to just have their baby in a peaceful and safe environment. Leave us alone! If there is an emergency, we are thankful to have the medical staff…but until then, please let us be and let us give birth! The doctor does not need an enema every time he has to use the rest room and women do not need any interventions or inductions to have their babies!!!!!
    Sincerely, A woman who just wants to give birth not have an operation,
    PS. A decision made out of fear is no decision at all!!!!!

    • hello angela

      my heart goes out to you as i feel the same i feel that all my 3 c sections were not necessary. they happened out of lack of competence, nurses and dr wanted to go home on time etc. i personaly feel that males should not be allowed to assist a woman giving birth as they do not and will never have a clue of what is going on no matter how long they studied. men are the ones that turned this into a medical condition which can be turned into cash dollars and how in the hell can a men tell you not to have more than 3 c sections? is it because it means they really would have to concentrate on what they doing if a woman has more than 3 c sections.. in general they welcome the rise of c sections as it makes more money but when it get complicated (a woman having more than 3 c sections) they tell you to get ur tubes tied? i think this is really a crime what they doing to frighten a woman about her natural abilities and make her a failure

  7. Linda, I completely agree with you. I am not in favour of a man assisting me during the birthing process.

    I am due in a few months and have requested all female staff. The genetic difference between men and women means men lack the biological point of reference necessary to gauge the pain experienced by women during the birthing process.

    There is a very specific and terrific amount of pain involved, which no man can ever experience. After all, I can read however much I like about photosynthesis, but I can never photosynthesize.

  8. I have 6 children and i have had 5 cesarean and one normal birth all my cesarean went well and was never told that i couldn’t have any more

    • I have had 6 c-sections. After my first, my Dr. scared me into having another. Then after 2 it seemed impossible to find a Dr. that would let me vbac. Even though I would like to have more children I am a little scared because my last c/s did not go as smoothly. I really struggle with what I should do.

  9. This is a really great post. I had never heard of women having a VBAMC before…but now that I know about this I am curious. I have had 1 CS, after a 24 hr homebirth turned emergency. Our daughter was born still after Csec to save her life was performed…

    Our miracle baby was born c-sec after more than 24hrs of VBAC-ing labor. His heart rate de-celled enough times that we decided to get him out, after I was stuck at 9/5 cm’s for many, many hrs with no progress!

    As it turned out, i had an obstructed labor…and a Bandel’s Ring, so baby was never coming out vaginally. So, now I am concerned for the next baby (prob a yr from now). Should I attempt another VBAC? How do I find out if I have a true Bandels Ring? What are things I can do to prevent this from happening?

    • Erin,

      I’m so sorry for your loss!

      I’ve done some research, and I wish I had better answers, but I wrote this post with the information that I was able to glean.

      An obstructed labor is the cause of Bandl’s Ring forming — at the juncture of the two different types of uterine muscle tissue. There are a few different reasons for an obstructed labor, including cephalopelvic disproportion (which is far too frequently the diagnosis for any lengthy labor, but is occasionally true), and a malpositioned baby — for instance, if the baby’s shoulder is presenting first, rather than his head.

      Fortunately, Bandl’s Ring is quite rare; unfortunately, because it is not common, there is not a lot of information about it.

      I don’t think that it’s likely to happen again — I came across one forum in which a woman was offered a chance to VBAC after having a Bandl’s Ring in her latest pregnancy, but was wondering if it would occur again, and the doctor that answered her question said that since she was being given a chance to VBAC, then that was a pretty good indication that it was definitely or even likely NOT to happen again.

      However, some doctors just don’t attend VBACs, and/or some hospitals don’t allow them, so just because a doctor says you can’t have a VBAC doesn’t mean it’s necessarily contraindicated in your particular case. If you go to a VBAC-friendly doctor (meaning that he encourages most if not all of his patients to have VBACs and has a high success rate of VBACs) and he reviews your case and gives you evidence and a reason why you should have a repeat C-section, then that changes things. At this point, I don’t know of a definite contraindication, but then I certainly don’t know everything!

      Questions for the future for you to answer, as you come to a decision, might include the following: why did you have an obstructed labor the first time, and what can you do to prevent a second obstructed labor?

      Resources like “Spinning Babies” and “Optimal Fetal Positioning” might help to determine how your baby is positioned in your uterus, and perhaps encourage him to move into a better position.

      Chiropractic adjustments may also help, as they put the body into alignment — they help breech and transverse babies turn prior to labor, so it might also help other babies who are not in the optimal position.

      Red Raspberry Leaf tea is often recommended and encouraged for pregnant women towards the end of their pregnancies (some midwives think it might increase the rate of miscarriage if used in early pregnancy; both of my midwives recommended that I drink it starting sometime in the 3rd trimester, but I forget exactly when). As far as I know, there is no contraindication for it for VBAC, but I haven’t researched much into it, so really don’t know much about it, except that it’s generally recommended for “female issues,” and particularly to help to tone the uterus. It may help to give your uterus the extra “oomph” it needs in labor to avoid an obstructed labor.

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  11. I did have c- section with my first daughter then vbac with my second then had c-section with my third so i wonder is there chance for VBAC again after these? because I wanna VBAC this time so is it allow?

    • It depends on what you mean by the term “allow.” Many doctors do not want to attend VBACs, and/or their malpractice insurance has told them not to. Some doctors will even tell their clients that VBACs are illegal (which is false); many other doctors will just say some version of “you’re not allowed to have a VBAC,” although the only legal way they can require you to have a C-section against your will is to get a court order. It has happened, although most of the time the court order was (eventually) overturned and ruled not lawful.

      Your chances for a successful vaginal birth go up with prior vaginal births, so you’re actually a good candidate, statistically speaking, to have a vaginal birth. Finding a supportive care provider and/or hospital is going to be the more difficult part. You can start by going to ICAN and checking out their information, including local ICAN groups, their “white papers” with information on VBACs and VBAC “bans”, and the hospital database for VBAC-friendly hospitals. Talk to as many mothers in your area as you can who had C-sections and VBACs to see who they recommend, because some doctors will say they support VBACs to get your business, and then schedule you for a repeat C-section and/or try to coerce you into it for no medical reason — “bait and switch.”

  12. I’ve had 1 vaginal and 3 c-sections. This last c-section was an emergency. I had placental abruption. The office I chose was VBAC friendly. So I chose that route. I, of course, ended up with the only doc that was NOT VBAC friendly. The whole birth was a fiasco. She had no beside manners. She was rude to me, rolled her eyes and much much more. she also said I had placenta acreta. I hemorrhaged before and after the birth. I lost lots of blood. Hemoglobin went from 14 to 6.5. There is so much more but would be a very long story.

    What I’m curious about is what if I get pregnant again? I am wondering about the odds of the acreta and abruption happening again. I can’t really find any info. I am prone to gestational diabetes. I am finally on medication for that though.

    If I got preggers, I would continue taking that medication.

    I just worry if I did something to cause the abruption. My 1st section, 2nd baby, was due to breech baby. 3rd was forced repeat section. 4th was unsuccessful VBAC attempt.

    I was seeing a chiropractor to help keep baby from becoming breech. Also the last week before birth, I used Evening or Primrose oil, vaginally.. trying to help cervix. I am just concerned that I might have caused the abruption. I felt the tender belly days before it all happened.

    I have done some healing, emotionally, but not completely. I was diagnosed with PTSD after this birth. This woman was SO RUDE to me and after the birth gets even worse.

    Thanks in advance for your response.

  13. Hi to all and I am sorry t hear the losses of some..

    I am in my early 30’s I have had 4 c-sections one 11 years ago,another one 8 years ago,3one 2 years ago and the last one 5 month ago..they all went healthy with no last one was the worse one yet! as I had lots of pain after delivery,but all of that had to do with the stupid ob who did the c-section..he was so hard and rude that i was all black in my lower abdomen for the longest baby born at 36 weeks and as healthy as can be 🙂 I will take all the pain out there as long I have my babies 🙂 ..I ask my ob who didn’t make it to the hospital on time because I was an emergency do to some pain in my lower abdomen and they decided to do an emergency c-section…when I ask him how long do I have to wait for the next one he laugh as I ask in pain for the one I just had,anyways…He said that I can have as many as I want as long I am healthy and has not have no complication(life threating one) with my body…after 6 to 8 weeks of my delivery that is safe to have sex and start planing..he said that our body is amazing as what it can do! the healing after c-section is 2 months..every doctor have their own opinion..and sometime they only think on their self..I am very happy for my family doctor and my ob..they always treat me like in the family and not a I am telling you my story as it is..Listen to your body and don’t go with what one ob says..

    Also talk to your family doctor,they know you the longest and they sure can give you advices like my..My husband and I are trying for number 5 🙂 and I might be pregnant as I speak ..

    Wish all of you the best..and remember,is your body and your mind! get advices from the ones that know you best! and talk to few ob’s before you make your final..tell your family doctor how your last ob made you feel and such and I am sure he will refer the best for your knowledge..that is what happen to us and can’t be any happier ..

  14. I just want to go through vba3c

  15. hey how many allow to having baby a cesarean section if ok that my 1st baby is now 7mons now im pregnant now is now dangers es of may health. pls reply

  16. Hi,
    How safe it is to have baby after hysterotomy , tranverse incision and how many baby can i have after that


    I’m not sure; best to check with your doctor. It depends on where the incision was (low transverse or higher?), what kind of stitching the incision was closed with, and other things in your personal medical history. Many women go on to have no problems even with 6+ Cesarean surgeries, but the risk of problems to you or the baby increase with every one. Just the other day, I read a story of a woman who nearly died from blood loss following her 4th C-section. There are no guarantees either way.

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