Pregnancy Risk Factors: Multiple C-Sections

Are multiple C-sections safe?

As your pregnancy nears your due date, you’ll likely have a conversation with your doctor about your birth plan and discuss how the delivery is likely to happen. Some pregnant women or their babies have risk factors that may necessitate a cesarean section delivery, commonly known as a C-section.

A C-section is a surgical procedure that is used to deliver a baby when there is a high risk of complications from a vaginal delivery. The CDC reports that nearly one-third of babies born in the U.S. in 2020 were delivered by C-section.

While elective C-sections have become more prevalent in recent years, most C-sections occur either because labor fails to progress or because medical issues with the mother or baby put them at an increased risk with a vaginal birth.

Many times your doctor is aware of these risk factors in advance of your delivery date, so they can discuss and schedule the procedure with you well before you go into labor.

Depending on the situation, some women with certain risk factors may opt to attempt a vaginal delivery with the knowledge that a C-section may be required if their baby experiences distress during delivery or their labor stalls.

C-section risk factors

While many factors can necessitate a C-section delivery, pregnant women are more likely to undergo a C-section if they:

  • Are over the age of 35

  • Have a higher body mass index (BMI)

  • Are pregnant with multiple babies (2 or more babies in a single pregnancy)

When is a C-section necessary?

While we hear about potential risks associated with C-sections, they may be necessary under certain circumstances in order to save the life of the mother, baby or both. Depending on your situation, a C-section delivery may be a safer option for you and your baby than a vaginal birth.

Some of the most common reasons your doctor may need to perform a C-section include:

  • Prolonged or stalled labor, particularly if labor extends beyond 20 hours.

  • The baby is too large to pass through the birth canal.

  • The baby is abnormally positioned in the birth canal, such as breech presentation (bottom first), feet first, sideways, or shoulder first.

  • The baby shows signs of distress like oxygen deprivation or low heart rate during labor.

  • The baby has been diagnosed with a birth defect that could lead to complications in a vaginal birth.

  • History of previous C-sections, depending on a variety of factors.

  • Maternal health conditions, such as heart disease, diabetes or certain infections.

  • Problems with the placenta, such as placenta previa, placenta abruption or placenta accreta

  • You're pregnant with multiples (more than 1 baby)

  • A prolapsed umbilical cord, in which a loop of the umbilical cord slips through the cervix ahead of the baby.

Risks associated with C-section deliveries

A C-section, like any surgical procedure, comes with potential risks and a longer recovery period than a vaginal birth.

Some risks associated with C-sections deliveries include:

  • Excessive blood loss

  • Blood clots or a pulmonary embolism

  • Bladder or bowel injury

  • Adverse reactions to the anesthesia

  • Infection

  • Uterine rupture (tearing along the uterine scar)

Babies born by C-section are at a greater risk of developing breathing issues immediately after birth. Although rare, they’re also at risk of an accidental surgical injury, such as a nick to their skin.

Are multiple C-sections safe?

While many women have multiple C-sections throughout their lives that allow them to safely deliver healthy babies, there are potential risks associated with repeat C-sections. Your doctor can discuss these risks and help determine if a repeat C-section or a vaginal birth after cesarean (VBAC) is right for you and your baby.

Some of the complications that could arise from repeat C-sections include:

  • Problems with the placenta. Women who undergo repeat C-sections are at greater risk of placental problems in future pregnancies, including placenta accreta (where the placenta implants too deeply in the uterine wall) and placenta previa (where the placenta implants over the cervix, preventing a vaginal birth).

    The chance of abnormal placental placement increases after each C-section and puts the mother at an increased risk of excessive bleeding, uterine rupture and premature delivery.

  • Adhesions. Surgical complications from extensive scar tissue or adhesions can make the procedure more difficult and increase the risk of injury to the bladder and bowels and cause excessive bleeding. C-sections also put women at a greater risk of adhesions forming between abdominal tissues and other organs.

  • Hernias. A hernia can occur if part of the intestines protrudes through a weakened area in the abdominal wall (from a previous C-section) and creates a bulge. The risk of a hernia increases with the number of abdominal incisions and surgical repair might be needed.

  • Prolonged surgery. Additional time may be needed in surgery because of scar tissue that developed from previous C-sections.

Can I have a vaginal birth after a C-section delivery?

If you have any concerns about a potential repeat C-section, make sure you talk to your doctor. They will explain the procedure and discuss any potential complications and risks to you and your baby associated with a repeat C-section.

Additionally, it’s important to understand that just because you’ve had a previous C-section, it doesn’t necessarily mean you can’t have a vaginal birth in subsequent pregnancies. In fact, many women go on to successfully have a vaginal birth after cesarean (VBAC), so talk to your doctor if you want to find out if this is an option for you.

If you’re pregnant and have concerns about having a repeat C-section, contact the experienced physicians at All About Women Obstetrics & Gynecology. Our compassionate OB-GYNs have been helping mothers in Gainesville and Lake City bring healthy babies into the world for more than 20 years. Our patient-centered practice is focused on providing you and your baby with the best prenatal care to suit your unique needs. Contact us today to schedule your appointment.