Caesarean section (C-section) has been a life-saving surgery for many mothers and infants. However, the rising trend of multiple C-sections has raised concerns about its impact on subsequent deliveries.

Women who have had more than one previous C-section are faced with limited options for childbirth, with the risk of complications and the need for repeat C-sections increasing with each subsequent surgery. Here, we examine the reasons why multiple C-sections can hinder attempts at vaginal birth.

C-section on Demand

In recent years, elective C-sections have become increasingly popular, with some women opting for the convenience of scheduling a delivery rather than going through the process of labor.

However, without a medical indication, a C-section can have serious implications on the woman’s future reproductive health. The scar from a previous C-section can weaken the uterus and increase the risk of rupture during subsequent deliveries. This risk increases with each surgery, making vaginal birth after one or more C-sections a risky proposition.

Uterine Rupture

Uterine rupture is a rare but serious complication of vaginal birth after C-section (VBAC) that can occur when the scar from a previous C-section opens up during labor.

The risk of uterine rupture is 0.5%-1% in women attempting VBAC after one previous C-section and increases to 2%-3% after two or more previous C-sections. Uterine rupture can result in severe bleeding, fetal distress, and even death of the mother and baby.

Placenta Accreta

Placenta accreta is another potential complication of multiple C-sections that can make vaginal birth more challenging. Placenta accreta occurs when the placenta grows too deeply into the uterine wall, making it difficult to remove after delivery.

Women who have had multiple C-sections are at a higher risk of placenta accreta as each surgery can further weaken the uterine wall. Placenta accreta can lead to hemorrhage, organ damage, and the need for a hysterectomy, making it a significant concern for women attempting VBAC.

Adhesions and Scar Tissue

Each C-section surgery can leave behind scar tissue and adhesions, which can make subsequent surgeries more difficult and increase the risk of complications.

Scar tissue can make it harder to access the uterus, leading to extended surgery times and increased blood loss. Adhesions, which are bands of scar tissue that stick to nearby organs, can also cause pain and interfere with bowel and bladder function. These complications can make a repeat C-section more risky for the woman and the baby.

Maternal Age

Maternal age can also play a role in the success of VBAC after multiple C-sections.

Women who have had multiple C-sections are more likely to be older, which can increase the risk of other pregnancy complications such as gestational diabetes, high blood pressure, and preterm labor. These conditions can further complicate attempts at VBAC and increase the likelihood of a repeat C-section.

Fetal Presentation

The position of the baby in the uterus, known as the fetal presentation, can also influence the success of VBAC. If the baby is in a breech position or is too large to fit through the birth canal, a repeat C-section may be necessary.

The likelihood of these scenarios increases with each previous C-section, further limiting the options for vaginal delivery.

Medical Indications for C-section

There are also medical indications that may make a C-section necessary, regardless of the number of previous surgeries.

These include issues with the placenta, such as placenta previa or a low-lying placenta, as well as problems with the baby such as a large head or a non-reassuring fetal heart rate. These indications should be carefully considered by the woman and her healthcare provider to determine the best mode of delivery.

VBAC Success Rates

Despite the challenges of VBAC after multiple C-sections, many women are successful in their attempts at vaginal delivery.

The success rates for VBAC after one previous C-section range from 60%-80%, while the success rates after two or more previous C-sections drop to around 40%. Factors that can influence the success of VBAC include maternal age, previous vaginal deliveries, and the reason for the previous C-section.

Conclusion

Multiple C-sections can significantly hinder attempts at vaginal birth due to the increased risk of uterine rupture, placenta accreta, adhesions, and other complications.

Women who have had multiple C-sections should carefully weigh their options with their healthcare provider to determine the safest mode of delivery for them and their baby. Ultimately, the decision should be based on a combination of medical indications, personal preferences, and a thorough understanding of the risks and benefits of each option.