A cesarean section, or c-section, is the surgical removal of a baby through the mother's abdomen. C-sections are generally considered safe but they are associated with risks and those risks continue to increase with each c-section. In addition to the typical risks related to surgery such as infection and bleeding, cesarean deliveries are associated with potentially serious complications.
Surgical adhesions are bands of scar tissue that develop on organs as a result of handling during surgery. According to information from the Harvard Medical School, adhesions are common in people who have had multiple abdominal surgeries. Every time another c-section is performed, more adhesions are created. After three or more c-sections there could be so many adhesions that it would take 10 to 60 minutes for a surgeon to cut through them. Adhesions cause abdominal pain and may cause organs to stick to one another or to the abdominal wall. In rare cases they result in infertility. If they form near intestines they can cause a bowel obstruction. In about 10 percent of small-bowel obstructions, the bowel has twisted around a band of adhesions.
Placenta Accreta and Placenta Previa
The risks for placenta previa and placenta accreta increase with repeated c-sections. Placenta previa is a condition in which the placenta partially or totally covers the cervix. Placenta accreta results when the placenta grows too deeply into the uterus, making it difficult for the uterus to detach normally. Both conditions can result in bleeding that puts the baby's or mother's life at risk. Over 60 percent of cases of placenta accreta occur in women who had multiple cesarean deliveries. In the June 2006 issue of Obstetrics and Gynecology, Silver, Landon et al. reported that the risk of placenta accreta was 0.24 percent in women having a first c-section, 0.31 and 0.57 percent for second and third c-sections respectively, and increasing to 2.13 percent for a fourth c-section. Women who have placenta previa and undergo a c-section have an even larger risk for placenta accreta—11 percent for the second, 40 percent for a third and 61 percent risk for a fourth c-section.
The chances of needing an emergency hysterectomy go up with the number of c-sections. While the risk of a hysterectomy is only 0.42 percent during a second c-section, it jumps to 2.41 percent after the fourth c-section and to 8.99 percent after a sixth, according to the study by Silver, Landon, et al.
Increased Bleeding and Difficult Delivery
In the July 2006 issue of Obstetrics and Gynecology, as study by Nisenblat, Barak et al compared women who had two c-sections with those having three. Excessive blood loss occurred in 3.3 percent of women with two c-sections but went up to 7.9 percent with a third cesarean delivery. Difficult delivery went from 0.2 percent to 5.1 percent. They found that any major complication, including placenta previa and placenta accreta, occurred in 4.3 percent of those having a second c-section and rose to 8.7 percent for a third.
Risks to Baby
Research by Beena Kamath, M.D. at the University of Colorado School of Medicine found that babies delivered by repeat c-section are nearly twice as likely to be admitted to the neonatal intensive care unit and have an increased chance of breathing problems that require oxygen.