Mode of delivery after two cesarean sections

The method of delivery following two cesarean sections is always a cesarean section. Of late, there have been divergent opinions that, in carefully selected cases, a trial of vaginal delivery can be attempted. In fact, this has been successful in a substantial number of cases. This is, however, unlikely to take a foothold in standard obstetric practice because, understandably; most women with such a history do not appear keen on the idea.

Interval after a cesarean section before trying for another baby

There is no evidence that, following a cesarean, any time is too soon to conceive. However, if a woman happens to conceive within three months of having a cesarean section, the chances are that she will end up with another cesarean delivery. This is because many obstetricians are anxious about the strength of the scar after such an abnormally short interval. This is doubly so if there had been post-operative complications, such as infection of the womb (endometritis).

Cases of such rapid conception following cesarean section are not unknown but they remain uncommon.

How many cesarean sections?

There is a myth among many people that anything beyond three cesarean sections is life-threatening! This is patently false.

What is true is that each subsequent cesarean section makes the next one potentially more difficult. There may be so much scar tissue and distortion of the normal anatomy that chances of injury to other structures, especially the bladder, ureters and bowel, are increased substantially.

There is also the issue of increasing risk of the placenta abnormally adhering to the old scar. This potential complication, known as placenta accreta, may be so serious as to lead to severe uncontrollable haemorrhage sometimes requiring an emergency hysterectomy.

Every individual's circumstances are different and the obstetrician will give advice regarding future fertility on the basis of those unique individual circumstances.

What is common to all such mothers is that the potential for serious complications increases with each subsequent cesarean; it is the extent that differs from person to person.

Next section: Forceps and Ventouse delivery