How Many C-Sections Is 'Too Many'?

Having a C-section is usually a decision that requires a lot of thought from health care providers and laboring people. But Cesarean sections are common—there are more than a million performed in the U.S. each year. They can be life-saving when medically necessary, but C-sections do have risks as all surgeries do. These risks can increase with repeat C-sections.

So how many C-sections can you have? The answer isn't clear-cut. There's really no set rule when it comes to the number of C-sections you can have. "I have performed a woman's sixth C-section with virtually no complications or difficulties, and I have performed second cesarean sections with many adhesions and potential complications," says Jason S. James, MD, an OB-GYN in Miami.

Everyone is different, so health care providers need to analyze each person's health, history, and concerns before deciding on the right path.

Should You Have Another C-Section?

Wondering how many C-sections you can have? Health care providers will consider several factors.

Your birthing history

After a C-section, some people will try having their next child vaginally. This is called vaginal birth after cesarean (VBAC). If you have a low-risk pregnancy, the procedure has a success rate of about 60-80%. However, most medical professionals don't recommend VBAC for those who've had two or more C-sections. That's because the risk of uterine rupture—a tearing in a past C-section scar or uterine muscles that can be life-threatening to the parent or baby—rises with each surgery and is more likely to occur after a VBAC.

Multiple C-sections risks

While there is no one magic number for how many C-sections you can have, experts agree that certain risks increase with repeat procedures. This might influence whether you can have another C-section. Risks might include:

• Uterine rupture
• Heavy bleeding that leads to blood transfusion
• Injury to the bladder or bowel
• Hysterectomy at the time of delivery (the risk continues to increase with each C-section)
• Abnormal implantation of the placenta, such as placenta accreta 
• Adhesions that develop with increasing thickness each time a new C-section is performed
• Hernia
• Diastasis recti (when the stomach muscles separate and the abdomen protrudes)
• Numbness and pain at the incision site
• Endometriosis in the incision

Your C-section recovery period

C-section recovery looks different for everyone. You might always recover at the same rate, or you might experience more difficult post-operational periods each time. Alternately, you could bounce back faster after each subsequent C-section, according to David Ghausi, DO, a board-certified OB-GYN at Los Robles Hospital in Thousand Oaks, California. Your health care provider will take your past recoveries into account when deciding whether you can have another C-section.

How Long Should You Wait To Get Pregnant After a C-Section?

To help prevent complications, Dr, Ghausi recommends waiting at least six months after a C-section before getting pregnant again. But many health care providers suggest waiting 18 to 24 months. In general, research has found adverse pregnancy outcomes were more likely when a person became pregnant again at six months compared to 18 months.

But note that Dr. Ghausi says he's has had patients get pregnant one, two, and three months after a C-section and be just fine. "There's no magical number," he says. By following your health care provider's advice, the chances of a healthy pregnancy will rise dramatically.