Multiple section risks

[AndFanjoWasHisNameO]

I booked in yesterday and discussed delivery which the ob and I agreed would be ELCS (my 3rd) however he was extremely put out that I won't agree to tubal ligation at the time of delivery. He impressed the many risks which I agreed I was aware of but wasn't ready to close that door just yet. He got more exasperated and basically said that if I attempted a 4th/5th baby then it would be a disaster and both I and the baby would probably die. now I'm a surgical nurse so know the contraindications of repeated surgery, but surely there must be some of you out there who aren't dead following multiple sections?!? Victoria Beckham for one, and I'm far more robust fat than her.... Thanks if you got this far :-)

[BartletForTeamGB]

Of course there are (Samantha Cameron is another one) but it comes down to the state of your uterus now. If you are a nurse, then you know we all scar differently. Did he go over the operation notes from your last section with you? Is he concerned because your uterus is now very thin and so you'd be higher risk of rupture? I don't know much about it myself, but I have a friend who has decided not to have any more because her uterus just wouldn't tolerate it.

[AndFanjoWasHisNameO]

Yes-both ops were wholly uneventful, no probs with healing, op notes boring, no other associated health risks maybe he's just nicely over cautious. I just felt rather railroaded tbh. Hormones eh...

[mayhew]

The main risks that are associated with repeat cs are placenta praevia and accreta. I expect he mentioned this. As a midwife, I have looked after women who have had 4 and 5 sections but with each one, the risks do accrue. I have had clients who have had a very stormy time from complications associated with multiple sections. I won't tell you any frightening stories but there is some scary territory here.

Placenta praevia is where the placenta positions itself over the cervix. This is more common after cs. It seems the placenta is attracted to the old scar. It creates a situation where massive haemorrhage can occur if the cervix relaxes and makes for tricky surgery because it is positioned where the lower segment incision needs to be made. It is common to need a blood transfusion after a section in this situation.

Placenta Accreta used to be very rare but is becoming more common, as more women have cs, and is very serious. Its where the placenta embeds itself into the old scar so that it doesn't come away at delivery. It can grow right through the uterus into surrounding tissues, causing them to also be at risk. It is not unusual to end up with a hysterectomy from this.

I'm sure you are aware of the problems of adhesions from repeated surgery. Because of the location of surgery, they can interfere with you bladder and bowel function.

I hope this is helpful and not feeling like shroud waving.

[chipmonkey]

Oh God, maybe I shouldn't post this.....

I had 4 CS's and decided to go for a fifth because the pregnancy with ds4 had been fine and uncomplicated.

I had placenta accreta with dd. I started to bleed at 28 weeks, was admitted to hospital, started to gush with blood and was rushed in for a crash section with barely enough time to be prepped.

Woke up, dd in NICU and was told I'd had a hysterectomy.
dd seemed fine, in fact seemed bright as a button but then died of SIDS 7 weeks later, four days after we took her home. Prem babies are more at risk of SIDS than other babies.

Having said that, the chances of that happening were low, just higher than for most mothers and babies. But when you're the bereaved mother, statistics don't mean a whole lot. I am glad I had dd, glad I had her for a little while. But the pain of losing her is not something I'd wish on anyone.

[AndFanjoWasHisNameO]

Thank you Mayhew, hadn't really heard a great deal about Placenta Accretia, will do a bit of research. Chip I am truly sorry for your loss you went through so much and then to lose her after all that. (unmums etty hug)

[mayhew]

Chipmonkey, I'm so sorry to hear your story. How awful. But yours was the sort of outcome I was thinking of.

I'll never forget a mum with placenta accreta who wrote her will going into theatre. She was in ITU for 2 weeks afterwards and had a very slow recovery.Her baby was ok.

[MotherOfNations]

I've had 4cs's. 3 in 3 years then a break of 6 years. I was offered sterilisation with my last almost 4 years ago but the doctor told me there were no limits to the amount of cs's I could have. I am currently considering having a 5th child and spoke to my GP who said that there was no reason not to go ahead and have another child but that I would have to be monitored closely. I really don't know what to do now after reading these stories.

[BikeRunSki]

I had a uterine rupture in my second labour, after emcs in previous pregnancy. DD's heart stopped, crash section under GA very quickly; she's fine. OBGYN recommended no more cs (therefore no more pg by my track record). I'm going with his expert opinion, but that is also fine by me.

[airforceone]

chipmonkey, I just wanted to say how devastated I feel for you having read your post. I'm so sorry for your loss.

[Shagmundfreud]

A friend had placenta percreta in third pregnancy following 2 c/s. she was in hospital for weeks, baby was ok, but friend was very, very I'll. Needed surgery on her bowel. Hysterectomy. She feels lucky to be alive.

[elizaregina]

A friend of mine also had placenta pravia - heomrage - rushed in for c section and nealry lost her life - but it was her first baby and she had no previous sections.

[chipmonkey]

You can have placenta praevia without having had previous sections but the risk of praevia and accreta increase with each section.