Has anyone had 4 (or more) caesareans? Are the risks any more than 3?

[Melody3boys]

I'm not even TTC (yet!) but need some advice before we do start.
I've had 3 sections, emergency then two electives. A lot of scar pain late in last pregnancy which was only 14 months ago.
Would I be taking too many risks to go again?

No personal experience but I know of a woman who has had eight children (!!) - all c-sections. She is only a casual acquaintance so can't ask her about details but I heard that doctors warned her after child number 8 that she would be seriously risking her life if she got pregnant again. Hope someone else comes along soon who can give you advice.

Surely you are best asking a medical professional? I don't mean to sound snippy but we don't know what sort of CS you had, how well you healed inside and out, chances of your particular scars rupturing etc.

I know nothing about this subject. However, if you were getting scar pain last pregnancy maybe you should give your body a bit of time to recoverr before you get pregnant again?

You're right and I have been to GP who's referred me to see consultant - still waiting to hear back from hospital just getting impatient!

You're all more sensible than me. I'm letting baby desire take over my common sense!

I'm 37 so if I do have another one I want it to be soon and my others are 7,5 and 1 so I'd also like #4 sooner rather than later so DS 3 has a closer sibling.

Caution and common sense would say wait. Better to wait than struggle through a painful pregnancy or worse.

Thanks for replies.

I think it depends on a lot on the state of your body tbh. I know one person who was told that if they had a 3rd they'd be risking their life but another who has has 7 all quite close together...

Generally fit and healthy but I thought that before I fell preg with #3 and was then very uncomfortable and in pain. He was my biggest baby though.

Ho hum.

Never mind, I already have three lovely children. I need to concentrate on enjoying them. I'll keep you posted once I've seen consultant.

Yes, the risks increase with each cs, regardless of spacing. Specifically
: difficult surgery due to adhesions from previous cs (bleeding, injury to bladder/bowel). Surgery should only be done by most experienced Ob available.
: placenta praevia, where it implants over the cervix and risks major haemorrhage (the scar tissue seems to attract the placenta to the lower segment)
: placenta accreta, where it implants abnormally deeply and causes major problems at surgery

Whilst i have seen women have straightforward 4th and 5th cs, the risk of ending up in ITU is not inconsiderable compared to 1st or 2nd. i do worry about Victoria beckham!

Put like that, it's all a bit scary! But thanks for jnfo. I did ask after all!

My midwife had 4. She was my reassurance, although I'm hoping for vbac next.

I've had 4 sections - three elective but first one emergency. I've had 10 pregnancies including 2 second trimester losses & have a clotting disorder - so I have a pretty complex obstetric history. I had a large pph after my first section - which was put down to uterine atony after a long, hard labour & have haemorrhaged twice during ERPCs. I have to take aspirin & inject clexane (another anticoagulant) daily during pregnancy.

With my third and forth sections I had blood available for rapid transfusion if required and I was aware that they might be more complex & time consuming due to adhesions, which meant a greater risk of bladder injury. My greatest worry has been placental issues which can be catastrophic & become more likely with each section. My last section was done at 37 weeks (I had steroids because of potential respiratory problems in the baby). I have consultant only (didn't even see a midwife last time) care and never have more than two weeks between appointments (due to clotting as much as anything) ... so extremely medicalised.

BUT ... my three elective sections were utterly uncomplicated - tiny blood loss, very quick, few adhesions, no bladder damage, little pain, baby fine, uterus in very good condition, placentas posterior & well away from the scar each time. I was not advised against another pregnancy after my third. I've had excellent recoveries & last time consultant said there was no specific reason to suggest another pregnancy would not be successful (we're done though!). She described the last section as easier than she could ever have imagined so I guess I'm pretty lucky. I know a woman who ruptured during (thank goodness she was already in theatre) her forth section & was told quite explicitly that it would be a disaster to risk another pregnancy.

Hi plebas thanks for sharing your story. I'm sorry that you've had to cope with so much, especially the losses . I find your history encouraging though. If your womb has been in such good shape and your recoveries were so good in spite of all your complications, my fourth should be a breeze

Thanks poocatcherchampion ( great name!). I need a midwife like that. Hat off to you to try vbac next time. I haven't got the nerve.

I remember a friend of mine telling me she was pregnant with her fourth, and how worried she was because she had heard the risks were not great.

She did have a fourth CS and there were, as she put it, complications - sorry, I don't know what. But she and baby were Ok. She was sterilised during the op, as they told her it was too risky to have any more.

Not sure if this really helps, sorry.

I think a lot depends on your individual circumstances, as someone else said.

However, the NICE Guidelines and info discuss repeat csections - link here - www.nice.org.uk/newsroom/pressreleases/CaesareanSection.jsp

Interestingly, it says: "... the evidence shows that for women who have had up to and including four previous CS, the risk of fever, bladder injuries and surgical injuries is the same with a planned CS as it is with a planned vaginal delivery, and the risk of the uterus rupturing is rare."

It really isn't accurate or helpful to say 'the risks increase with each cs, regardless of spacing.'

Thanks so much EVERYONE for all the responses. It seems there is a lot of information out there that I need to tap into.
I love reading about your experiences and those of friends and aquaintances. Even those that aren't positive - they've helped me to get a realistic picture of what I might be up against.

And I received a letter from the hospital this morning inviting me to an appointment this coming Friday with one if the top consultants!!! Apparently they've had some cancellations (I guess with it being Christmas). So hopefully my previous surgical notes can be reviewed and I can discuss the options. If the consultant gives me any indication that the risks are too great for me then I'm going to forget about the whole idea and concentrate on enjoying the three boys I have got... And send DH off for the snip!

And if I get a green light I'll have a little bit of work to do to convince DH and if I do conceive I will ask to be sterilised at CSection #4.

Thanks again.
M x

Got green light from hospital. Though didn't see consultant, as I was hoping, just registrar. I grilled her though and made her show me in my file the details of the surgical notes... There was nothing to indicate any problems last time so, for me, 4th elcs is no more risky than (or, as risky as - depending on levels if optimism!) 3rd.

My sister has had 5. They've all been fine- she had some complications from infection after two of them but all fine and no scar rupture or anything serious.

I would love to hear how you got on- have you decided to go ahead with another baby. I am in totally the same predicament. I have three boys, 7,5 and 7 months but I would love one more. However I'm also 40 and have had these three sections so probably inadvisable. Out of interest was it easy to get the referral for the consultant, as I have been thinking of trying to see my op notes.

I'd like to know how you got on too. Having said I was going for vbac, dc2 is breech at 36 weeks so not likely. :-( so now its unlikely I would be allowed to go for vbac so I'm again interested in this issue...