Fourth c-section-what and who should I ask?

[MrsBobDylan]

I have had 3 cs and would like to TTC a fourth dc.

I want to make an informed decision - I asked a gynaecologist I saw about another issue and she said I was fine to go ahead, but although I think she had my notes in front of her, I am not 100% sure and wished I'd paid more attention!

Do I ask my GP if he could write to the hospital to see what my notes say about the last cs?

Each of my cs have been fairly uneventful and no mention was made of scaring, adhesions or thin womb.

I recently miscarried at 10 weeks and I spent most of that short pregnancy utterly terrified that I should have looked more carefully into my risks and that something terrible was going to happen. I don't want to feel that way again if I am fortunate enough to conceive.

Any guidance gratefully received!

You could ask your GP. There may be notes if you had a lot of scar tissue from a previous section.
I had 4, didn't ask for advice.
I had plenty of negative comments from people, like "you're not allowed a fourth", but none from midwives or consultants or anything, who were very non-plussed about it and we're very reassuring.
As far as I was told, the actual risk for the third and fourth cs is no different, but it's that you're going through it again (it was explained so much better to me by the Dr who performed the cs, but it was nearly 6 years ago now and I can't remember exactly what he said).

Thanks cloud. I don't remember anyone saying I shouldn't have another or that I had any increased risk factors. I think I know what you mean about the risk not increasing, its more that any cs brings with it risks.

When I asked my GP and the other gynaecologist I saw when I was pregnant, I thought they were quite negative but that could be because I felt that way and my fear meant that what I was looking for was out and out reassurance and nothing else.

I've had 2 c sections, and during the last one, the surgeon actually said to DH and I that I had so much scar tissue from the 1st and it took quite a long time to get to my uterus, that he didn't recommend that I had any further pregnancies. This was also sent to my GP, who mentioned it during my 6 week check up. I would imagine that if they had seen anything they didn't like the look of during your last section, they would have made a note of it at the time?

The risks increase the more caesareans you have.
These risks include bleeding and emergency hysterectomy (most commonly due to a rare condition called placenta accreta where the placenta grows too deeply into the wall of the womb) as well as damage to bowel and bladder during surgery (can usually be repaired if seen straight away).
The chances of these things happening in a first CS are less than 1 in 200. If you have 5 CS, it's about 1 in 20.
That's not to say you should not have another child. I'm a consultant obstetrician and at our hospital, I see several women a week who are having 4/5/6th CS. It's risky and we counsel them carefully before the op (mainly so we don't get sued!) but nobody would be mean to you!
We routinely offer sterilisation for women having their third or higher CS. There's no pressure but it's an option.

The main thing is that you understand that it is higher risk and that you decide you definitely won't regret it, even if a complication happened that led to permanent problems. If you (and DH) still feel the same, go ahead :)

Listen to Nan0, OP. She clearly knows what she's talking about. One friend of mine had four sections and recovered well from all of them. Another had placenta accreta when she fell pg after three sections, and she nearly died. It was very risky for the baby too.