What are the big risks involved in 4th c-section?

[KTNoo]

Had 3 c-sections already, 2 emergencies, 1 elective.

Thinking about going for number 4 but really don't want to be stupid about it. Lots of people tell me there are more risks after 3 c-sections, but anyone know more about this?

No complications with any c-sections so far, btw.

This mainly relates to how much addtional scar tissue has formed after your last CS. At the time of the operation the risks are the same as for the previous CS's:
Increased bleeding (therefore risk of blood transfusions/occ. additional surgery or even hysterectomy in rare life-threatening cases)
Damage to bladder or bowel (which may have got stuck to the previous scar tissue (either as the surgeon enters the tummy or bladder/bowel tissue sticking to the uterine scar)
Wound and urine infections
Thrombosis and problems with blood clots forming in the legs or lungs post-op (DVT/PE)
With previous CS sections there is more of a risk that the lacenta my implant into the uterine scar a condition called Placenta Accreta (this is normally excluded by checking that the placenta is not lying at the front of the uterus near the cervix on a scan during the middle / latter stages of the pregnancy)

If there was not a great deal of scar tissue at the last CS then hopeflly it should not be any more difficult a procedure than last time!

I don't think there is any thing "magic" about 3 or 4, but there is an increasing risk of complications with every c/s, which will obviously vary from person to person.

This may be helpful.

It might be worth seeing of you can get an appt with the consultant who cared for you in your last pregnancy, so you can discuss if there are any increased risks in your particular case.

This was taken from the latest ICAN statistics

Risks associated with a 3rd CS:

Risk of hysterectomy: 0.9%(1 in 111)
Risk of blood transfusion: 2.26% (1 in 44) Risk of placenta accreta: 0.57% (1 in 175)Risk of major complications: 7.5% (1 in 13) Risk of dense adhesions: 32.2% (1 in 3)

You can then compare these figures with risks associated with a 4th CS:

Risk of hysterectomy: 2.41% (1 in 41)
Risk of blood transfusion: 3.65% (1 in 27)
Risk of placenta accreta: 2.13% (1 in 47)
Risk of major complications: 12.5% (1 in 8)
Risk of dense adhesions: 42.2% (2 in 5)

I remember being in the same position as you before getting pregnant with my 4th baby - when I did some research into it all I decided that a VBA3C was less risky than a 4th CS. It's a personal choice and I think you're being very sensible by looking into it before you make your choices. Good luck, whatever you decide.

Thanks everyone, that's very helpful.

nina, is there a way you can tell if you have a "dangerous" amount of scar tissue, do you know? I wouldn't have a clue how much I have but externally it looks ok!

vbacqueen, those stats are very interesting. Well done for on VBA3C by the way! Incredibly impressed. Did it depend on the reason for your previous c-sections, if you don't mind my asking? My 2 emergencies were because I did not dilate beyond 3-4cm after 36 hours labour, and baby was distressed. Because we had exactly the same scenario twice it was suspected my pelvis is too small for the baby's head (carried them very high), in which case same would probably happen again so I should go for elective section the third time, which I did. Presumably same would happen 4th time.

BetsyBoop I could try to contact the consultant from dc3 but we live in different country now! Going for record of how many countries I can have c-section in then I can write the guide....

My first baby was induced at 35 weeks for pre-eclampsia. I never dilated past 4cms, foetal distress, usual story, whisked off to theatre. I was talked into having an elective with my 2nd and my 3rd baby was breech (besides which, it would never have crossed my mind to look into VBAC at that point.....)
I went into labour naturally with my VBAC baby and stalled for hours at 4cms with her head very high. If I hadn't insisted on no interventions as long as baby and I were ok, I'd have definitely had a 4th CS. After around 20 hours of labour, and still being at 4cms, I got into a bath, had a bit of gas and air, and within 2 hours, my 9lbs 10oz baby was born. I'm 5' 2".
I know that CPD does occasionally exist but generally I think that when women are told their pelvises are too small, it's often a load of old bollocks (if you'll pardon the language)- babies are squashy by design and for a very good reason. I'm obviously not saying ignore medical advice if baby becomes distressed, but the more I learn, the more I believe that given time and patience, most women could probably birth their babies vaginally. Can I ask if you were induced or had your labour augmented with a drip? In some women a little artifical help can work miracles in speeding things up but in others their stories are very similar to yours....

What I'm trying to say in my long-winded way is that VBA3C is a valid option - you'd need to be very strong-minded to get what you want, but it IS an option.

You can have a scan of your scar late in pregnancy to establish what shape it's in - I had one because I had problems in my second pregnancy with my scar from the first CS. It showed some major adhesions - which it's worth knowing about before you get to the op theatre and the surgeon has to extend the surgery by an hour to do a mass repair job

sorry to hijack OP xxx
vbacqueen i have also had 3 c sections and i am pregnant again (28 weeks) i deliver early for no apparant reason just go into labour early so my babies so far have all been 5 pound and under...but saying that at only 5ft myself im not the biggest mummy in the world either...do you think they would allow me to have vba3c's ?? xxx thanks

duh just realised this thread is 27th feb 2009 lol sorry hehe