4th section advice needed

[Iwonderif]

I posted this elsewhere but feel on here it may get a reply. I've had 3 sections. My first by emergency and sadly our son passed away minutes old, this was in 2006. DD arrived 13 months later by elective and youngest will be 5 in June, also born via section. I had a gynae appt this morning and asked registrar about 4th section. He was extremely nice and very honest and gave me lots to think of. Just wondering if any mammas on here have had 4 sections. Many thanks in advance. Xx

Hi iwonder,

I'm very sorry to hear about your son. I, too, lost my first daughter in 2006. She would have been 9 last week.

I've subsequently given birth to 4 dcs - another at the end of 2006, 2008, 2010 and 2012. All these were sections. My understanding is that your 'suitability' for another section should be based on what the surgeon 'saw' during your last section. How thick or thin your uterus wall is, scar tissue and stuff like that. I could still have another section, although for some, the fourth would be too much. Did your gynae say it all seemed ok?

I found my fourth a lot harder to recover from, but I discharged myself early because the kids were in such a bad way at home. The oldest at the time was 5 yrs and 2 months - it was crazy days. Over each section, I had noticed I had a little reaction to the post-section drugs. In my case, the volteril (sp-I think it is the anti-inflammatory). On the 4th section I also had a wound infection, was also on co-condo mol and, frankly, they just kept swapping drugs and I got sicker with vomiting and diarrhoea. I was eventually admitted at 10 days post section for dehydration.

I did overdo it early on, but I'd had such wonderful recoveries the first three times, i thought id be fine. This time around, though, I have more of a overhang urgh! The wound wouldn't stay dry and it caused and infection and a very slow heal. Two 'smallish' things combined for a hellish recovery. But seeing as though we have both left a hospital with empty arms, I'm sure you'll understand that this didn't feel like it was the worst thing that could happen, and I kept it all in perspective (hope I'm making sense, it was a shit recovery but my baby was safe and happy - I just felt sick for a while, but it was partially just taking on too much too soon). My sections were close together at 19,20 and 22 months and given that your youngest is 5, it does seem like you wouldn't exert yourself too much too soon. How do you feel about it?

Sorry that was so long!

Thank you imip for a lengthy reply. Much much appreciated. Sorry too for your loss, yes the empty arms over recovering from a section I can see what you were explaining & sorry you suffered so much and it was all very yucky. I must add I'm not currently pregnant and we are not ttc but I feel I needed to be armed with knowledge should the time come later this year. I saw gynae today about another issue but unfortunately it wasn't the consultant who looked after me during my 2nd and 3rd pregnancies. I've got scarring from a laparoscopy 1 years ago (this was what the appt today was regarding...tedious tale!) so whilst I was there I thought I would ask about carrying another baby and 4th section (being as he's an expert) we had a look at laparoscopy photos and the scarring and adhesions were minimal from what he could see and in my latest pg notes there was no mention of what my internal scarring was like....I could always contact the consultant who brought my DD & DS into the world and ask him...you've given me food for thought. Thank you. Really appreciate the time you took to reply. ??

Hi Iwon, I am sorry to hear of your loss. I have had 4 sections. I was 31 when I had my first section and 39 when I got my last.

I recovered really well from all of them. Though found the fourth harder to recover from. I was lucky, no infections from any. I don't know about outer and internal scarring and certainly my consultant diddn't know anything. I have had the babies in 3 different hospitals so never ever had the same consultant.

During my pregnancy with my fourth child I had scarring across my womb (bottom of my womb) but there was a chance the developing baby could have limbs amputated by the scarring, as apparntly the scarring is as sharp as a sword. I was told the chances were very remote, and got an extra scan later on in pregnancy. This scarring was due to previous sections.

Also whilst in theatre, after the baby was out but whilst being stitched I had terrible nausea. I have never had that before. The nausea lasted for about 8 hours after, I was given medication to try to combat the nausea. I got sterilised before I was stitched back up so this could have been reason for harder recovery and nausea (I have no idea)

Also fourth baby came out seemingly healthy. After 2 feeds (so less than an hour old) was taken to special care baby unit as an infection was suspected. He was fine and I got him back the next day. Apparently this is quite common in c section babies!

I would say that the first 2 sections I was pretty much recovered after 2 weeks. Third section recovered same amount of time but felt the first few days worse than previous 2 sections. 4th section I found the first few days after the hardest. Took about 3 weeks to feel I could do thing again without too much strain.

I had some help for first 10 days or so post birth but pretty much nothing after that and I managed. After fourth section my kids were 7,4 and 2.2.

Oh before children I had two laperoscopies.

I haven't had any health issues so far from all the sections. Hoping that will always be the case! I do have a terrible overhang but think that might be more to do with all the cakes I eat.

It is such a hard decision and a real leap of faith. I have had 3 sections, all of them went well with few complications - quite severe blood loss with second, requiring a transfusion, but other than that all has been fine and the third was the easiest. We agonised over all the statistics and ultimately decided to ttc a 4th last year - sadly I miscarried and we haven't tried again. I still think about it a lot - it was such a leap of faith to try for a 4th and then it didn't go to plan, the gap is widening and widening (dcs 1-3 very close in age) - but something is stopping me. It is HARD. So, whilst I can't offer a great deal of advice, I do sympathise enormously.

Thank you to each of you for posting. So many different experiences but all feel quite positive. That's good to read. Much appreciated. Xxx

I had 4 sections between 2000 & 2011.

The first was an emergency & medically the most complex - I had a large pph & was in a pretty poor condition & I had a wound infection.

#2 was elective and so easy - perfect recovery no pain etc - they corrected some of the damage (adhesions) done in the first section.

#3 was okay had more pain than #2 - mostly after pains - but the recovery was fine.

#4 was at 37 weeks & I had steroids beforehand which made me feel ill. The section was fine but I had a lot of post surgical pain, mainly my fault because I asked the anaesthetist to use less diamorphine in the spinal because it made me itch so badly. Had a lot of tramadol but the pain definitely slowed my recovery.

The electives were all very straight forward - my uterus was still in good condition after #4 though we didn't want another child - the emergency section was 20x worse than any of the others.

Having had two sections (2nd consultant was called due to scar tissue) is there any source of advice on risks of multiple sections or has anyone spoken to a consultant before getting pregnant again etc? We were told after 2nd section that any further babies would be delivered by elective section no later than 38 weeks to ensure that they had sufficient time to operate safely (both DSs arrived early). DH is concerned that further sections would be high risk for me (I.e. Damage to bladder etc), so was hoping someone might be able to advise.

I believe that they tell you at the time of your last section if they don't recommend you have any more. I've had 3 and would have had a 4th (had a miscarriage last year and didn't ttc again) - the second (elective) was the worst for me, as the registrar wasn't that experienced and struggled to get through scar tissue and then to get dd out (consultant was called in the end and I had a big pph from the bigger incision he made). The third was the easiest by far, after a crash section with dc1 and the drama described above with dc2 it was lovely.

I did a lot of reading before ttc a 4th and the biggest risks with multiple sections are placenta previa (which is a risk factor for placental abruption), placenta accreta and uterine rupture - the risk jumps up a bit at a 4th section, but remains relatively low for the 3rd. After 4 it is quite a steep jump. I felt happy enough to go for a 4th, although obviously it was a huge consideration - I didn't even think about it when ttc dc3!

I wouldn't worry, I've had six and having a 7th in July. My number 4 went better than number 3

I had a haematoma with my fourth which left a messy scar and was v painful.
It also took much longer than my third but I was sterilised at the same time so that was part of the reason why.

Am due a 4th section in August, my first was in 2008 then 2011, and last one was 2014. There was another surgeon in theatre but that was to do any scar tissue removal due to the previous sections, but all was fine and I had minimal scar tissue so she was not needed. I have had no problems with this pregnancy so far, my midwifes have no concerns either.

I think safely the recommendation is no more than 3 elscs. I have had 3 cs. One em cat one ga. It was horrific, two electives. One vaginal delivery first.
No my consultant didn't say at the time no more, but I know her as a friend too and she knows I only want 4dc.
In a recent conversation she did tell me that due to "tired" uterine arteries, fat necrosis and scar tissue plus adhesions she would go as far as suggesting a termination if I was pg again. Beyond three Cs the risks increase for many things.
I guess it's how badly do you want dc4 and how well can you cope with mc it still birth aph etc?