Baby Care

Women who previously had Cesarean sections can worry that the scar will not be strong enough to support subsequent pregnancies.

The wound in the uterus is almost fully healed three months after delivery, which is why women are told to wait a while before attempting to drive or to lift heavy objects which could put a strain on the uterine scar.

Evidence shows that the uterine scar gets stronger and stronger over time, and that the risk of the scar separating remains small even with a small interval between pregnancies. Gaps of less then six months still have a small but higher risk.

Doctors still advocate women not getting pregnant for at least a year after having Cesarean, so the body has time to heal and the women are emotionally ready for another baby.

There are more complex issues to consider such as your age, how easily you conceived the first time and how ready you feel to go through it all again.

Plenty of women go on to have perfectly normal pregnancies and deliveries even when the gap between pregnancies is short, but bear in mind that pregnancy and birth take their toll on your body, so it’s probably best to leave it for at least six months before trying again.

At least two studies have pointed to the incidence of potential risks if you get pregnant within six months of having a Cesarean. These include a higher risk of your baby being premature and also a slightly higher risk of uterine rupture.

Will I have to have another Cesarean?
In the past women have been told ‘once a Cesarean, always a Cesarean’. This is because of the risk of uterine rupture from the strain of labour contractions on your scar. But this view is changing all the time. Some doctors feel it is safer for women to attempt a VBAC (vaginal delivery after Cesarean, pronounced vee-back) because of the strain on the scar tissue that any repeat Cesareans may have. Seventy per cent of mothers who attempt labour after a Cesarean have successful VBACs.

The general rule is, if the same reasons you had the first Cesarean exist with your second pregnancy, for instance if your baby is breech, you have twins or multiples, you have a very large baby or you fall into a high-risk category, you will probably have a Cesarean again. If you have a straightforward pregnancy there is no reason why you shouldn’t attempt a VBAC.

With all this in mind, the gap that you decide to have between your last pregnancy and the next one is up to you. Some women they will find themselves pregnant again soon after having their first baby, and it’s worth remembering that the risks mentioned above are very small. Even in the case of uterine rupture, the risk is still small and there are steps to take such as avoiding induction when attempting a VBAC. It is more important that you feel ready for a second baby when planning one. Many women who got pregnant relatively soon after a Cesarean found that they had straightforward pregnancies and labour and birth.

How many Cesareans can I have?
There is no set limit for the number of Cesareans a women could or should have. A first Cesarean is fairly straightforward, but subsequent Cesareans can be more complicated and you will need to discuss your individual concerns with your midwife and consultant. Damage to the bladder and bowel during subsequent Cesareans can be an issue, as is the increased risk of infection with a Cesarean. You will be advised by the medical team who assess your pregnancy about a repeat Cesarean but ultimately it is up to you.

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