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Are C-sections harder the second time?

Each repeat C-section is generally more complicated than the last. However, research hasn't established the exact number of repeat C-sections considered safe. Women who have multiple repeat cesarean deliveries are at increased risk of: Problems with the placenta.

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How many C-sections can women safely have? Answer From Yvonne Butler Tobah, M.D. Each repeat C-section is generally more complicated than the last. However, research hasn't established the exact number of repeat C-sections considered safe.

Women who have multiple repeat cesarean deliveries are at increased risk of:

Problems with the placenta. The more C-sections you've had, the greater is your risk of developing problems with the placenta — such as the placenta implanting too deeply into the uterine wall (placenta accreta) or the placenta partially or completely covering the opening of the cervix (placenta previa). Both conditions increase the risk of premature birth, excessive bleeding, and the need for blood transfusion and the surgical removal of the uterus (hysterectomy). The more C-sections you've had, the greater is your risk of developing problems with the placenta — such as the placenta implanting too deeply into the uterine wall (placenta accreta) or the placenta partially or completely covering the opening of the cervix (placenta previa). Both conditions increase the risk of premature birth, excessive bleeding, and the need for blood transfusion and the surgical removal of the uterus (hysterectomy). Complications related to adhesions. Bands of scar-like tissue (adhesions) develop during each C-section. Dense adhesions can make a C-section more difficult and increase the risk of a bladder or bowel injury and excessive bleeding. Bands of scar-like tissue (adhesions) develop during each C-section. Dense adhesions can make a C-section more difficult and increase the risk of a bladder or bowel injury and excessive bleeding. Incision-related complications. The risk of incision-related problems, such as a hernia, increases as the number of previous abdominal incisions grows. Surgical repair might be needed. The number of C-sections you've had can also affect your future delivery options. A trial of labor isn't recommended after three or more prior C-sections. Deciding how you will deliver your next baby after a previous C-section can be a complex decision. Talk to your health care provider. He or she can help you weigh the risks of a repeat C-section against your desire for future pregnancies.

With Yvonne Butler Tobah, M.D.

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How does placenta come out after C-section?

There are various methods of delivery of placenta at caesarean section. These include placental drainage with spontaneous delivery, cord traction and manual removal. The last two methods: cord traction (usually combined with massage or expression of the uterus) and manual removal are frequently used.

We included 15 studies (4694 women). There was significant heterogeneity for the duration of surgery, blood loss and haematological outcomes. The only possible contributing factor found was greater protection from blood loss in two trials in which cord traction was combined with uterine massage. A random-effects model meta-analysis was used for these outcomes. Manual removal of the placenta was associated with more endometritis (relative risk (RR) 1.64, 95% confidence interval (CI) 1.42 to 1.90; 4134 women, 13 trials); more blood loss (ml) (weighted mean difference (WMD) 94.42 ml, 95% CI 17.19 to 171.64; 2001 women, eight trials); more blood loss > 1000 ml (RR 1.81, 95% CI 1.44 to 2.28; 872 women, two trials); lower haematocrit after delivery (%) (WMD -1.55, 95% CI -3.09 to -0.01; 384 women, two trials); greater haematocrit fall after delivery (%) (WMD 0.39, 95% CI 0.00 to 0.78; 1777 women, five trials); longer duration of hospital stay (days) (WMD 0.39 days, 95% CI 0.17 to 0.61; 546 women, three trials).

The duration of surgery was shorter in one trial but not overall.

There were no significant differences in feto-maternal haemorrhage, blood transfusion, puerperal fever (numbers studied for these outcomes were small).

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