There is no definitive answer as to how many children a woman can have via cesarean section.
A cesarean section involves cutting open the abdominal wall and uterus to deliver the baby; it is an important surgical method of assisted delivery. According to experts, cesarean sections were originally limited to remedial surgeries for pathological factors affecting the mother and baby. For example, if the mother has a clear pelvic abnormality, pelvic stenosis, or serious internal or surgical conditions such as heart disease, placenta previa, or placental abruption, obstetricians would recommend a cesarean section. However, due to reasons such as fear of childbirth pain, choosing an auspicious time for delivery, and not wanting to affect the quality of their postpartum sex life, many healthy expectant mothers choose cesarean sections. It is understood that the cesarean section rate in many large hospitals in China is as high as 70%, while the cesarean section rate in major hospitals in Guangzhou is controlled at 40%-50%.
"I've seen people have had five cesarean sections, but that's extremely rare!" an expert told reporters. The maximum number of cesarean sections a woman can have varies from person to person, and there's no definitive answer yet. Several years ago, an expert in Guangzhou met a woman from another province who had successfully undergone four cesarean sections. During her fifth pregnancy, before delivery, her uterus ruptured spontaneously, causing severe bleeding. Her family rushed her to the hospital for emergency surgery, saving her life.
A second cesarean section typically requires an interval of 2 years.
For women who have already had a cesarean section, whether they can have another cesarean section during a subsequent pregnancy depends on their physical recovery.
Experts say that clinical evidence shows that women who undergo cesarean sections lose an average of over 300 ml of blood, more than twice the amount lost during vaginal delivery. Cesarean sections can lead to wound infection, amniotic fluid embolism during surgery, surgical complications, and uterine injury/removal. The risk of postpartum hemorrhage and accidental death is higher than with normal vaginal delivery. Postoperative recovery is slower, and complications such as venous congestion, chronic abdominal pain due to pelvic and abdominal tissue adhesions, pelvic inflammatory disease, and endometriosis are more likely to occur. A cesarean section should only be considered again after all complications from the previous cesarean section have resolved.
Furthermore, the ideal interval between two cesarean sections is approximately two years. "If you become pregnant again too soon, the scar may not be fully healed, increasing the risk of uterine rupture and endangering both mother and child. If the interval is too long, the uterine scar may have become fibrotic and brittle, making it more prone to tearing," the expert explained. Many women who cannot tolerate the pain of a cesarean section want a vaginal delivery when they become pregnant again, but this needs to be considered based on prenatal examinations, such as the size and position of the fetal head, and the progress of labor.
The more you dissect, the greater the risk.
"The uterine scar left after a cesarean section can pose many risks to future childbirths," experts explained. If a woman becomes pregnant again after a cesarean section, the placenta will expand and pull the uterus upwards as it occupies more space during the second trimester. If the placenta implants in the uterine scar, uterine rupture is highly likely.
Another scenario is that the gestational sac implants on the uterine scar from the start, which can easily lead to severe bleeding and is often misdiagnosed as a miscarriage. An obstetrician once treated a 22-year-old patient whose first pregnancy was via cesarean section. Less than three months into her second pregnancy, she experienced massive bleeding due to the gestational sac implanting on the uterine scar, losing six to seven thousand milliliters of blood. "The more cesarean sections a woman has, the more fragile her uterus becomes, and the greater the likelihood of premature birth or uterine rupture leading to intrauterine fetal death."
What precautions should be taken when trying to conceive again after a cesarean section?
1. In late pregnancy, it is important to prevent abdominal compression. To prevent the scar tissue from rupturing, it is essential to protect the abdomen from pressure. In daily life during late pregnancy, avoid crowded places when traveling by car or walking, do housework in moderation, sleep on your back or side, and practice moderation in sexual activity to avoid abdominal impact.
2. Seek medical attention promptly if abdominal pain occurs. Some women with scarred uteruses may experience spontaneous rupture in late pregnancy, with abdominal pain being the primary symptom. Due to poor healing of the uterine scar, as the pregnancy progresses, the intrauterine pressure increases, and the uterus can rupture through the scar tissue even without any apparent cause. Uterine rupture can cause abdominal pain of varying severity; sometimes, even mild pain may indicate uterine rupture, requiring immediate attention.
3. It is advisable to be hospitalized for delivery in advance. The closer to the due date, the greater the risk of rupture for women with scarred uteruses. To prevent uterine rupture or fetal death, it is recommended to be hospitalized two weeks in advance so that any problems can be addressed promptly.
4. A cesarean section is recommended for subsequent deliveries. For women who have had a first cesarean section and become pregnant again, 80% of the time a cesarean section will be performed for the second delivery, which is safer than vaginal delivery. The timing of the cesarean section should be chosen appropriately. Too early, and the fetus is less likely to survive; too late, and it may cause uterine rupture or stillbirth. The surgery can be performed as soon as the fetus is fully developed; it is not necessary to wait until labor begins.
5. Pay attention to fetal movement. Fetal movement is the irregular activity of the fetus in the uterus, and the speed of fetal movement is one of the early indications of the fetus's well-being. Generally, during pregnancy, there should be 3-5 fetal movements per hour or at least 10 movements per day (12 hours). After a cesarean section, even a minor rupture of the uterus with scarring, or placental abnormalities, can lead to fetal death. In this case, the fetal heartbeat disappears. 24-48 hours before fetal death, fetal movement will slow down or disappear. Therefore, paying attention to changes in fetal movement can help detect abnormalities in the fetus early, allowing for timely intervention.
6. Tubal ligation should be performed during a second cesarean section. A woman can only have two cesarean sections. To ensure the mother's health, tubal ligation should be performed during the second cesarean section to achieve sterilization.
(Editor: Ruan Wenling)
