Should I Worry About Having a Third C-Section?

I have two children, and had C-sections with both (both breech). I want to have a third baby, but the surgeon noticed a considerable amount of scar tissue during my second C-section.

My OB shared a few concerns with a third pregnancy/delivery. She recommended a third C-section (even if not breech), so that way it could be planned, as it would likely be a more difficult procedure — potentially requiring a vertical incision. Ultimately, she didn’t seem thrilled about this but said she’d support whatever I decide.

I’ve always wanted a third child — I don’t mind the tougher procedure and recovery but also don’t want to put myself in a risky situation. I know C-sections progressively get more complicated, but is this beyond the norm? Potentially even dangerous for myself?

—Scar Tissued

So, I want to begin this response by noting that I am not a doctor, and this is a complicated enough situation that you certainly want to engage in joint decision-making. It sounds like you’ve talked to your doctor already about this, but I think a longer conversation is probably in order, specific to your situation.

What I can do here is give you a sense of the set of concerns that are worth discussing.

The primary concern with pregnancy after multiple C-sections is the increased risk of placental complications. In particular, placenta accreta, a condition in which the placenta grows into the uterus, is significantly elevated after a C-section, and more so after multiple C-sections. This is especially true if you have a second condition — placenta previa — during pregnancy. Developing placenta accreta during pregnancy means a need for a C-section, and likely also a hysterectomy to remove your uterus. It puts you at risk for serious bleeding during delivery. Basically, this is a scary complication for both you and your baby.

I am not saying this to scare you, but it should be part of your conversation with your OB. She can give you a better sense, based on the placement of the scar tissue, of your individual risks. In addition, if you do decide to pursue a pregnancy, it will be important to have in place a plan for monitoring these issues, so you can proactively address possible complications.