Every cesarean makes the next one harder
This is the consent conversation that is almost never had.
The risks of a single cesarean are modest. The risks of a fourth are not. In a prospective study of 30,132 cesareans, rates of placenta accreta, hysterectomy, bladder injury, bowel injury, ureter injury, intensive care admission, transfusion of four or more units, and operating time all rose with each additional operation.
| Cesarean number | Placenta accreta | Hysterectomy |
|---|---|---|
| First | 0.24% | 0.65% |
| Second | 0.31% | 0.42% |
| Third | 0.57% | 0.90% |
| Fourth | 2.13% | 2.41% |
| Fifth | 2.33% | 3.49% |
| Sixth or more | 6.74% | 8.99% |
A separate California study of 779,382 women found that a cesarean in a first birth raised the risk of severe complications in the second birth by about 70%, and estimated that 15.5% of severe complications in second births were attributable to the first cesarean.
Where this comes from:
268. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226-1232.
347. Bane S, Snowden JM, Simard JF, Odden M, Kan P, Main EK, et al. A counterfactual analysis of impact of cesarean birth in a first birth on severe maternal morbidity in the subsequent birth. Epidemiology. 2024;35(6):853-863.
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This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.