Do Cesareans limit your family size?

[JoyFilled]

Does having a c-section or two or three affect the number of children you were planning on having?

In what ways and why?

[mamapigeon]

I've been wondering this same thing...

For me, if I have 2 sections I would go for a third pregnancy and see if I could vbac, but if I had 3 sections I don't know if I would want to try again... I did not like having someone cut me open.

I am hoping that baby #1 being a c-section does not limit family size (want 6).

[AlexisT]

Not me personally, since I never planned a large family.

Statistically, complications begin to rise after the 4th, and the women I know who want large families try to avoid a CS and are more keen on VBAC. You never know when you're going to hit your personal limit (I know one woman whose uterus was in bad shape when they did her 3rd and another who had 6 CS) so it makes sense not to gamble.

[Drummer's Wife]

Maybe. I've had 4 c-sections, and then a 5th major abdominal surgery when my youngest was a year old (exploratory laparotomy - so much more invasive than a bikini cut c/s).

I know, statistically, a 5th c-section would be risky, but I also really want at least one more baby. I said maybe about if impacting family size b/c we've been trying for 3 years and haven't been successful. My other pregnancies were pretty easy to achieve, so I wonder if surgical births messed with my fertility. I suppose it could be age, but I'm only 32, not 42. Could be something else entirely, but of course I wonder.

I won't stop TTC even though chances are I'd end up with yet another section. It would be worth it for me, to be able to add to our family.

The thing is that vbamc tend to be less risky than cbamc -- yet, providers are more comfy agreeing with numerous c-sections (I mean, what could they say, no?), than agreeing to take you as a client/patient attempting anything more than a vba2c.

[Storm Bride]

No, but only because I'm really, really stubborn, and by the time I managed to carry my second to term, had become pretty obsessive about having the four kids I'd always wanted. (It's a long story, but the relevant segment here is that ds1 is 10 years older than dd1, and I was actively trying to have a second baby for most of that time.) If I hadn't already been absolutely hellbent on four children, I don't think I'd have been able to go through another pregnancy after dd1, and I know I wouldn't have been able to after ds2. I had nerve damage with ds2 that appears to be permanent - but it did heal somewhat. It was hellish for the first year.

My uterus is apparently in pretty good shape, but my pelvis is kind of wrecked from the nerve damage, and my abs are shot...probably a combination of the c-sections and the big babies, fairly close together (my last four were in May '03, July '05, November '07, and June '09, and the last one was the only one who was under 10 pounds, at 9lb. 15oz.). Add in the nerve damage that makes any kind of lower ab work (or kegels, for that matter) so difficult, and...yeah - pretty sure I'd have stopped if I weren't so obsessed with having four kids. Physically, I should have stopped after we lost Aaron, but I wasn't psychologically able to do that...and I wouldn't trade dd2 for the world.

[seili]

 I think 3 or 4 c-sections is common limit. But everyone is different, so that doesn't mean you have to only have 3 or 4 if you handle the surgeries well. But if you are going into as a decision, I think it is best to remember that it might not be best for you or baby to have more than 4, if that. I've never planned on having more than 4, so it just hasn't been too much of an issue. It is something to consider if you want a larger family, but VBAC is a good option for many women, too.

Subsequent c-sections can cause more placenta problems in future pregnancies. An ultrasound should be able to detect most of those problems for you.

[Bokonon]

No, but the complications that led me to having c-sections did.  I had pre-term, severe preeclampsia with both pregnancies.  I'm not interested in enduring that again.  The c-sections had little to do with mine and my husband's decision to stop at 2, but being able to have a tubal ligation with my second c-section was one benefit to my having the second c-section.

[Storm Bride]

Oh - cesareans did affect my family of origin. My mom had planned to have six children, but after having us all by c-section, she "wasn't allowed" to have any more, and got a tubal ligation at 26.

[parsley]

I've been thinking about this a lot the past few weeks.  I'm recovering from my second c-section right now (had the baby on Monday!).  So, far my recovery has been better than I ever could have expected.  But, leading up to the baby's birth, I've had a TON of stress related to my complete placenta previa, bleeding, fear of placenta accreta and risk of hemmorage. 

Even though I didn't have any additional complications and I feel great, I don't know if I could do any of this again knowing that my best case scenario was another likely c-section. 

But, I'll decide in 2-3 years.   

[Megan73]

It's not clear why but CS is actually linked to infertility: http://humrep.oxfordjournals.org/content/18/10/1983.full

[Red Pajama]

Not wanting another section is one of many reasons I feel like I'm done: two pregnancies, 3 kids. There are many other factors, from health to finances, that cement that choice.

[MsDolphin]

For myself, I always wanted two children. We are TTC #2, so having a c-section didn’t effect our decision on family size.

My ex-coworker's wife had four c-sections for all her children. All kids are under the age 10. I wish I still worked with him and could get more details how it was for her doing it four times, especially so close together.

[Sol_y_Paz]

I was told by my doctor it would not limit my family size.  

[McGucks]

No, my c/s was my last childbirth experience.  I am 41 and done with having children.  My decision to not have any more children, however, is entirely unrelated to having a c/s.

[FrugalGranolaMom]

It wasn't a factor for me. DH and I only planned on having one child and due to complications I ended up needing a c-section. If I was really set on having more children, I don't think having a section would have changed my mind.

[Monkey Keeper]

The nurse at my OB's office started to say something about this at my intake visit. I am expecting #4, and she thought I had had 2 or 3 c/s (wasn't clear). I did not get to hear her out because I corrected her that I had had 2 vaginal births with a c/s in between, so the point was moot. I think, though, that she was going to say that they would recommend this being my last pregnancy if I'd had whichever number she thought, making this either the 3rd or 4th c/s in her mind.

[Storm Bride]

Oh - didn't even think about the doctor's viewpoint in my original reply. When I was pregnant with ds2, the OB mentioned the possibility of a tubal at every prenatal appointment, starting at about 14 weeks along. I was very clear, right from the beginning, that I didn't want one, wasn't ready for one, and asked him not to bring it up again. Somewhere around 7 months along, he also started telling me that "three is a perfect family", "three is enough for anybody", "you don't need more than three children" and other variants on the theme. So, he may have told me repeatedly that c-sections were a safe way to have a baby, but he reminded me every time I was there that he didn't really believe that.

If I'd let him decide for me, then having a c/s definitely would have limited my family size. He was quite adamant that I should have a tubal and that I would have enough children with ds2. He did throw me an occasional "I'm okay with up to four c/s, but no more than that" bone, but would usually follow it with another reference to a tubal.

[MaryLang]

My doctor just says we will evaluate after each one. So far so good. I'm having my 6th c/s in June. His record is 8 or 9 I can't remember.
This is not always the case though. I find that a lot of doctors are apprehensive about doing more than 3 or 4, and I personally think it has more to do with experience. First off most women don't have many more than that period, vaginal or c/s. It does seem to take skill to maneuver all that scar tissue. So I sort of look at it as- you may have to do some hunting just as you would a good VBAC doctor or midwife. Don't always take one opinion.
And do keep in mind that c/s's can complicate issues with the placenta attaching properly, higher rate of anterior placenta, and a few other things.

[roadfamily6now]

the risks during a future pregnancy after a c-section go up exponentially. To me THOSE risks would limit my choices to have more kids.

Risks of cesarean

The risks of cesarean birth have been well documented. It is major abdominal surgery and as such carries inherent risks associated with such surgery. Cesarean has now become so commonplace in many countries that these risks are often glossed over or fail to be communicated to the mother before her decision is made.

Complications for the mother	Risk
Maternal death	5-7 times higher than vaginal birth
Emergency Hysterectomy	1 in 110 cesarean births (d)
Injury to bladder, uterus & blood vessels	2%
Hemorrhage	1-7%
Blood clots developing in legs	6-20 per 1,000 (0.6-2%) 8 times higher than vaginal births
Pulmonary embolism	1-2 per 1,000 (0.1-0.2%)
Paralyzed bowel -- mild	10-20%
Paralyzed bowel -- severe	1%
Infection	50 times higher than vaginal birth
Require readmission to hospital	2 times higher than vaginal birth
Difficulties with normal activities 2 months later	10%
Pain at incision site perceived as a major problem	25%
Incisional pain 6 months or more after birth	7%

(d) The rate of emergency hysterectomy after vaginal births is 1 in every 824 vaginal births

Complications for the baby	Risk
Baby cut during surgery	1-2%
Lower Apgar scores than vaginally born babies	50% more than vaginal births
Babies require assistance with breathing	5 times higher than vaginal births
Admittance of baby to intermediate or intensive care	5 times higher than vaginal births
Persistent pulmonary hypertension in baby	4-5 times higher than vaginal birth

In addition to the inherent risks of cesarean for both the mother and the baby, the risks increase with accumulating cesarean operations.

Complications related to future fertility	Risk relative to women with no cesarean history
Incidence of placenta previa after 1 cesarean(*)	4 times the risk
Incidence of placenta previa after 2-3 cesareans	7 times the risk
Incidence of placenta previa after > 3 cesareans	45 times the risk
Placental abruption(U)	3 times the risk
Placenta accreta after 1 previous cesarean	1 in 1,000 (0.1%)
Placenta accreta after 2 or more previous cesareans(z)	10 in 1,1000 (1%)
Placenta percreta after 1 previous cesarean(¥)	25%
Placenta percreta after 2 previous cesareans	50%
Placenta percreta after 4 previous cesareans	70%
Hysterectomy after 1 cesarean	27 times the risk

[Storm Bride]

That table doesn't make sense, as written. It shows the risk of placenta percreta for a woman with one previous cesarean as being 25% of the risk for a woman with no previous cesareans! It's very poorly laid out.

I don't have the exact numbers in front of me, but those percentages are very misleading (and terrifying!), anyway. If 70% is accurate, for example, it means that the risk of developing placenta percreta after four previous cesareans, is 70% if the woman already has placenta previa. It's not 70% of all pregnant women who have had four cesareans, which is what it kind of looks like in this table.  I seem to recall that the risk is something like 66%, but that was based on one particular study, and the number of women who had four or more previous cesareans was quite small. It's still scary - I was definitely freaked out, just from finding out that I had an anterior placenta with dd2. Fortunately, I didn't develop a previa or any other placental complications.