What problems are more common with repeat C-section?

Systematic reviews have found that repeat cesarean is worse than planned VBAC, for

  • Physical problems for mothers. Compared with vaginal birth, C-section increases a woman's risk for a number of physical problems, ranging from less common but potentially life-threatening problems like hemorrhage (severe bleeding), blood clots and bowel obstruction (due to scarring and adhesions from the surgery) to much more common problems like longer-lasting and more severe pain and infection. Scarring and adhesion tissue can make it more likely that women will have ongoing pelvic pain and twisted bowel.Guise, J.M., Eden, K., Emeis, C., . . . McDonagh, M. (2010). Vaginal birth after cesarean: New insights. Evidence Report/Technology Assessment No.191. (Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-2007-10057-I). AHRQ Publication No. 10-E003. Rockville, MD: Agency for Healthcare Research and Quality.
  • Longer hospital stays. If a woman has a C-section, she is more likely to stay in the hospital longer and to be re-hospitalized.Guise, J.M., Eden, K., Emeis, C., . . . McDonagh, M. (2010). Vaginal birth after cesarean: New insights. Evidence Report/Technology Assessment No.191. (Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-2007-10057-I). AHRQ Publication No. 10-E003. Rockville, MD: Agency for Healthcare Research and Quality.

As the number of cesareans (and related scarring and adhesions) grow, risks for women and babies grow. A systematic reviewMarshall, N., Fu, R., & Guise, J. (2011). Impact of multiple cesarean deliveries on maternal morbidity: A systematic review. American Journal of Obstetrics and Gynecology, 205(3), e1-8. found that risk of the following complications associated with cesarean increases with each additional cesarean:

  • Measures of serious maternal health problems (severe morbidity)
  • Emergency surgery to remove the uterus (hysterectomy)
  • Serious condition of the placenta covering the opening of the cervix (placenta previa)Guise, J.M., Eden, K., Emeis, C., . . . McDonagh, M. (2010). Vaginal birth after cesarean: New insights. Evidence Report/Technology Assessment No.191. (Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-2007-10057-I). AHRQ Publication No. 10-E003. Rockville, MD: Agency for Healthcare Research and Quality.
  • Serious condition of the placenta growing into the wall of the uterus (placenta accreta)Guise, J.M., Eden, K., Emeis, C., . . . McDonagh, M. (2010). Vaginal birth after cesarean: New insights. Evidence Report/Technology Assessment No.191. (Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-2007-10057-I). AHRQ Publication No. 10-E003. Rockville, MD: Agency for Healthcare Research and Quality.
  • Excessive blood loss (hemorrhage)
  • Blood given through IV line (blood transfusion)
  • Scars that cause organs to bind together and may lead to pain and other problems (adhesions)
  • Surgical injury