Q:My husband and I have always dreamed of having a large family. I am now 34 and we now have three children. The youngest two were born by Caesarean section. Now we really want another baby, but my gynecologist says that is not wise, because a third caesarean section would be too stressful for my body. Is this correct? T.G., ZIERIKZEE
Gynecologist Lucie Ribbert: 'I think your gynecologist wanted to warn you about the possible risks of a third caesarean section. In fact, there are several risks. I will try to clarify these.
There are risks that are directly caused by the cesarean section, such as certain infections or a pulmonary embolism. Fortunately, the mortality of mothers in the Netherlands due to childbirth is very low. Even after a cesarean section. In addition, there are the risks that are caused by the scar in the uterus from a previous caesarean section.
The scar can cause problems in two ways. First, the scar is a weak spot in the uterus. If you give birth vaginally after a previous caesarean section, there is a small chance that the scar will tear. This chance is about one percent. Therefore, a woman who has previously had a caesarean section should give birth in the hospital. The contractions and heart rate of the baby will then be continuously measured during labour, so that it can be noticed if the scar has a tendency to tear.
Secondly, the scar in the uterus can cause the placenta to be incorrectly positioned. The placenta then lies in front of the exit of the uterus, a 'placenta previa'. The probability of this increases with the number of cesarean sections:without cesarean section the probability is 1:200, after one cesarean section the probability is 1:77 and after two cesarean sections already 1:27. A placenta previa often causes blood loss during pregnancy and can be a reason to deliver the baby earlier (via Caesarean section). A placenta previa is sometimes accompanied by a too deep ingrowth of the placenta into the uterine wall, which can also cause the placenta to become stuck and not let go after the birth of the child. This is a serious complication and may require removal of the uterus after the baby is born.
I can imagine that you are shocked by this information. In your case, the gynecologist will probably advise you to have a Caesarean section by appointment if you are pregnant. This reduces the chance of the scar tearing out. During your pregnancy, the ultrasound will also determine where the placenta is located. It is difficult to talk about the risks for mother and child in something as beautiful as pregnancy and birth. Gynecologists will say that a cesarean section is a safe operation, in the Netherlands and in all other western countries. But there are risks. A pregnant woman with whom a second caesarean section is discussed is usually made aware of the possibility of having sterilization performed immediately after birth. This in the knowledge that the risks for mother and child increase quickly after two caesarean sections.'
