Q: My husband and I have always dreamed of a large family. I'm now 34, with three children—the youngest two delivered by C-section. We want another baby, but my gynecologist advises against it, citing excessive stress from a third C-section. Is this accurate? —T.G., Zierikzee
Gynecologist Lucie Ribbert: Your doctor is wisely highlighting the risks of a third C-section. Let me explain them clearly based on established medical evidence.
Direct surgical risks include infections or pulmonary embolism, though maternal mortality from childbirth in the Netherlands remains very low, even with C-sections.
The uterine scar from prior C-sections poses additional concerns. First, it weakens the uterus: after a previous C-section, attempting vaginal birth carries about a 1% risk of scar rupture. That's why hospital delivery with continuous fetal monitoring is essential to detect any issues early.
Second, multiple scars increase the chance of placenta previa, where the placenta covers the cervix. Risks rise with C-sections: 1 in 200 without, 1 in 77 after one, and 1 in 27 after two. This can lead to bleeding, preterm delivery (often by C-section), or placenta accreta—deep implantation requiring hysterectomy in severe cases.
This information can be daunting amid the joy of pregnancy. For you, a planned C-section would minimize rupture risk, with ultrasounds monitoring placental position. While C-sections are safe in the Netherlands and Western countries, risks escalate after two. Discussions often include sterilization options to safeguard future health.
