Why Are Multiple C-Sections "Harder"?

I had a question asked of me by Shati in a comment response to my post Question About Repeat C-Sections. Since my answer got a little wordy (isn't everything I write? LOL) I decided to put my answer in a separate post. Here's her question:

Hi There! I have had three c-sections and i really desperately want one more baby via c secion(i dont want to vbac!) I asked my GP doctor and she asked the OB doctors, and they advised me not to get pregnant again. They also said that it's still up to me..if i do get pregnant then they'll monitor me very closely. I'm really stuck here now! My third c-section was elective. Can anyone who had 4 c-sections explain to me if it was any harder than three c-sections? Pleaseeee help me!

Well, Shati, I'm not sure if you're asking why multiple c-sections are harder, or why they're riskier. So I'll answer both. But first, just in case you change your mind someday about having a VBAC, there is the possibility of having a VBAC, but chances are the only way you'd get one is to use a midwife.

Depending on the state you live in, and the laws, some more experienced midwives are willing to do a VBAC even after four cesareans, although that is not the norm, and it depends on your situation. Here in the state I live in, there are a ton of very experienced midwives, and two or three of them are willing to consider a VBAC after multiple cesareans. Another state I lived in, they would only do it after two, no more, and you had to have at least a year between pregnancies. Just in case you changed your mind. You just need to research and talk to your local midwives. You can usually find lists of them online.

EDIT: I also should mention what a midwife told me: "It's your body, they can't make you have a surgery that you don't want." That being said, you won't be treated very well in a hospital where you refuse a c-section after more than one previous cesarean. They don't like to be inconvenienced. And watch out...they could try to pull stuff on you if you don't cooperate with their "routine" once your baby is born. Threatening "uncooperative" mothers with a call to social services is one way some hospitals try to keep you in line. This is more common with first-time mothers, but you should be aware of it.

As far as why repeat c-sections are harder: I didn't really feel that mine were all that much harder, but I do tend to recover from them somewhat easier than some women. It's kind of up to your body. There was a slight increase in the level of difficulty in my recovery over the first four cesareans, but not much. You can have a bad recovery one time, and a good one the next. My fourth c-section was the hardest, but I think that was because my doc was evil and gave me the minimum amount of drugs. ;-) Hope for his sake he never gets in a car accident and has a doc like him controlling his meds! My fifth was the easiest recovery by far, and I believe it was because I was on a raw food diet. I recovered soooo easy from that one. Oh yeah, and my doc was awesome and gave me lots of drugs, too. LOL.

Now, if what you meant to ask is why doctors consider repeat VBAC's more DANGEROUS, that's a different story. My personal opinion is that they don't want the liability in case something goes wrong, so they freak you out with statistics that I KNOW are being misrepresented, because I've read the same studies they are referring to, and they leave out important information that allows you to understand and weigh the REAL risks. There definitely are more risks with more c-sections, but it's not as bad as they make it out to be. (Don't these people know anything about repeat business? LOL)

There are a few main things to consider. One is placenta problems. With more c-sections, you have a slightly higher risk of the placenta choosing to grow in the wrong spot, like over the cervix or previous scar tissue. Over the cervix is particularly bad, but it can be managed. It's just not the best situation to be in. More serious can be when the placenta grows through the side of the uterus. Obviously a bad thing. These can be detected during ultrasounds, and you can be delivered early if necessary. The risk goes up a little more with each pregnancy, but the risks aren't that big. Of course, if you're the one out of fifty or a hundred (or whatever it is--don't quote me, because it's been a long time since I researched it) that it happens to, that's of little comfort to you or your loved ones.

The other big issue is uterine rupture. That's when you get a tear in your uterus, and that can cause hemorrhaging, and in worse-case scenarios, death for you and/or your baby. That's rare, but it happens. But what they DON'T tell you is that the studies don't differentiate between a catastrophic rupture and a "window" rupture--and there is a BIG difference.

A catastrophic rupture is when the uterus tears all the way through. That's what can kill you. You bleed out quick, and if you're not right by a O.R., you're in trouble. But that kind is rare. Another thing they don't tell you is that a woman who has no previous c-sections, and is given drugs to induce labor for a vaginal birth, is actually more likely to have a uterine rupture than a mother who has one or two c-sections. Yet they don't have a problem pushing those drugs on you, or tell you about that risk, do they?

The other kind of rupture, which is much more common, is the "window" rupture. That's when you get little holes in the inner lining of the uterus that do NOT go all the way through. They are not a big deal, and you can have those and they won't hurt you...though the docs always repair them when they find them during your c-section. That kind isn't dangerous, and yet they are lumped in with the kind of ruptures that can kill you, which makes the statistics sound much, much worse.

Fortunately, I've educated myself, and since I don't believe in birth control anyway, and I trust God 100% with everything, including my body and my reproductive health, the doctors can't scare me. And many of them WILL try to scare you. I've had doctors go so far as to basically tell me that if I have a baby, there's a good chance I will die, and leave my other children motherless. Implying that I'm a bad mother, essentially. There is a woman doctor in my doctor's rotation who is the one who said that to me, and I told my current doc I will NOT see that woman again, and she will never deliver me--I'll go to a different hospital if she's on duty. I do not trust her in any way, shape or form. If you get a doc like that, RUN, because they do not care about you. Education is one thing--scare tactics and guilt-trips are another, and it's just unprofessional and wrong.

My doctor now is great. I don't have a problem with him educating me on the risks and my options, and he's always nice about it, and realistic. I get the real information from him, without scare tactics. He respects me, and that's important in a doctor. Plus, he really seems to know his stuff. He's cautious, but not an alarmist. He's really great.

Now I can't (and won't) tell you what you should do, but hopefully this gives you some more insight into the real risks of multiple c-sections. I'm not a doctor obviously, and this is all just my personal opinion based on my own research--you shouldn't trust me, you should find out for yourself. I'm pregnant with my sixth right now. I'm not worried. When it's my time to die, it will happen whether or not I'm pregnant. I can't stop that by not having a baby. So if I'm going to die, I'd rather it be while carrying or delivering a baby, than by getting hit by a bus! That's my personal take on the situation. I know people who have had at least nine c-sections, without complications, and one of those people had the old, less-safe, vertical incision. No problems for her so far.

Personally, I think three c-sections isn't that big of a deal. Four is on the border of having higher risks, but then you're talking going from 1-2% on some of these risks, to maybe 3-4%. So it's not like it's a 50% risk or anything (like they would like for you to believe). However, the risk is still there. There's always at least a 1% risk of death with ANY surgery, because stuff just goes wrong sometimes. And if you're overweight, your risk can be a little higher. But the risks are, in my opinion, not terribly high, and even placental problems can be managed if you keep an eye on them with repeat ultrasounds.

In my own case, I'm also dealing with a damaged aortic heart valve, and just after I got pregnant this time, I found out I have an aneurysm. Having an ascending aortic aneurysm while you're pregnant is NOT a good combination. Sure, I freaked out for a day or two. Then I remembered "Oh yeah, I'm supposed to trust in God." ;-) After that, I realized that my life is in His hands, and my time will come when it was meant to come. I don't feel like that time has come yet. Maybe in a few months more, I'll feel differently. But right now, I think God is telling me I'm okay. So, no more stressing. I'm getting great care, and they're monitoring the aneurysm, and they will repair my aorta with open heart surgery sometime after the baby is born--we're still trying to figure out when. Now, recovering from a c-section AND open-heart surgery.....THAT will be hard. But I'm up for the challenge. (Please God, let them give me lots of drugs...)

As I said before, even with small risks, it really stinks if you are one of the few that experience them. I'm willing to take that risk, because of my religious beliefs and trust in God. But for others who don't have that confidence, the decision isn't as easy. I would strongly recommend researching more on your own and making an educated decision. Contact the ICAN network: the International Cesarean Awareness Network at www.ican-online.org. They can give you realistic statistics, and there are also local monthly meetings, hopefully in your area. Let me know if you decide to get pregnant again, so we can follow how you're doing!