Third Caesarean section: Features and opinions of doctors

For expectant mothers, a third Caesarean section is a topic that raises many questions. Concerns regarding safety, recuperation, and subsequent pregnancies are becoming more pertinent as more women experience multiple C-sections. Those who intend to have another child delivered by Caesarean section must comprehend the special features of this process.

The number of C-sections that are safe is a topic on which doctors frequently disagree. While some emphasize how much safer repeat C-sections have become due to medical advancements, others maintain that every additional surgery carries an increased risk. In any case, making educated choices requires understanding what to anticipate from a third Caesarean section.

In this piece, we’ll examine the opinions of healthcare professionals and the most crucial things for women preparing for a third Caesarean section to think about. There’s important information ahead, whether you’re looking for reassurance or are just inquiring about what this experience involves.

Dangers and risks

A woman’s third pregnancy is always risky if she has already given birth to two children via cesarean section. It all comes down to whether the uterus has any scars. The female reproductive organ expands and grows during gestation; all told, the uterus grows 500 times larger than it was before conception.

There is a lot of connective tissue in the scar region. Because it is not elastic, stretching it is not as easy. Therefore, a woman is automatically "registered" in the risk group for the likelihood of pregnancy complications after her first two pregnancies, with rupture of the uterus along the scar being the most formidable. This happens automatically after her third pregnancy. Doctors at antenatal clinics are most afraid of ruptures because they can potentially happen at any time. In fact, most ruptures on scars are fatal to both the mother and the unborn child.

Furthermore, uterine scarring raises the risk of intrauterine growth retardation, placental abruption, low placentation, and fetoplacental insufficiency.

This explains why, when a woman who is about to have her third cesarean section comes to see an obstetrician-gynecologist to register for a pregnancy, there is no great joy or enthusiasm in his eyes during the consultation. This makes sense—no physician requires tainted data. The risk of a third pregnancy is a much overstated concern.

Furthermore, since the doctors are in charge of the expectant mother and any potential complications, they frequently exaggerate it.

In actuality, scar rupture at labor’s onset happens in 5–9% of cases, and during pregnancy, the likelihood is less than 1%. However, there are hazards, and you should be aware of them.

It’s possible that a risky pregnancy developed shortly after the prior surgery (if two years haven’t gone by, it’s best to avoid getting pregnant).

It’s also not good to wait more than five years between births. The scar becomes less elastic as it ages. Another crucial factor is the scar’s initial thickness prior to pregnancy, which shouldn’t be less than 7 mm. The scar should be smooth and devoid of "niches."

Discipline will be required for a woman carrying her third child. Compared to other pregnant women, she will need to see the doctor more frequently and undergo ultrasounds more frequently, which will include an examination of the area that was scarred during uterine growth.

It is advised to have an ultrasound twice a month starting at the end of the second trimester and once every ten days during the third trimester.

Numerous factors include the expectant mother’s age, health, and placenta attachment. Strategies for handling a pregnancy of this kind are decided upon individually. There is only one topic that is not covered: childbirth. It is not possible to give birth naturally after two CS procedures. Both the mother and the child are in grave danger because of this. Surgery is always used to give birth.

How the third operation is performed?

The procedure is carried out according to a schedule. If the doctor is on board, the woman is free to select the date herself.

The third cesarean section is typically done between 38 and 39 weeks in order to rule out the possibility of spontaneous labor because contractions run the risk of rupturing the uterus along the scar. Additionally, if the doctor has reason to believe that the woman may go into labor, they operate between weeks 36 and 37. However, they forbid carrying a pregnancy to term earlier than the scheduled delivery date (EDD).

Similar to the last two procedures, this one is carried out under anesthesia.

Nowadays, epidural or spinal anesthesia is used in the majority of these births, allowing the parents to "participate" in the procedure by seeing the newborn right away.

In addition, a woman has the option to request general anesthesia instead of a spinal canal injection, which will cause her to be "absent" from her own birth and only allow her to see her child a few hours later.

The procedure is carried out "along the old scar," meaning the surgeon makes an incision where one was made during the prior procedure. The old scar and adhesions are removed.

These days, the lower uterine segment is incised horizontally. The lower portion of the reproductive organ stretches less during a subsequent pregnancy (assuming the woman desires a fourth child) and the tissue heals more quickly in this location.

The bladder is moved to the side and the muscles are spread apart following the incision. The amniotic sac is then punctured after an incision is made on the uterus. The baby is extracted, and the cord is severed. The placenta is manually separated by the surgeon before the baby is given over for processing and weighing.

Following this, external sutures are placed, the uterus is sutured, and the muscles of the abdomen are realigned.

Usually, the procedure takes about 30 minutes. However, because more time is needed to remove the old connective tissue in the third operation, the surgical intervention may take longer.

It is advised to closely monitor the laboring woman for 24 hours following the procedure. Drugs for contractions are administered to the woman if needed to improve the uterus’ ability to contract. Antibiotics may be necessary at times. It is nearly always advised to take pain medication for one to two days following surgery. It is thought that the uterus will contract more effectively and quickly the earlier the baby is placed to the breast, potentially resulting in fewer postoperative complications.

In a day, the woman will be able to rise. Spending a lot of time in bed is not recommended.

How to prepare?

Starting with the pregnancy planning stage is when preparation should start. By calculating the risks as much as possible beforehand, many difficulties during pregnancy and during surgery can be avoided. To do this, you must forgo the possibility of having an abortion, curettage, or uterine surgery, and you must use contraception following the prior cesarean section.

Following a two-year hiatus, you have to see a gynecologist. It is advised to perform a hysteroscopy and hysterography with contrast in addition to an ultrasound that assesses the scar’s condition (this is not very informative outside of pregnancy). These diagnostic tests enable you to determine the scar tissue’s viability, homogeneity, potential nicks, and thinned areas.

Although a third Caesarean section presents special difficulties, many women now find it to be a safer option thanks to advancements in medical care. Physicians keep a close eye on the mother and child to reduce risks and guarantee a safe delivery.

Since every woman’s experience is unique, it’s critical to speak with medical professionals who can provide advice based on specific medical conditions. Even though complications are a concern, many women who have multiple C-sections go on to have healthy pregnancies and deliveries.

In the end, the mother’s health and the safety of the child should be taken into consideration when making the decision, with the assistance of reputable medical experts. Precise planning and open communication can contribute to the process going as smoothly as possible.

Many doctors concur that, with the right planning and care, a third Caesarean section can be a safe option for both mother and baby. However, concerns regarding potential risks and recovery are often raised. Medical professionals consider a variety of factors when making decisions, including the mother’s health, scar tissue from prior surgeries, and the interval between pregnancies. Although there are some risks associated with the procedure that are not present with previous C-sections, improvements in surgical methods and post-operative care help make the experience more comfortable for many women.

Video on the topic

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