Repeat C-Sections

[SJ]

Has anyone ever been told that there is a limit on how many RCS one is "allowed" to have?

Pregnant friends were supposedly told by their practice that 3 is the limit. That they would tie tubes during the 3rd to ensure there were no additional pregnancies. They want 4 kids, so are leaning towards going the VBAC route if possible.

I don't see how anyone can "force" you to have your tubes tied. Maybe it just means that practice would no longer see you as a patient due to the risks?

My mom had 3 c-sections and I have never heard anything about this. What have you been told by your practice, if anything?

[jeaniebueller]

I don't see how any doctor can perform a tubal without your consent. My doctor did not advise me anything about the number of RCS but I made it clear that we were done after DD. My mom had 3 C sections and my H's cousin had 4.

[SJ]

I agree they would have to have consent!

I don't really trust the sources as they are not the type to push or ask a lot of questions. I was definitely confused hence my curiosity about others' experiences and practices.

Thank you!

[annieh22]

I've heard it recommended on an individual basis, never an across the board mandate.

I was told I could do a 3rd, but wouldn't recommend a 4th due to the internal scar tissue. She would never force me to have my tubes tied though.

I hope they would work with the patient to figure out the best plan based on their health, scar tissue and reaction to surgery.

[Deleted]

Uhh..no. My doctor advised me of the risks when making my decision to VBAC vs. RCS about having multiple c-sections, but I have never heard of "forcing" someone to have their tubes tied.

[CloudBee]

I've heard this as an advisement, but not rule.

My OB tells CS patients to wait at least a year before getting pregnant again, and advises waiting up to 2 yrs if you had complications. (My uterus tore, so I was told it could be dangerous to get pg earlier than a year.)

They can't force a tubal. I think she's stretching what they told her. They probably would LIKE to tie tubes during the 3rd, and hope you're onboard with that.

[cmarie11]

No one can force you to tie your tubes without consent.

However, every surgery you have increases the amount of scar tissue and can cause issues like bowel and bladder injuries during surgery. Therefore, a lot of times it is recommended not to have more than 3-4 c/s.

Does this mean you can't have more than 3-4 kids? No. It just increases your risk of complications with each additional surgery.

[laurenh]

Uh, lol that the practice thinks they can perform a procedure they don't have signed consent form. I sincerely hope they somehow misunderstood :/

I do believe rupture risk does increase but I'm not sure exactly how much.

[mlt]

Well a doctor cannot force someone to get a tubal. I doubt the doctor said that. Probably he or she was strongly encouraging your friend to stop at three sections. Time is also a factor. How close together have these sections been?

[cmarie11]

One doctor that I work with uses this as an argument when a patient is trying to decide whether to VBAC or to have a RCS. He says that if you want 4+ kids, the chance of having a complication from having multiple RCS is probably greater than the change of uterine rupture during a VBAC.

[runblondie26]

I'm going on my third c-section and they've never mentioned it to me.

The few times we've discussed pp birth control plans, I've said probably IUD, but nothing permanent on the slim possibility I want a fourth baby in a few years. Again, no objections from the doctor. The only thing the OB has told me in the past is that it was optimal to wait about a year before getting pregnant again.

[Deleted]

They would need consent to tie tubes. That said, some doctors do set limits on the number of sections, as in they wouldn't perform more than x amount. This is one of the reasons that VBAC is suggested if you want additional children.

My BFF will have her 4th section in November. Her doctor has been fine with it. But she did have a lot of scar tissue that had to be cleaned up during her 3rd c section.

[barefootcontessa]

Yes, there are definitely OBs who say this as a blanket statement -- IME OBs who are younger and have less experience. I have had five CS and my OB said given the status of my uterus he would have no problem with me having a sixth. I know he has told other women something different, based on the particulars of their situation. Your friend should find a new OB if she wants to have more kids. It is one thing if your doctor says your particular health situation warrants limiting pregnancy and another thing to say it is SOC to tie your tubes after three CSs.

[holly116]

Yeah, no lol. Thanks for the tag @starry.

I had three (non complicated, first was emergent after labor, two scheduled) c sections in 37 months. And this hasn't been even mentioned to me at all. In fact, while they were wrapping up the third, my DH asked my ob in the or about how we looked for a fourth, if we decide to have another. She said everything looked great regarding scar tissue and that she saw no reason that we couldn't. So obviously this isn't some sort of universal standard. As with anything, everyone specific circumstances, histories, and situation should be taken into consideration.

And wtf to an automatic tubal ligation to prevent future pregnancies.

[sporklemotion]

They may have been saying that they would not keep them as patients, should they choose to have a fourth after a third CS.

It doesn't make sense to force a tubal ligation, as there are other ways to avoid a fourth child (not that the practice can mandate that, either). I'm guessing (hoping) that they misunderstood the doctor, who may have been just discussing the risks and benefits of a VBAC vs. RCS.

[mpc]

My coworker had 6, but the doctor would see how things looked during each section then tell her she looked ok for one more each time.

[swimmette]

I was told that it depends on the patient.  During the c-section my OB looked at whatever he needed to and let me know that everything was fine for a 3rd c-section.  He asked me before if I wanted a tubal or more children, and when I said more children then he looked at the lining and whatnot and said I should be fine for a third.

[mlvmd]

I was told a max of two. That was unique to my particular situation because of the way they had to cut for DS1 would make subsequent pregnancies risky. She phrased it nicely through and basically said that she would want to sit down with me if we considered a third pregnancy and really discuss the risks because she would really, really advise against it. No talk of tying tubes.

[GotWine]

My doctor only told me that after my repeat c/s that I will not be a candidate for a VBAC for a third pregnancy.

[barefootcontessa]

Aug 6, 2015 8:15:00 GMT -5 SJ said:

Has anyone ever been told that there is a limit on how many RCS one is "allowed" to have?

Pregnant friends were supposedly told by their practice that 3 is the limit. That they would tie tubes during the 3rd to ensure there were no additional pregnancies. They want 4 kids, so are leaning towards going the VBAC route if possible.

I don't see how anyone can "force" you to have your tubes tied. Maybe it just means that practice would no longer see you as a patient due to the risks?

My mom had 3 c-sections and I have never heard anything about this. What have you been told by your practice, if anything?

Even though I had a failed VBAC, I would still try it again (if in that circumstance again).  Assuming your friend is a good candidate and the hospital has good support, I would go for the VBAC if I were her -- especially since she wants more kids.  I am fortunate my uterus held up and could still have more kids but that is not always the case.  Some other tips re:  VBAC, find out the hospital's VBAC success rate as well as her doctor and the practice generally.   

[thebreakfastclub]

My boss had 4 c-sections, and her first 2 pregnancies were 15 months apart. No issues.

[hopecounts]

My OB/Gyn highly recommends and encourages tube tying with a third c/s
the risks with a 4th are just really high and he counsels his patients strongly against it, he also brings it up from the 1st c/s so those wanting to have more can try for a VBAC and avoid the issue.

If you look up the studies a 4th c/s is risky and many docs try to encourage patients NOT to do it.
The primary risks are related to adhesions leading to bleeding out/poor healing of the uterus and it separating post birth leading to hemorrhage/and so on leading to maternal death, there is also an increased risk of the uterus splitting during pregnancy leading to fetal demise because the uterus hasn't healed properly.

[Deleted]

I honestly don't believe a doctor told her they would tie her tubes to prevent a 4th pregnancy. She may have been counseled to do so, but she wasn't told this was happening period no discussion.

I know nothing about limits on c sections.

[Deleted]

What? No. We are still in charge of our bodies. There is no medical procedure that could happen without your consent. 

I know a few people who've had >3 C-sections, but I know the risks are higher over 3 so some OBs recommend stopping there. 

[hopecounts]

Aug 6, 2015 9:54:37 GMT -5 @starry said:

I don't know why doctors are pushing tying tubes vs vasectomies. I guess since the tube tying is a "guarantee" for mom who is the one at risk with another pregnancy. Still I would much prefer an IUD.

Because mom is already open on the table so tying her tubes is just an additional 10 minutes at most to the C/S rather then her H having a separate procedure.  

[thebreakfastclub]

There is also some new research finding that the tubal can reduce ovarian cancer rates. The theory is that the cancer may begin in the tubes.

[cilantro]

I was told that generally after three c sections they would try to talk a patient into sterilization (and yes that is the awkward way my doc put it) at my 6 week follow up. Fortunately, a nonissue over here!

[laurenh]

Aug 6, 2015 10:02:32 GMT -5 thebreakfastclub said:

There is also some new research finding that the tubal can reduce ovarian cancer rates. The theory is that the cancer may begin in the tubes.

That's with removing the tubes rather than tying, right? My cousin had her third (uncomplicated) c/s in Feb and her doctor advised to remove the tubes versus tying them due to cancer risks.

[thebreakfastclub]

Aug 6, 2015 10:05:17 GMT -5 laurenh said:

Aug 6, 2015 10:02:32 GMT -5 thebreakfastclub said:

There is also some new research finding that the tubal can reduce ovarian cancer rates. The theory is that the cancer may begin in the tubes.

That's with removing the tubes rather than tying, right? My cousin had her third (uncomplicated) c/s in Feb and her doctor advised to remove the tubes versus tying them due to cancer risks.

I had a brief tubal consult with my OB at my annual exam last year.  I had no intention of getting it done, but I wanted to review it so I could further badger my H about a vasectomy, which he was putting off at the time.  

My doc said that the cauterizing procedure was enough to cause a decline in ovarian cancer rates, although the research is pretty new and perhaps removal is better if there is a family history of cancer.  He also said he's had patients return to work as soon as the next day, so it seemed to be pretty straightforward.

Then he told me to tell my H to get over himself and schedule the V.  

[Susie]

I haven't had personal experience, but I have one friend and one former colleague who each had 3 c-sections. Both were advised that a 4th wasn't a great idea, but it wasn't a "limit" per se, and definitely neither had their tubes tied during the 3rd cs. They both happen to be a lot more Catholic than I am (I'm pretty lapsed) and I think either would've balked big time at the tube tying suggestion.