Introduction
If you’ve had a C-section, you may start wondering what that means for any future pregnancies. Can you have a vaginal birth next time? Is it safe to have more than one or two caesareans? And what about things you may have heard of, like placenta praevia or placenta accreta? This blog will walk you through the key issues in everyday language, so you can feel more informed and confident when talking to your midwife or doctor.
A caesarean is an operation where the baby is born through a cut in your tummy and uterus (womb). This leaves a scar on your uterus. In most cases, people heal well and go on to have healthy pregnancies in the future. However, the scar does change two main things:
- It slightly changes the risks of future labour and birth.
- It can affect how and where the placenta attaches in later pregnancies.
The big picture is this: the more caesareans you have, the more important it becomes to keep an eye on the placenta and to plan the birth carefully. That doesn’t mean you can’t have more children; it just means the team looking after you will pay more attention to certain details.
How Many Repeat C-Sections Can I Have?
There is no fixed number of caesareans that is automatically “unsafe” for everyone. Some people have three or more and recover well. Others run into complications earlier. Safety depends on several things:
- Your overall health.
- Why you needed previous caesareans.
- Whether you’ve had any complications (like infection or heavy bleeding) before.
- How much internal scarring there is.
- Where the placenta attaches in later pregnancies.
What we do know is that risks tend to increase each time you have another caesarean. With each operation:
- The surgery can take longer and be more technically difficult because of scar tissue.
- There’s a higher chance of injury to nearby organs (like the bladder or bowel).
- The risk of heavy bleeding increases.
- The chance of serious placenta problems in future pregnancies rises.
In short, there is no simple “maximum number”, but the risk gradually increases with each repeat C-section. The more caesareans you have, the more carefully your next pregnancy needs to be monitored. Decisions about further pregnancies are best made with a discussion from a specialist who knows your history in detail. If you think you might want several children, it’s worth having an honest conversation with your obstetrician. If it’s safe for you and your baby, trying for a vaginal birth after caesarean can help reduce the number of scars on your womb and keep options more open for the future.
Vaginal Birth After Caesarean (VBAC)
If you've had a previous caesarean, you have options in your future pregnancies:
- VBAC – a vaginal birth after caesarean.
- Planned repeat caesarean - another caesarean booked in advance.
For many healthy women with one straightforward previous caesarean, both options are usually safe. There is no "better" choice, and what you decide to do will depend on your personal preferences, medical history, and your current pregnancy.
How Likely Is VBAC to Succeed?
In general terms, around three-quarters of women with one previous caesarean and an uncomplicated pregnancy who go into labour naturally have a successful vaginal birth. If you've ever had a vaginal birth before (either before or after your caesarean), your chances of a successful VBAC are even higher.
A successful VBAC can have some advantages for future pregnancies:
- You avoid another scar on your womb.
- Future births can carry fewer risks.
- The chance of placenta problems linked to scarring is lower.
The RCOG’s patient information makes two recommendations that may guide your decision-making:
- The risks increase with each caesarean, so if you hope to have more children, it may be better to avoid another caesarean when a VBAC is suitable and likely to succeed.
- VBAC is “normally an option for most women”, but if you have had more than one caesarean, you should have a detailed discussion with a senior obstetrician about your individual risks/benefits and chances of success. RCOG also notes VBAC is not advisable in certain situations (including “three or more previous caesarean deliveries”).
What Are the Main Risks of VBAC?
The main serious risk that people talk about with VBAC is uterine rupture. This means the old caesarean scar on the womb opens up during labour. This is rare, but it is an emergency when it happens. For most women with one previous caesarean, the risk is often quoted as around 1 in 200. Inducing labour (starting it off with medication or a drip) can increase the risk of scar problems, so this should be discussed carefully with you beforehand.
Because of this, VBAC is usually recommended to be:
- In a consultant-led hospital rather than at home or in a standalone birth centre.
- With continuous monitoring for you and your baby.
- In a setting where an emergency caesarean can be done quickly if needed.
Placenta Praevia
What is it?
The placenta is the organ that develops during pregnancy to feed your baby with oxygen and nutrients. Usually, it sits high up in the womb. “Placenta praevia” is when the placenta is low down, near or actually covering the cervix (the opening at the bottom of the womb). It is estimated that 1 in 200 women have placenta praevia (by the end of pregnancy).
Why Is Placenta Praevia Important?
Placenta praevia matters because it can cause bleeding, especially later in pregnancy:
- If the placenta is covering or close to the cervix and you go into labour, it can lead to heavy bleeding.
- This bleeding can be dangerous for both you and your baby, which is why doctors take it seriously.
The good news is that a low‑lying placenta often moves up as the womb grows:
- It’s usually first picked up at the routine 20‑week scan.
- For many women, the placenta is no longer low at a follow‑up scan later in pregnancy.
- If it’s still low, you’ll usually have extra scans, often around 32 weeks and possibly again after that.
If the placenta is still very close to or covering the cervix towards the end of pregnancy, a planned caesarean is usually the safest way to give birth.
How Does a Previous Caesarean Affect This?
Having had a caesarean before makes placenta praevia more likely in a future pregnancy. The placenta is also less likely to move upwards if it’s attached near a scar on the womb. That’s one reason why your scan reports and placenta position are watched more closely if you’ve had a previous caesarean.
If you’re told you have a low‑lying placenta or placenta praevia, your team will give you clear advice about:
- When to seek urgent help (e.g. with any bleeding, contractions, or sudden pain).
- Their recommendations for your birth.
Placenta Accreta Spectrum
What is it?
“Placenta accreta spectrum” (often shortened to PAS) is a group of conditions where the placenta attaches too deeply into the wall of the womb. Instead of peeling away easily after the baby is born, it can be stuck.
There are different levels:
- Placenta accreta - the placenta is more firmly attached than normal.
- Placenta increta - it grows into the muscle of the womb.
- Placenta percreta - it grows right through the womb and may reach nearby organs, such as the bladder.
Why Does a Previous Caesarean Increase the Risk?
A previous caesarean leaves a scar on your womb. In a later pregnancy, the placenta may attach over that scar. Scar tissue behaves differently from normal tissue, and sometimes the placenta can grow more deeply into it. The more scars you have (from caesareans or other operations on the womb), the higher the risk that:
- The placenta will attach low down.
- It will attach abnormally deeply, leading to placenta accreta spectrum.
What are the Risks?
Placenta accreta spectrum (PAS) can be serious because it is strongly linked to heavy bleeding around the time of birth. If the placenta cannot separate properly:
- You may lose a large amount of blood very quickly.
- You may need blood transfusions.
- In some cases, doctors may need to perform a hysterectomy (remove the womb) to control the bleeding.
Because of these risks, if it is suspected, your care is usually moved to a specialist team. Birth is often planned a bit earlier than your due date, by caesarean, in a hospital with the right staff and facilities to manage heavy bleeding if it happens.
How is PAS Diagnosed and Managed?
If you have risk factors (like a previous caesarean and/or a low‑lying placenta), your doctors will look very closely at your scans. They may:
- Arrange extra ultrasound scans to examine the placenta in detail.
- Consider an MRI scan to get a clearer picture - MRI doesn’t use radiation and is considered safe in pregnancy.
Sometimes, PAS is only confirmed during the caesarean itself. If it is present, your team will act quickly to keep you safe. Management can involve:
- Careful planning of the caesarean with senior surgeons and anaesthetists.
- Having extra blood available for a blood transfusion.
- Sometimes using specialist techniques (like interventional radiology) to reduce bleeding.
- In some cases, performing a hysterectomy is the safest option.
What About Future Fertility?
If a hysterectomy is needed, you won’t be able to carry another pregnancy because the womb has been removed. Your ovaries are usually left in place, meaning your hormones continue as normal. If your womb is preserved, having had PAS once can increase the risk of placenta problems in any future pregnancies (around 1 in 3 women develop PAS again).
Planning for the Future: Practical Tips
Thinking about future pregnancies after a caesarean can feel daunting, but a few steps can help you feel more in control:
- Share your history early. At your appointment, tell your midwife or doctor how many caesareans you’ve had and whether you’ve ever had a vaginal birth.
- Talk about your long-term plans. If you have a sense of how many children you might like, it can help your team tailor their advice.
- Ask about placenta checks. Make sure you understand what your scans show about placenta position and whether any follow-up scans are needed.
- Know the red‑flag symptoms. If you are told you have a low-lying placenta or placenta praevia, ask exactly when you should call or come to the hospital (e.g., with bleeding, pain, or contractions).
- Take time with the VBAC vs repeat caesarean decision. Ask about your personal chances of a successful VBAC, and what the main risks are for you, not just in general.
- Write down your questions. It can help to bring a list to your antenatal appointments, so you don’t forget anything important.
Future pregnancies after a C-section are usually very possible, and many people go on to have more healthy babies. Understanding how caesareans affect things like placenta position, bleeding risk, and birth options can make those conversations with your care team less intimidating and more empowering.
