People sometimes joke that having a baby via cesarean delivery is like “taking the easy way out,” but if you’ve ever actually had a C-section, you know this is hugely inaccurate.
No, you didn’t squeeze a baby out through your birth canal, but you did have your abdominal wall surgically opened up and then stitched back together again, and that’s a big deal.
But what about the next time you decide to have a baby — how does your C-section affect your future pregnancies? Here’s what you need to know.
We like to jump right in with clear, definitive answers that quickly dispel medical myths and rumors, but unfortunately, the answer to this particular question is still somewhat unknown.
Why? Because there are two major conflicting studies we have to look at. The first, a 2014 study, suggests that the differences in birth rates after C-section are minimal enough to be insignificant.
Out of the nearly 2,500 people followed for the study, about 69 percent were able to conceive again within 3 years after having a C-section. Of those who had vaginal births, about 76 percent were able to conceive in the same time frame.
Still, the researchers of the 2020 study admit there were other factors (like geographical location and socioeconomic status) that could have easily affected the results.
So we don’t know for sure whether a C-section could affect your future fertility, but here are some things to keep in mind:
- If cesareans are linked to lower rates of fertility, it’s probably a minimal — not astronomical — difference.
- Some studies show there’s no effect on fertility and the ones that do have been, so far, limited in scope.
- It’s possible that the correlation between C-sections and infertility isn’t about the surgical procedure itself. Instead, the connection could be related to the cause for your C-section (like needing to be induced for low amniotic fluid or other common reproductive issues that often lead to C-sections).
The question of “how long is the perfect amount of time to wait in between pregnancies” is dependent on a lot of factors — how old you are, whether you had a high risk pregnancy last time, and, yes, if your previous delivery was a C-section.
In general, you should wait at least 6 months before getting pregnant again after a C-section. That’s the bare minimum needed; some experts suggest it’s better to wait 12 to 15 months, while others say 18 to 24 months.
How long you, specifically, should wait should be a conversation with your doctor. Ideally you want someone who knows you to assess your overall health, your pregnancy and fertility history, and your age before giving you a recommendation.
A C-section is major abdominal surgery, and your body needs time (probably more than you realize) to fully heal. Otherwise, you could be at a higher risk for:
- Uterine rupture. Basically, the longer you wait, the lower your risk of rupture. A
2010 studyfound that the rate of uterine rupture in people who had prior cesareans was:
- almost 5 percent in those who got pregnant again in less than 18 months
- almost 2 percent in those who waited 18 to 23 months
- just over 1 percent for those who waited 24 months or longer
- Placenta accreta. Sometimes the placenta embeds itself into the lining of your uterus (or even into an existing C-section scar), which can lead to serious complications during delivery. People who have had a C-section are more likely to experience this condition.
- Preterm birth. Two recent studies published in 2019,
one from BJOGand one from PLOS One, correlate C-sections in first pregnancies to preterm births in second pregnancies. In both, there was a statistically significant higher rate of preterm births in people who’d had prior cesareans. Some researchers suspect this may be worsened by shorter periods of time between pregnancies, but at this point that hasn’t been studied carefully enough to say for sure.
We’ve hit you with a lot of science, but now we’re going to get real: Waiting 24 months between pregnancies isn’t always doable. If you’re over the age of 35 or suspect you might have trouble conceiving again, you may not be able to hold off a whole 2 years.
And, of course, let’s not forget about all those “oops” babies. If you accidentally get pregnant 7 months after a C-section, are you doomed to face uterine rupture, birth hemorrhaging, a preterm baby, and all kinds of other complications?
No! Remember, the risks are still fairly low in the grand scheme of things. You can have a perfectly healthy pregnancy soon after having a C-section if you work closely with your doctor to head off potential complications.
If you’re older or have known fertility problems, talk to your doctor about future pregnancies and your unique timeline.
Way back in the day (like, the 70s — was that really 50 years ago?!), people were mostly discouraged from trying to have a vaginal birth after cesarean, or VBAC. Doctors just didn’t know enough about the safety of it to recommend it or take the chance.
Now, thankfully, we do know enough about VBAC: While it’s definitely not recommended in some cases, it can be a totally safe and viable option for delivery, even if you’ve had more than one C-section in the past.
In many cases it can be safer than repeat cesareans, helping you recover faster and avoid infection.
That said, your ability to have a VBAC depends on your pregnancy and your C-section history. There’s always a chance that your prior cesarean incision could rupture during delivery, especially if it was a vertical incision versus a side-to-side incision.
But these rates are awfully low, coming in
In theory, you’re keeping up with your regular OB-GYN appointments, including your 6-week postpartum check-up and your annual gynecology exam. These are both great times to bring up the matter of conceiving again with your doctor.
If you’re not mentally ready to think about having another baby yet (the first one is still keeping you up all night, after all), that’s OK, too. You can schedule a separate appointment to talk about your fertility options with your provider when you’re ready.
Whenever the conversation happens, make sure to ask your doctor:
- How long they recommend you wait until trying to conceive again, based on your previous pregnancy and overall health.
- If you can “afford,” in terms of your age and fertility, to wait the preferred 24 months before getting pregnant again.
- How they handle pregnancies that happen sooner than expected after C-section (e.g., if they’ll schedule extra ultrasounds to check the health of your uterus or placenta).
- What their position is on VBAC and whether or not they think you could possibly be a candidate for it, should you get pregnant again in the near future.
Of course, if you’re nowhere near ready to think about another baby — let alone have one — make sure you let your provider know that, too, so they can advise you on the best way to avoid pregnancy. Some forms of contraception and family planning don’t exactly play nice with breastfeeding.
Chances are, your C-section won’t change much about your plans to continue growing your family. Any effects these surgeries have on fertility and pregnancy health are typically minimal at best (and some are still pretty unconfirmed).
Generally speaking, the longer you wait between pregnancies the healthier you’ll be, but that doesn’t mean two pregnancies close together is always dangerous or something to avoid. When in doubt, talk to your doctor and make a plan together.