Dear Dr Mitchell,

I am 41 years old and I'm borderline hypertensive but on low dose one-a-day tablets. I had two sons (15 and six) by C-section delivery. Can I have a third C-section? Rumour is that a woman can only have two C-sections.

Several decades ago it was the recommendation that a woman should only do three Caesarean sections because of the potential complications associated with the procedure. Caesarean sections in those days were done under general anaesthesia and this was associated with significant risks. These included failed intubation (putting the anaesthetic tube into the oesophagus instead of the trachea) and sometimes aspiration of stomach content into the lungs causing severe pneumonia and deaths. This risk was increased especially in emergency situations where the procedure was done with a full stomach.

Other complications of repeated Caesarean section included rupture of the uterus in a subsequent pregnancy and damage to structures such as bowel and bladder. Blood loss from a Caesarean delivery was also considerable and led to the deaths of several mothers.

In modern obstetric practice, general anaesthesia is rarely even done and anaesthetists worldwide are extremely skilled in administering regional anaesthesia (both epidural and spinal). Deaths or complications or from anaesthetic problems are now very rare, thus making Caesarean sections a lot safer especially in situations where repeat surgery has to be done. We now have trained obstetricians and gynaecologists widely available even in developing countries so there are fewer complications that result from damage to vital organs such as the bowel and bladder. Blood banks with adequate supplies are widely available so death from haemorrhage is also significantly reduced.

The usual rule of three Caesarean sections then tubal ligation is no longer the mainstay. Women have a choice and can have as many babies as desired. It is still a fact though that the greater then number of deliveries, the greater the risk of complications developing.

It is advised that if you are contemplating having additional children you should do so now. The risk of pregnancy complications will definitely increase as you go beyond 40 years old. Fertility also falls off so your chance of becoming pregnant will decrease the longer you wait. Your risk of developing birth defects in a subsequent pregnancy is significantly higher once you go beyond 40 years old. There are screening tests that you can do to detect some of these before the actual birth of the baby. Your risk of diabetes mellitus also increases with advancing maternal age. It is important for you to start taking folic acid before attempting conception and continue this at least throughout the first trimester.

Your best chance for conception is certainly now if you have any desires for additional children. Get a complete physical examination, pap smear and proper baseline screening tests for your hypertension before becoming pregnant.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@ jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.