- With Mayo Clinic obstetrician and medical editor-in-chief
Roger W. Harms, M.D.read biographyclose window
Roger W. Harms, M.D.Roger W. Harms, M.D.
"Nothing helps people stay healthy more than the power of real knowledge about health." — Dr. Roger Harms
As medical director of content, Dr. Roger Harms is excited about the potential for Mayo Clinic's health information site to help educate people about their health and provide them the tools and information to live healthier lives.
The Auburn, Neb., native has been with Mayo Clinic since 1981 and is board certified in obstetrics and gynecology. Dr. Harms is a practicing physician and associate professor of obstetrics and gynecology, and his specialty areas include office gynecology, high-risk obstetrics and obstetrical ultrasound.
From 2002 to 2007, Dr. Harms was director for education at Mayo Clinic, Rochester, Minn. Dr. Harms was the 1988 Mayo Medical School Teacher of the Year and served as associate dean for student affairs and academic affairs. He is the co-author of the "Mayo Clinic Model of Education." In 2008, Dr. Harms was presented the Distinguished Educator Award, Mayo Clinic, Rochester.
Dr. Harms is vice chair of the Department of Obstetrics & Gynecology and medical editor of the Pregnancy section on this website. In addition, Dr. Harms is editor-in-chief of the "Mayo Clinic Guide to a Healthy Pregnancy" book, a month-by-month guide to everything a woman needs to know about having a baby.
"My medical education experience has grown out of a love of teaching, and that is what this site is about," Dr. Harms says. "If any visitor to this site makes a more informed and thus more comfortable decision about his or her health because of the information we provide, we are successful."
Repeat C-sections: Is there a limit?
How many C-sections can a woman safely have?
from Roger W. Harms, M.D.
Although there isn't enough research to support a specific limit on repeat C-sections, most women can safely have up to three cesarean deliveries. Each repeat C-section is generally more complicated than the last.
For some women, the risk of surgical complications — such as infection or heavy bleeding — increases only slightly from one C-section to the next. If you had a long and difficult labor before your first C-section, a repeat C-section might be less physically taxing. The healing process will take at least as long, however, and possibly longer if you develop complications.
For other women — such as those who have significant internal scarring or bands of scar-like tissue that cling to the uterus (adhesions) — the risk of each repeat C-section increases substantially.
Primary concerns with repeat C-sections include:
- Weakened uterine wall. Each uterine incision leaves a weak spot in the uterine wall. This might interfere with future pregnancies.
- Problems with the placenta. The more C-sections you've had, the greater the risk of developing problems with the placenta — such as when the placenta implants too deeply and firmly to the uterine wall (placenta accreta) or when the placenta partially or completely covers the opening of the cervix (placenta previa).
- Bladder injuries. Bladder injuries, which are possible but uncommon with initial C-sections, are more likely with repeat C-sections. The increased risk is likely due to scar-like tissue that developed after a previous C-section, binding the bladder to the uterus.
- Heavy bleeding. Heavy bleeding is possible after any C-section. The risk of excessive bleeding increases with the number of repeat C-sections. The risk of needing a hysterectomy — removal of the uterus — to control life-threatening bleeding also increases with the number of repeat C-sections.
Repeat C-sections appeal to many women. Beyond three C-sections, however, the surgical risks must be weighed carefully against the desire for subsequent pregnancies.
- Berghella V. Repeat cesarean delivery. http://www.uptodate.com/index. Accessed Feb. 29, 2012.
- Berghella V. Cesarean delivery: Postoperative issues. http://www.uptodate.com/index. Accessed Feb. 29, 2012.
- Lyell DJ. Adhesions and perioperative complications of repeat cesarean delivery. American Journal of Obstetrics and Gynecology. 2011;205:S11.