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Wow. That is almost opposite of what my OB told me. She said that if we wanted more than 1 or maybe 2 more kids (total of three), that I should try for VBAC. That risk of uterine rupture, scar tissue forming and other complications increases with each surgery. She also said that she wanted there to be at least 2 years between births. If you are concerned, then you should get a second opinion.

My OB hasn't given me a number but I only want one more. My friend had 3 uncomplicated c sections!

Maybe get a second opinion? I had an emergency c with my LO and have already told my OB I do not want to try for a VBAC with my next LO. While he would prefer I try a VBAC and I am sure will try to persuade me when the time comes, he's willing to do an elective c section without much fuss so long as I'm not planning on having more than 2 children.

Just from a quick read through a few studies, I've found that women who have MRCS (multiple repeat cesarean sections) are five times more likely to have preterm delivery.

In the first study I listed below, 18% had either placenta praevia or accreta. Within this sub-group there was a further increase in maternal complications including major obstetric and postpartum haemorrhage, which resulted in 50% of the women requiring a hysterectomy and two thirds needing critical care after delivery.

It appears to be really risky.

Here are some studies and articles you might find helpful.

http://www.bjog.org/details/news/2865141/BJOG_release_Higher_risk_of_maternal_complications_and_preterm_deliveries_for_wo.html

http://www.cnn.com/2009/HEALTH/11/11/caesarean.section.risks/index.html?iref=mpstoryview

http://health.usnews.com/health-news/news/articles/2012/11/01/multiple-c-sections-linked-to-raised-complication-risks-study

http://www.webmd.com/baby/news/20060607/more-c-sections-more-complications

http://www.obgmanagement.com/home/article/repeat-cesarean-again-and-again-and-again/79e78ef6b2c736556e2343c317b0a9a2.html

@Skadi: Wow - there are a lot of risks associated with having that many c sections. I know several people who have had 3 and said the recovery gets easier every time. I have now had 2 and the second recovery was harder. I am a physician and did tons of research before having an elective section for my second. I'm hoping to try a VBAC for my 3rd.

Uterine rupture is certainly a concern but the risk is highest during labor and if you have elective c sections prior to going into labor that isn't really the biggest risk.

A major risk with having multiple incisions into your uterus is that the placenta could grow into your uterine wall and beyond - this risk increases with each c section and is very high after 3-4. It can grow into your bladder, intestines or blood vessels.

I know you said that delivering at an alternate hospital isn't really an option - but I would encourage you to give it another thought. While it isn't the most convenient thing in the world, if you could deliver further from home for your next baby and give your body a chance to deliver vaginally, that would allow you to attempt VBACs for each subsequent pregnancy closer to home - a safer option for you if you're planning on 5-6 little ones.

There are lots of people who have strong opinions about VBAC vs elective repeat c section. I don't - but I feel like you haven't been given appropriate information from your OB and hope you consider a second opinion. I hope you can safely have the big family you're dreaming of, whatever you decide! I love big families

@Skadi: Uterine rupture during labor, for a woman like you who has had one c-section, happens in less than 2 per 1000 women (slightly higher if labor was induced. If you include ALL vbacs no matter what drugs were used or how many previous c-sections the mother has had, the odds are 4.2 in every 1,000). The odds are quite low.

The risks of several repeat c-sections are astronomically higher than those of a VBAC (you can read the actual numbers in the studies I linked). Unfortunately both options come with risks, but the risk in VBAC is quite a lot lower.

@Skadi: I've had three c-sections and haven't been told I can't get pregnant again. I found this last csection to be the easiest to recover from.

A friend of a friend (who wants 6 kids) was told that VBACs were best if she was a candidate for it, because her first was a c-section, and 6 c-sections were unsafe.

But, i was told this at a bbq. Her second LO and my first aren't far apart in age. She's the only one I knew who'd ever had a VBAC and she said her desire for a large family was the reason her doctor was so for it.

A second opinion NEVER hurts, especially when there is so much contradicting information out there. I would at least speak with a doctor more well versed in this.

I do have a friend of the family who has had 5 c-sections. That was over 20 years ago. Pregnancy sucks because there are so many risks no matter what you do. The important thing is to listen to your heart/body, and find a physician who you can trust.

@Skadi: I'm so sorry you're in this position.

If you can find a chapter somewhat nearby, I'd encourage you to try the International Cesarean Awareness Network (ICAN). Most local groups have an online presence and they usually hold meetings. Some chapters are more active than others, but hopefully you can get plugged in to a group that will offer some constructive advice. The women in them often have knowledge of which doctors and midwives will do TOLAC/VBACs. Also, ICAN has a list of hospitals that have VBAC bans on their national website, but I'm not sure how recently it was updated. That might be a starting place to narrow your search (start with the hospital, then go to your insurance company's website and filter by specialty and privileges at the VBAC hospital). If there isn't a local ICAN chapter, I'd find local doulas to get a sense of your options regarding doctors and midwives. I think it's best to try to pin down a provider you're comfortable with before you get pregnant.

ACOG (the professional association many OBs are members of) released evidence-based and fairly conservative VBAC guidelines in 2010. These are worth reading. They're short, they're not full of jargon, they point to the actual studies that were reviewed in developing the recommendations, and they can help you decipher whether a provider is really VBAC-friendly.

@Arden: not to thread jack, but I'd love a doctor to chime in on this. I am sure litigation and malpractice insurance play a part - my GYN doesn't deliver bc the insurance is too crazy - but I also wonder if standard of care (sadly) just varies depending on your location. I'm in a major metro area and my doctor and hospital push VBACs over repeat sections and I'm sure they have malpractice insurance.