There is no added risk to the mother or baby when a woman has five or more repeat cesarean deliveries compared with three or four c-sections, according to a study from Saudi Arabia.

Women are often counseled not to undergo more than three c-sections due to an increased risk that uterine scars may rupture. However, in certain countries where large families are encouraged, such as Saudi Arabia, this advice often falls on deaf ears.

Although the safety of cesareans has improved over the years, little is known about the risks of having five or more c-sections, according to a report in the British Journal of Obstetrics and Gynaecology.

To investigate, Dr. Mumtaz Rashid, from the Security Forces Hospital in Riyadh, Saudi Arabia, and Dr. Rabia S. Rashid at the University College School of Medicine in London, compared the outcomes of 308 women who had undergone at least four previous c-sections with those of a comparison group of 306 women who had had two or three previous c-sections.

In the group of 308 women, most had four previous c-sections, but one woman had 8, two women had 7, seventeen had 6, and seventy-nine had 5 previous cesareans.

The researchers found that the mothers’ and infants’ outcomes for the two groups were general similar. No mothers in the higher-number c-section group died, whereas one died in the comparison group, the team notes.

“Nevertheless,” they write, “the general risks associated with operative delivery and frequently repeated pregnancies remain real and patients must be made aware of these.”

SOURCE: British Journal of Obstetrics and Gynaecology, October 2004.