There are no hard a fast rules. In theory, a women should be able to have as many children by cesarian as she wants. In reality, it all comes down to how well a woman's body heals. UTERUS: for some women, the uterus heals with a thick lower segment. In this case, many sections are possible. For others, the lower segment becomes very thin and attenuated. In such cases, labor/contractions should be avoided because of risk of rupture of the uterus. Keep in mind that a very thin uterus can rupture even before labor begins. Doctors will sometimes counsel women to avoid future pregnancy if the lower segment becomes too thin. SCARRING: Another consideration is the amount of scarring within the abdominal cavity. Whenever any surgery is performed in the abdomen, raw surfaces are left behind and adhesions (things stuck to other things) can form. This is very individual. In some patients, they can have multiple abdominal surgeries with almost no adhesion; in others, they can have huge numbers of adhesions, involving uterus, omentum, bowel and bladder. In the second case, surgery (including cesarian section) becomes very difficult and there is a risk of bowel perforation and damage to other organs. PLACENTA: The more cesarian sections a woman has, the more likely it is that the placenta may implant in the uterine scar. If it does so, it will not develop properly, but will grow into the uterine muscle and not just the endometrium. Such a placenta is called an accreta (part way through) or percreta (all the way through), and will not separate properly from the uterus after the baby is delivered. In many cases, especially with a deep accreta or percreta, a hysterectomy is necessary (because removing the placenta is not possible without causing massive bleeding and potential maternal mortality).
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