With the steady increase in cesarean births across the world, valid concerns have been raised about the prevalence of this procedure, and it has become extremely urgent and important to ensure safer future deliveries for women who have previously delivered via Cesarean section.

We spoke to three fertility experts who provided us with information on the major things a woman who has had a C-section procedure should know before considering getting pregnant after a C-section. We also discuss the effects of a Cesarean on fertility, and the best time to have sex after a C-section.

A previous delivery via C-section does not mean that the chances of a successful and stress-free future delivery are unattainable for you. However, extra care should be taken to minimize the risk of complications during pregnancy and childbirth. Here are some of the things you should consider to ensure the safety of both mother and baby.

Does a C-section affect your fertility?

Having a C-section rarely has an effect on your future fertility, says Dr. Barry Witt, the medical director at WINFertility. The procedure is mostly performed as an emergency where an infant is positioned feet first (called the breech position), and this is not associated with reductions in a woman’s ability to reproduce. When the C-section is performed as a result of the baby’s breech position, an initial condition such as a uterine fibroid may have resulted in the breech. Witt explains that such fibroids may be associated with future fertility problems, but they do not specifically occur as a result of the C-section. 

According to Witt, some factors—when coupled with the performance of the C-section—may lead to a decline in fertility. “Women who have had prior C-sections should be counseled that shorter intervals between pregnancies have been associated with an increased risk of uterine ruptures and maternal complications,” he says. He also adds that some decrease in fertility occurs as a result of aging from the time of the previous C-section to the time that another pregnancy is attempted. “There might also be some scarring outside the uterus or defects in the uterine wall at the site of the C-section scar that may adversely affect fertility,” he says, adding, “But these are rare.”

How long after a C-section can you get pregnant?

Most medical experts recommend waiting at least six months after a live birth before getting pregnant again in order to reduce the risk of complications like premature birth, low birth weight, and congenital disorders. According to the Mayo Clinic, research generally suggests waiting between 18 and 24 months, although women older than 35 might want to wait 12 months. Ultimately, this timeline is dependent on many factors and is best to discuss with your medical provider.

When is it safe to have sex after a C-section?

You may also be uncertain about the safest time after the procedure to start having sex. Being able to have sex comfortably is an important consideration involved in getting pregnant after a C-section. As Witt explains, it is commonly recommended that sexual activity should be delayed until at least six weeks postpartum. 

On the whole, there are minimal medical concerns about returning to sexual intercourse after a C-section. Dr. Krystyna Holland, a physical therapist and owner of Inclusive Care, LLC, suggests that it might be better to opt for simpler positions for a while. “Usually, the time it takes for the incision to heal is six weeks,” she says. “This does not necessarily mean that your body is completely back to normal and ready to go at that point, therefore, some pain during intercourse can be expected.” 

It is also common to feel discomfort while having sex as a result of the pressure in your core, or anxiety and self-consciousness from your C-section scar. Witt suggests that as you resume sexual activity after the healing of your incision, your comfort must come first before anything else. This means that it’s best to hold off on having sex until you’re mentally and emotionally ready.

Why won't my C-section scar stop hurting?

Additionally, after a C-section, a lot of women continue to feel pain from their incision scar for quite a longer time than they expected, which makes them think there is something wrong with their scar, or that they are not healing properly. For a woman who is trying to get pregnant, this can be an issue. Holland, who guides women through the healing process after a C-section, explains that there usually isn’t anything wrong with the scar or the tissue underneath, but it can become sensitized, which can be resolved with treatment by an expert. 

“A lot of women are told that their C-section scar will heal with time,” she says, “And even though this is true in most cases, there are some situations whereby women have to wait for a long time to heal, because they were previously unaware that they could have done so sooner by engaging in physical therapy sessions led by a professional.”

Pain relief tips during C-section recovery.

If you have gone through a C-section, it is important to ensure that you heal completely, so as to avoid complications with future births. Simple exercise routines such as Kegels are recommended to ease the pain, strengthen the pelvic floor and quicken the recovery process. A few things you may also need around you while you heal: heating pads, prescribed painkillers, and lots of water.

Yoga can also help with recovery after cesarean delivery. Dr. Heather Bartos, a Board Certified OB-GYN and founder of Badass Health, highly recommends this practice for women who are recovering from a C-section. 

“Yoga helps in modulating the stress response after the surgery, and this, in turn, helps in shortening the recovery period,” she says. Meditation also has the added benefit of relaxing the mind. According to Bartos, both are important for every mom recovering from a C-section, and their combined effect helps in strengthening the mind and body.

Finally, it is important to keep in mind that a C-section is a major procedure, and it takes time for your body to get back on track and prepare for the reproduction process again. You should take time to carefully plan future pregnancies only when you feel physically and mentally ready to do so. Consulting your OB-GYN regularly will also help you ensure that your health and safety are guaranteed both during and after the pregnancy.