Recommended Interpregnancy Interval After Cesarean Section
You should wait at least 18-24 months after your cesarean delivery before conceiving again, which means at 20 months postpartum, you are approaching the safe window to begin planning your next pregnancy.
Why the 18-Month Minimum Matters
The American Academy of Family Physicians identifies an inter-delivery interval shorter than 18 months as a specific risk factor that increases the likelihood of uterine rupture in subsequent pregnancies 1. This recommendation is based on the time needed for complete uterine scar healing and tissue remodeling after cesarean section.
Your Current Timeline (20 Months Postpartum)
At 20 months after your cesarean delivery, you are just past the critical 18-month threshold. If you conceive now, your inter-delivery interval would be approximately 29 months (20 months + 9 months pregnancy), which falls within the safe range 1.
Risks of Short Interpregnancy Intervals
- Uterine rupture risk increases significantly when the interval between deliveries is less than 18 months, which can be fatal for both mother and baby 1
- Each additional cesarean delivery progressively increases risks in future pregnancies, including abnormal placentation (placenta accreta, increta, percreta) 1
- After one cesarean section, placenta accreta risk is 12.9 per 10,000 births; after two cesareans, it rises to 41.3 per 10,000 1
- Placenta previa incidence increases with each cesarean: 9 per 1,000 after one cesarean, 17 per 1,000 after two, and 30 per 1,000 after three or more 1
Long-Term Considerations for Future Pregnancies
Repeat cesarean deliveries carry cumulative risks that should factor into your family planning decisions 1, 2:
- Risk of hysterectomy increases with each cesarean delivery 1
- Surgical complications compound with multiple cesarean sections 1, 2
- Women with several cesarean deliveries may lose the option for vaginal birth after cesarean (VBAC) in future pregnancies 1
Options for Your Next Delivery
If you had a low transverse (horizontal) uterine incision during your cesarean, you should be counseled about attempting a trial of labor after cesarean (TOLAC) for your next pregnancy 2, 3:
- Approximately 74% of women who attempt VBAC achieve successful vaginal delivery 2, 3
- Short-term maternal outcomes are as good or better with successful VBAC compared to repeat cesarean delivery 1, 2
- Previous vaginal delivery (either before or after your cesarean) is the single strongest predictor of VBAC success 2, 3, 4
Critical Safety Points
- Never use misoprostol (Cytotec) for cervical ripening or labor induction if you attempt VBAC, as it carries a 13% uterine rupture risk 1, 2, 3
- If labor induction is needed, oxytocin carries a 1.1% rupture risk, while prostaglandin E2 carries a 2% risk 1, 2, 3
- Discuss your delivery options early in prenatal care, ideally establishing a plan by the end of the second trimester 2
Bottom Line
At 20 months postpartum, you are in a reasonable timeframe to begin planning your next pregnancy, as conception now would result in an inter-delivery interval of approximately 29 months, well above the 18-month minimum safety threshold 1. However, ensure you discuss your specific uterine scar type and future childbearing plans with your obstetrician early in prenatal care to optimize outcomes for both you and your baby 2, 3.