You generally cannot become a surrogate after three C-sections because most fertility clinics and the ASRM set three as the maximum safety limit.

By respecting these medical boundaries, you protect your long-term health and ensure that every surrogacy journey begins with the highest standards of clinical safety.

If you want to know if you qualify based on your unique medical history, you can fill out our online form to get in contact with a surrogacy specialist today.

Can You Be a Surrogate After 3 C-Sections?

No, you generally cannot become a surrogate if you have already had three C-sections.

Most surrogacy agencies and fertility clinics strictly adhere to the American Society for Reproductive Medicine (ASRM) guidelines, which recommend a maximum of three cesarean deliveries for any surrogate candidate.

These evidence-based recommendations are designed to protect your long-term well-being and ensure the best possible outcome for the baby. When evaluating a candidate’s surgical history, fertility specialists focus on:

• Uterine Integrity: Assessing the strength of the uterine wall. Each subsequent C-section can thin the myometrium (the muscle layer of the uterus), increasing the risk of complications in a future pregnancy.
• Scar Tissue (Adhesions): Evaluating the buildup of scar tissue from three previous major abdominal surgeries, which can make a fourth surgery significantly more complex.
• Incision Type: Reviewing past operative reports to confirm that previous incisions were “low-transverse.” Other types of incisions may further limit eligibility.
• Previous Recovery: Confirming that the three prior C-sections were not accompanied by serious conditions like placenta accreta or uterine rupture.

While having a history of three healthy C-sections is a testament to your body’s resilience, the medical community views a fourth C-section as an unnecessary risk to your health.

Why Surrogacy Agencies Limit the Number of C-Sections

Surrogacy agencies limit the number of C-sections to three because each subsequent surgery increases the risk of life-threatening complications, such as uterine rupture and placenta accreta.

Every time a C-section is performed, the muscle of the uterus (the myometrium) is replaced by fibrous scar tissue at the incision site.

This tissue is less flexible and resilient than healthy muscle, leading to several primary medical concerns:

• Uterine Rupture: This is a medical emergency where the scar from a previous surgery tears during pregnancy or labor. Because surrogacy often involves IVF and potentially higher birth weights, the strain on a thrice-scarred uterus creates a high risk for this life-threatening event.
• Placenta Accreta Spectrum: This is a serious condition where the placenta grows too deeply into the uterine wall, often anchoring itself into previous C-section scars. This can lead to severe hemorrhaging during delivery and frequently results in a necessary hysterectomy.
• Placenta Previa: With each additional C-section, there is an increased likelihood that the placenta will attach to the lower part of the uterus, covering the cervix. This can cause severe bleeding throughout the third trimester and requires a high-risk delivery.
• Surgical Adhesions: Repeat abdominal surgeries cause bands of scar tissue (adhesions) to form. These can cause internal organs, like the bladder or bowels, to “stick” to the uterus. This makes a fourth surgery significantly more complex and increases the risk of accidental organ injury.

By adhering to these limits, agencies and fertility clinics prioritize your long-term health. Respecting these medical boundaries is the best way to honor the incredible gift you are offering to hopeful parents.

What Are the Alternatives if Surrogacy Isn’t Possible After 3 C-Sections?

If you cannot become a surrogate due to having three or more C-sections, you can still make a profound impact on the surrogacy community by becoming an advocate, joining a referral program, or providing peer support.

If carrying a pregnancy isn’t the safest path for your health, consider these meaningful ways to stay involved:

• Participate in a Surrogate Referral Program: At our agency, we offer a surrogate referral program that allows you to play a direct role in creating a new family.
• Become a Surrogate Advocate: Use your personal birth experiences and your passion for surrogacy to educate others.
• Join Emotional Support Networks: Experienced mothers possess unique insights into the emotional nuances of pregnancy and recovery.
• Community Education: Share your story to help destigmatize surrogacy. Whether through social media, blogging, or local community groups, your voice helps humanize the process for those just beginning their research.

Your contribution to the surrogacy community isn’t defined solely by a pregnancy. Whether you are the one carrying the baby or the one empowering another woman to do so, you are a vital part of the mission to bring families together.

Can Exceptions Ever Be Made for Surrogates With 3+ C-Sections?

No, exceptions for women with more than three C-sections are extremely rare, as fertility clinics and insurance providers strictly follow ASRM safety parameters.

These rigorous standards are in place because a surrogate pregnancy involves specific legal and financial risks that a standard pregnancy does not.

Similarly, many insurance policies that cover surrogate pregnancies have strict eligibility requirements. If a surrogate has a history that falls outside of “standard” safety limits, the provider may refuse coverage, leaving both the surrogate and the intended parents vulnerable.

If your medical history, specifically the number of previous C-sections, makes a journey unsafe according to clinical standards, we will be honest with you about those boundaries.

Our priority is ensuring that every woman who works with us remains healthy for her own children and her own future.

Other Requirements You Must Meet to Become a Surrogate

To protect your health and the future of the intended parents’ baby, you must meet specific medical and lifestyle requirements, including having no more than three previous C-sections.

While every journey is unique, our agency and fertility clinics follow these core requirements:

• You must have a history of at least one successful, uncomplicated pregnancy and be currently raising a child.
• You can have no more than three previous cesarean births and five vaginal births.
• Be between the ages of 21–40 and
• A healthy BMI of 19–32.
• No smoking or illicit drug use.
• At least six months must have passed since your last vaginal or cesarean birth before starting a new journey.
• You must have no major complications from previous pregnancies
• Must be off anti-depressants or anti-anxiety medications by the time you begin medication for the medical process.
• All candidates must pass a background check with no felony convictions.

These criteria are designed to ensure that you are in the best possible position to help a family grow while remaining safe and healthy for your own family.

If you want to talk to someone about your medical history and see if you qualify to become a surrogate, you can fill out our online form to connect with a specialist today.

Not Eligible to Be a Surrogate? Here’s How You Can Still Help

If you are not eligible to be a surrogate due to your C-section history, you can still play a vital role in our community as a dedicated advocate.

Your experience as a mother and your passion for helping others are powerful tools.

By connecting with our team, you can determine the best path forward for your unique situation, honoring your own health while still helping others fulfill their dreams of parenthood.

If you’d like to participate in our referral program for a potential bonus, learn more today.