With the opening of the singleton birth policy, more and more mothers are planning for the birth of their second child to add a companion to their little one and add more fun to their family. For mothers who had their first child by cesarean section, the preparation for pregnancy and delivery of the second child has added some risks due to the scar, which requires more careful and serious pre-conception preparation. (a) Problems associated with cesarean section: 1. The incidence of secondary infertility is significantly higher than that of normal births: According to the British Journal of Obstetrics and Gynecology, the study, conducted by the University of Aberdeen in the UK, surveyed 25.371 million women over a 17-year period since 1980. The researchers found that women who had a cesarean experience were more likely to give birth again and at longer average intervals than women who had a natural birth. Of the women who had a cesarean section, 66.9 percent gave birth again after an average of 36.3 months. In contrast, 71.6% and 73.9% of women who had a spontaneous delivery were likely to give birth again, with an average interval between births of only 30.4 and 31.8 months, respectively. The high incidence of secondary infertility is related to factors such as postoperative pelvic adhesions affecting the function of the fallopian tubes and the formation of cesarean scars in the lower part of the uterus changing the uterine cavity environment. 2.Incomplete menstruation after cesarean section: It is mainly caused by the formation of scar diverticulum in the lower part of the uterus with poor wound healing after cesarean section. The main manifestation is dripping menstruation and infertility, and some patients may have chronic lower abdominal pain or abdominal pain during menstruation. Some patients may suffer from chronic lower abdominal pain or menstrual abdominal pain. Some patients may suffer from uterine rupture during pregnancy or delivery, which may endanger the life of the mother and child. In addition, scar diverticulum causes difficulty in the drainage of menstrual blood in the uterine cavity, resulting in infection and fluid accumulation in the uterine cavity, which also interferes with the implantation of embryos in the IVF cycle and requires surgical treatment if necessary to improve the symptoms. 3. High complications during pregnancy after cesarean section: the scar of the uterine incision is weak and inelastic, which will be stretched and thinned with the increase of the uterus during pregnancy, easily leading to uterine rupture in the middle and late stages of pregnancy and even endangering the life of mother and child. The presence of the scar also increases the risk of placental abnormality, resulting in low placental position, placenta adhesion to the scar, placenta implantation in the myometrium which is not easily delivered during labor, resulting in heavy bleeding during labor and risk of hysterectomy. Therefore, if you have a second pregnancy after cesarean delivery, you need to strengthen monitoring and strict obstetric examination throughout pregnancy and delivery to reduce the occurrence of adverse maternal and child outcomes. 4. Uterine cesarean scar pregnancy: it is a rare ectopic pregnancy in which the gestational sac is laid in the scar of the uterus after cesarean section, and is in fact a special kind of myometrial pregnancy. As the gestational sac grows, the cesarean scar is continuously stretched and thinned, and the blood supply of the gestational sac is abundant, leading to complications such as uterine bleeding, uterine rupture, and even hysterectomy to save the patient’s life. Therefore, a close obstetric examination for a second pregnancy after cesarean section needs to start with a positive pregnancy test. (2) Second pregnancy preparation for mothers who had a first cesarean section: 1. timing of pregnancy: two years after cesarean section. Because of poor healing of the uterine wounds in the short term after surgery, premature pregnancy, due to the development of the fetus makes the uterus increasing in size, the uterine wall becomes thinner, especially at the surgical incision is connective tissue, lack of elasticity. Fresh scars can easily swell and break at the end of pregnancy and during delivery, which can cause abdominal hemorrhage or even threaten life. Therefore, it is safer to have another pregnancy two years after the surgery. 2. Obstetric checkups during pregnancy: those who are pregnant again after cesarean delivery should closely strengthen the obstetric checkups throughout pregnancy to know in detail the thickness of the uterine incision scar, the location of the placenta and the intrauterine development of the baby, and monitor the mother’s condition during pregnancy according to the opinion of the obstetrician to reduce the incidence of complications during pregnancy and delivery. 3. Pay attention to abdominal pain during pregnancy: Scarred uterus will have the risk of spontaneous rupture in late pregnancy, and abdominal pain is the main manifestation. Due to the poor healing of the uterine scar with the increase of pregnancy months, the intrauterine pressure increases and the uterus can rupture from its scar without any trigger. When the uterus ruptures, abdominal pain of varying severity can occur, sometimes the abdominal pain is light but the uterus has ruptured, we must be alert and seek medical attention. 4. Early admission to hospital for delivery: The closer the scarred uterus is to the delivery date, the greater the risk of rupture. In order to prevent uterine rupture or fetal death, you should be admitted to hospital two weeks in advance for delivery so that problems can be detected and dealt with in time. The mode of delivery needs to be guided by an obstetrician who will assess the scar condition. There is a high incidence of recurrent cesarean delivery in pregnancy after cesarean delivery. Cesarean delivery is a double-edged sword that helps us to avoid severe pain during labor and delivery when we are first mothers, but at the same time brings us worries about postpartum recovery and second childbirth. Therefore, we suggest that mothers-to-be who have not yet had a baby should avoid cesarean delivery without medical indication, avoid risk factors for cesarean delivery such as twin pregnancies, and bravely face and experience the pain and joy of welcoming a new life as a gift from nature; mothers-to-be who have a history of cesarean delivery should do their homework before and during pregnancy to have a smooth delivery and upgrade again.