I don't believe they will do a csection hysterectomy because you are worried that a tubal will fail. I have seen 4 different drs. Every one of them have told me I need a hysterectomy due to adenomyosis (endometriosis of the uterus), surgically/pathalogically confirmed endometriosis, fibroids, and heavy and painful periods. The first endometriosis specialist I saw did not recommend a csection hysterectomy due to my having partial hellp and severe pe. I have a risk of pp hemmorage as I had hemmoraged after my loss with Peyton. He said that the postpartem/pregnant uterus is full of extra blood volume. That would make me at risk for a hemmorage. HOWEVER, I have had adhesions for no reason. So balancing a csection hysterectomy against bloodloss or adhesions. I would have to have a surgeon and team prepared for it. My pcp, second endometriosis specialist (one that performed my lap in May), my ob, and my peri recommend a csection hysterectomy if I get pregnant. 1) because I have had severe pe/pih/mild pe three times and they don't want anymore babies (well my ob says he'll work with it) 2) endometriosis, adenomyosis, and fibroids. I have several medical conditions that indicate I need a hysterectomy. If they can be prepared for potential bloodloss, then the csection/hysterectomy is ok'd. We knew when I lost Peyton I was high risk for hemmorage and the staff were ready and acted quick when it happened. When I delivered Cate, I was CONSTANTLY being checked by my ob and the nurses for a pp hemmorage and blood loss during delivery and after delivery. They controlled the bleeding well. As I remember my ob saying, you are not going to like me very well after I delivered Cate. You know what, I wasn't liking him to well at that moment.
Anyway, my ob has said if I get pregnant again that he will absolutely do a csection hysterectomy for me. That I have very good reasoning and it was an excellent decision for me. It is a very high risk surgery. In 10 years of practice, he has done only one so far by request (not counting an emergency situation of hemmorage where they have to do a hysterectomy). The other time was because the woman had similar problems as I did. Her baby was breech. She was going to have a csection anyway and she needed a hysterectomy as well and was done with her family. My ob said ok to her. He did that one last year. At least that is what he told me. In fact, my ob got a little excited about the prospect of getting to do one because he never gets to do them. I told him hold on doc, I was just THINKING about if I had another (well I want one more but dh is flipflopping).
It is a pretty rare procedure. It is major surgery and comes with it's own set of complications. I have only considered it due to my medical issues and being done with the childbearing years with the next one. I researched it heavily before I approached my ob about it. It is NOT recommended unless you have very good reasons and medical indications for one.