Unfulfilled expectations: how circumstances impinge on women's reproductive choices

Throughout Europe women are having fewer babies, but more of them are being delivered by caesarean section. There is some evidence that this major surgical procedure discourages women and/or their partners from having further children. This study is aimed at ascertaining the extent to which mode of delivery in first confinement affected women's decision-making about having another child. This paper reports results from (1) a questionnaire sent to 5300 women who delivered their first baby in Aberdeen in northeast Scotland between 1980 and 1995, but who did not have another viable pregnancy within 5 years, and (2) in-depth interviews with a stratified random sample of 82 of these respondents which covered experiences of birth, decision-making about subsequent pregnancies and infertility. Verbatim transcripts were analysed thematically. Questionnaires were returned by 3204 women (60%). Among those who had no further pregnancies, 1182 (71%) had deliberately limited their fertility. Of those who had a second child, 696 (66%) deliberately left a gap of 5 or more years between them. The factors which apparently influenced the decision to limit fertility included early intention, experience of the first, or index birth, health, lifestyle, influence of partner, age, first child and fertility problems. In interviews, women presented these factors as constraints on their behaviour, which restrained them from freely choosing to have more children and in some cases to have the number they had planned. As the decision to have only one child or to leave a large gap between children is unusual, women may have been presenting their choices in this way to make their actions appear more socially acceptable and their motivations as blameless.