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Published on: January 17, 2019
First birth Caesarean section and subsequent fertility: a population-based study in the USA, 2000-2008
K H Kjerulff1, J Zhu, C S Weisman
1Department of Public Health Sciences, College of Medicine, Penn State University, 600 Centerview Drive, Hershey, PA 17033, USA.
Human Reproduction (Oxford, England)
|September 12, 2013
Summary
Women who had a first birth via Caesarean delivery were less likely to have a subsequent live birth compared to those with a first birth vaginal delivery. This finding suggests a potential impact of delivery method on future childbearing.
Area of Science:
- Reproductive Health
- Obstetrics and Gynecology
- Perinatal Epidemiology
Background:
- Conflicting evidence exists regarding the association between first birth delivery method (Caesarean vs. vaginal) and subsequent childbearing rates.
- Previous studies have reported both reduced and similar birth rates following Caesarean delivery compared to vaginal delivery.
Purpose of the Study:
- To investigate whether a first birth by Caesarean delivery is associated with a lower likelihood of subsequent childbearing compared to a first birth by vaginal delivery.
- To analyze the impact of delivery method on subsequent live birth rates in a large cohort of US women.
Main Methods:
- A retrospective cohort study was conducted using birth certificate records from Pennsylvania, USA, for women with a first singleton live birth in 2000.
- Data from 52,498 women were followed through the end of 2008 to identify subsequent live births, utilizing linked birth certificate and hospital discharge records.
- Poisson regression models were employed to assess the association between first birth factors and subsequent live births, controlling for demographic and pregnancy-related confounders.
Main Results:
- Over an average follow-up of 8.5 years, 40.2% of women with a Caesarean first birth had no subsequent live birth, versus 33.1% of women with a vaginal first birth (Risk Ratio [RR]: 1.21).
- After adjusting for demographic factors, the RR for not having a subsequent live birth remained elevated (RR: 1.16).
- Adjustment for pregnancy and childbirth complications minimally affected the association (RR: 1.15), indicating the primary effect is not solely due to these complications.
Conclusions:
- First birth Caesarean delivery is associated with a reduced likelihood of subsequent live birth compared to first birth vaginal delivery.
- The findings corroborate previous research suggesting lower fertility rates after Caesarean sections.
- Limitations include potential selection bias due to unmeasured factors like emigration and inability to account for pre-pregnancy BMI, weight gain, or prior infertility.
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