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Likelihood of continued childbearing after Cesarean delivery in the United States.

Masinter LM, Feinglass J, Grobman WA, Simon MA.

Obstet Gynecol. 2014 Jun 4.

Editor’s comment: Prof. Jim Thornton: Caesarean delivery reduces likelihood of having more children.
There has long been evidence that delivery by Caesarean section is associated with reduced likelihood of having further children. Another large study from the United States has again confirmed the relationship. The cause remains unclear.

Abstract

OBJECTIVE::

To estimate the likelihood of continued childbearing as a function of mode of delivery and number of cesarean deliveries and to explore whether it varies by sociodemographic characteristics.

METHODS::

Cross-sectional data from the 2006-2010 National Survey of Family Growth were used to conduct an analysis of U.S. childbearing women. The birth trajectory for respondents who identified a live, singleton, first birth was assessed through four births. Population-weighted analyses were performed to test the association between route of delivery and sociodemographic characteristics with the likelihood of subsequent birth.

RESULTS::

Among 6,526 respondents, cesarean delivery, regardless of birth order, was associated with a lower likelihood of future birth, which decreased in a dose-response fashion as the number of cesarean deliveries increased. Among women with three births, those with two or three cesarean deliveries were 37% and 59% less likely (P<.05), respectively, to have a fourth birth when compared with women with three vaginal deliveries, adjusting for confounders. When interaction terms were added to the model, lower income women were significantly more likely to have a fourth birth after undergoing two or three cesarean deliveries than women with higher incomes (adjusted incidence rate ratio 2.50, 95% confidence interval [CI] 1.23-5.05 and adjusted incidence rate ratio 2.39, 95% CI 1.01-5.65, respectively).

CONCLUSIONS::

U.S. women who have cesarean deliveries are less likely to continue childbearing, especially because they undergo higher numbers of cesarean deliveries; however, this relationship is attenuated among low-income women. Given the risks associated with multiple cesarean deliveries, these findings underscore the need to further examine this relationship and what factors may be driving the income-based difference in childbearing after cesarean deliveries. LEVEL OF EVIDENCE:: II.

Visit the website: http://www.ncbi.nlm.nih.gov/pubmed/24901285

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Commentaries by Editor Prof. Jim Thornton