Giving birth by Caesarean may risk future pregnancy

According to research published in the British Journal of Obstetrics and Gynaecology, women who deliver their first child through a Caesarean are more likely not to get pregnant again. In addition, those who do conceive a second time may take longer to do so, say the scientists.

A study performed by researchers at the University of Aberdeen, UK, reveals an association between having a Caesarean and the occurrence and timing of conceiving a second child. However, further studies are needed to discern whether this is due to physical, emotional or social factors.

Of the 25,371 women studied at Aberdeen Maternity Hospital between 1980 and 1997, 73.9 per cent of women who had a spontaneous vaginal birth went on to have another child, while 66.9 per cent of women who had a Caesarean followed the same course. For those who did, it was 36.3 months before they conceived again as compared to 30.4 months for women who had a spontaneous vaginal birth. Researchers say it made no difference whether the Caesarean was planned or emergency.

The authors of the study conclude that the likelihood of conceiving another child after having a Caesarean is 'significantly reduced'. However, the study did not distinguish between the causes of this. It is unknown whether the women could not get pregnant due to reduced fertility arising from damage to their organs during the Caesarean, or if the women voluntarily chose to prolong, or rule out having subsequent children.

The study does, however, recommend to those who plan to administer a Caesarean to consider its implications. 'This study highlights an association between mode of delivery and subsequent pregnancy. This is an important finding against the background of rising Caesarean rates,' says Jill Mollison of the Department of Public Health at the University of Aberdeen and lead author of the paper.

Currently, the rate of delivery by a Caesarean in the UK stands at 23 per cent. In the US, the Caesarean section is the most common medical procedure performed, and accounts for over 20 per cent of births annually, according to a report issued by the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. These rates are both higher than the 10-15 per cent recommended by the World Health Organisation. The mother's option to request a Caesarean so that she will know the exact date of delivery contributes to this. However, in its guidance on Caesarean Sections, the UK's National Institute for Health and Clinical Excellence (NICE) provisions that a mother's request alone, where no medical reasons for a Caesarean exist, does not automatically entitle her to the procedure.