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Likelihood of Continued Childbearing After Cesarean Delivery

Masinter, Lisa M. MD, MPH; Feinglass, Joe PhD; Grobman, William A. MD, MBA; Simon, Melissa A. MD, MPH
Obstetrics & Gynecology: May 2014
doi: 10.1097/01.AOG.0000447377.90673.d4
Monday, April 28, 2014: PDF Only

INTRODUCTION: Women have higher risk for obstetric complications as they have increasing numbers of cesarean deliveries. The objective of this study is to clarify both the likelihood of continued childbearing after cesarean deliveries and the influence of sociodemographic characteristics on that relationship.

METHODS: Data from the National Survey of Family Growth, 2006–2010, were used to describe the childbearing trajectory for U.S. women. Respondents with a live, singleton, first birth were included. Population-weighted bivariate and multivariable analyses were performed to test the association between route of delivery and number of cesarean deliveries with subsequent birth, up to four deliveries.

RESULTS: The cohort included 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 who had three births, those with two and three cesarean deliveries were 36% and 58% less likely (P<.05), respectively, to have a fourth birth when compared with women with three vaginal deliveries adjusting for known predictors of increased parity. Income level moderated this relationship with lower-income women having a greater probability of childbirth after two or three cesarean deliveries (P<.05).

CONCLUSIONS: U.S. women are less likely to continue childbearing as they have higher numbers of cesarean deliveries; however, this is less true for low-income women. Given the risks associated with multiple cesarean deliveries, these findings underscore the need to inform and counsel women, especially low-income women, about pregnancy planning both pre- and postcesarean delivery.

Financial Disclosure: Lisa M. Masinter, MD, MPH, Joe Feinglass, PhD, William A. Grobman, MD, MBA, and Melissa A. Simon, MD, MPH—These authors have no conflicts of interest to disclose relative to the contents of this presentation.

© 2014 by The American College of Obstetricians and Gynecologists.