C-Section May Affect Future Fertility

Surveyed Women Had Harder Time Getting Pregnant After Surgery

http://my.webmd.com/content/article/79/96260.htm?z=1728_00000_1000_ln_04 

Jan. 14, 2004 -- Women who deliver their first child by C-section may have more trouble getting pregnant again, a new report from Scotland suggests.

When compared with moms who had difficult deliveries ending in vaginal birth, women in the study who had cesarean deliveries said they had more problems getting pregnant after the birth of their first child. Roughly 20% of the cesarean mothers reported difficulty conceiving a second child, compared with 5% of women who had vaginal deliveries aided by instruments like forceps.

But a childbirth expert who commented on the study for WebMD says fertility issues are way down the list of concerns regarding cesarean section.

"If there is an effect on fertility, it is certainly a very small one," says California ob-gyn Bruce Flamm, MD, who has written two books on cesarean deliveries. "My concern is that this will divert attention from the much more significant issues surrounding C-section. Most women will not have any trouble getting pregnant again after having this operation, but there are other big risks they need to consider.

Fear of Second Delivery High

The study involved 283 women who completed questionnaires roughly three years after delivering their first child by cesarean section or vaginal delivery using forceps or vacuum pump. Three quarters of the women who said they wanted a second child achieved a pregnancy during that time. But the women who had vaginal deliveries were twice as likely to have conceived as those who had cesarean sections, lead author Deirdre J. Murphy, MD, and colleagues reported.

Not surprisingly, women who had their first child by cesarean delivery were at high risk for having their second child the same way. Four out of five women who delivered first children vaginally achieved vaginal births the second time around, compared with just 31% of women with a history of cesarean births.

Of the 91 women who said they did not plan to get pregnant again, just under half in both delivery groups cited a fear of going through childbirth again as a reason. The researchers conclude that fear of childbirth following a difficult delivery is common and deserves further study. The findings are reported in the Jan. 17 issue of the British Medical Journal.

C-Section Rates Rising

After falling modestly in recent years, cesarean delivery rates are again on the rise, with roughly one in four babies in the U.S. and the U. K. now delivered by C-section. There is also a trend away from offering vaginal deliveries to women who have had C-sections, says Flamm, who is a clinical professor at the University of California Irvine Medical School.

U.S. and world health officials want cesarean section rates to drop to no more than 15%, but Flamm says the chances of that happening anytime soon are "slim to zero." He says the driving force in the increase is the very real fear of lawsuits among practicing ob-gyns.

"The average obstetrician has been sued two to three times," he says. "If anything goes wrong and the baby isn't perfect, the doctor always has to be concerned about a lawsuit."

A smaller, but growing, factor in the rise is a trend among women to request elective cesarean deliveries, even when there is no compelling medical need for them. Women may choose to have planned C-sections to accommodate personal schedules because they believe it is safer for the baby, or to reduce the risk of pelvic injury.

But Flamm says women should think long and hard about asking for what he calls "cesarean on demand."

"Once a woman has a C-section, she is very likely to have to have another one if she has another child," he says. "You are leaving a big scar on the uterus, so having a vaginal birth after a cesarean carries the risk of having your uterus rupture. That is something to think very carefully about."

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