Women whose first child is born by Cesarean section are less likely to have more kids compared to women who give birth in the traditional way, a recent study shows.
Do C-sections lower birth rates? (Enrique Castro-Mendivil/Reuters)The finding is based on nearly 600,000 births between 1967 and 2003 tracked by the Norwegian Institute of Public Health and the University of Bergen. The study, published in the journal Obstetrics & Gynecology, showed that women who underwent C-section to have their first baby were 12 percent less likely to have another child than women who gave birth vaginally.
The study authors noted that the lower subsequent-birth rate among women who had undergone C-section was not related to medical problems that might have necessitated a Cesarean delivery in the first place. Instead, they speculated that women’s views about childbirth may have been affected by the surgical procedure.
“We do not think it has anything to do with the medical reason for the Cesarean section or any physical consequences of the operation,” said Dr. Kari Klungsøyr, head physician with the Medical Birth Registry of Norway, in a press release. “We can ask ourselves if it is such that if the women have had the child they want, maybe some cannot bear the thought of pregnancy, birth and any new operational procedures.”
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From 1 to 25 of 238 Comments
age of mother. reason for c-section. reasons i chose to have no more children after c-section.
— joyceOn what basis do they think the underlying health reasons for a c section were unrelated? What about age? What about being cheesed off with your hospital and thinking you wouldn’t want to go there again (which I assure you vaginal birth mothers feel too but we can’t attribute it to surgery).
I have had 30 operations in my life, perhaps more (they lost count before I was 2 years old). I have no particular love of hospitals, especially American hospitals but I am not intimidated by them. I suggest that many women who are unfamiliar with hospitals are scared by them, and the more surgical the intra-hospital experience the more scared they are. This is totally uncessary really. It is just a question of being used to the environment. I think that women who are having planned c sections (or know they have a high liklihood of needing an emergency one) would be well served by more time spent getting used to the environment there before the birth.
Though the catch is when you have antenatal mothers who are not drugged to the eyeballs see how badly US hospitals are run you’d probably face more demands to change them. No doubt hospitals wouldn’t like that.
— JillyFlowerWhat does the age of the mother have to do with having a c section?
This is a huge issue. I would recommend anyone interested in this subject read “A Better Way to Be Born?” in an article that was in the New Yorker about 1 or 2 years ago. We simply seem to be heading the way of routine c sections, for a myriad of reasons, a few of which are medical, and some of which have to do with fear and convenience. It’s just one more way our modern conveniences are reducing our physical capacities.
— francoisResearch has shown that when a woman is in labor and gives birth, the hormone oxytocin is released in a huge rush - both the mother and the baby are basically saturated with it. Oxytocin is the “love hormone” and scientists believe it contributes to initial bonding between mother and baby. If a c-section is done before labor naturally begins, this natural hormonal process is unfortunately bypassed. There is a fascinating study that showed monkey mothers would not care for their babies at all if they were born surgically.
Now I’m not saying (of course!) that c-section moms can’t bond with their babies. Given that more than 1/3 of US women now deliver via surgery (mostly not by choice) many of them will porbably post to say that they bonded and loved their children just fine, thank you.
But there is an obstacle, a challege that they have to overcome, without all that oxytocin and with all that post-surgery pain and suffering. Breastfeeding has also been documented as much more challenging for c-section moms (for a host of reasons) and struggling with that may add to the challenges of good attachment. It seems logical that all this would make the process more difficult, and maybe some portion of those moms don’t quite connect as well as they might have. Those who do manage it are succeeding against the odds, a testament to our ability as women to embrace the ups and downs of motherhood.
— Believer in birthWhile I would be thrilled to have a second child, my post C-section experience was difficult and I was simply overwhelmed with my recovery and the needs of my newborn son. Compounding my current reluctance are the studies of increased incidents of maternal deaths/ and or complications after subsequent c-sections. What is alarming is the trend of women and doctors scheduling c-sections as if the procedure was minor surgery. Having delivered my son post 41 weeks, he was in utero perpendicular to my spine with his cord around his neck,so I am grateful for the process, it was lifesaving for us.
— RobinI would however cautions those who choose the procedure as a time saving device or because somehow they perceive it as being more “convenient.” Your recovery will be longer, slower and more painful.
I am a mother of three, had my children naturally and w/o pain meds. I would have more as it was a completely satisfying experience. Pain during, but not after, no i.v.’s , no incisions etc. I would think there is something to this persepctive. If doctors weren’t afraid of getting sued, I’m sure more women would be comfortable with a natural birth. But pregnancy and childbirth has evolved into a medical condition and frankly a science experiment. Women getting pregnant artifically with multiples. Inducements galore for primarily convenience of patient and doctor. And let’s not forget how expensive all of that is for healthcare. C-sections should be an exception. What a circus.
— DoraMaybe they just have less sex afterward….I hear the scars aren’t terribly attractive.
— AWI was 32 at the time of the birth of my daughter. I was healthy starting out, no issues at all. I remember going to the child birth classes and was told what percentage of women deliver via c-section. I thought to myself, there is no way that will happen to me. Well I was wrong. In my 7th month of pregnancy I started having heart issues and then in my 9 month I had bells palsy. My doctor thought it was the best way to go considering what I had been through the last two months. It was not a planned c-section. I was admitted to the hospital and was started on an IV drip to get the contractions started. I was in labor for 24 hours and ended up needing an emergency c-section. My niece had her first child via c-section and now had her second child naturally. She was thrilled to have it naturally. So there you have it.
— SusiThere is really insufficient data in this story to make sense of what the real causes for the trend observed. I think age is a likely cause. I would also submit concern over one’s ability to have natural child birth after a C-section (remember the very graphic horror stories several years ago) and concern over having to have a second C-section should be considered also.
— NicoleI’m the mother of 4, all delivered via C-section. I’ll admit, I’m a bit disappointed by never having experienced a vaginal delivery, but at the same time, I know my C-sections were medically necessary for the health of my children and myself.
After my first daughter was born via C-section, I was told I had to wait 6 months to get pregnant again, and I did. My second daughter was born 16 months after my first daughter………..:)
I had a positive experience with each of my pregnancies and deliveries, and wouldn’t trade one moment away…………:)
— LisaNThat makes so much sense. It’s difficult enough taking care of a newborn and your other child(ren), but to do it while recovering from surgery? Also, not everyone has family nearby to help out.
I was lucky to have natural childbirth two times. I wasn’t thrilled with the hospital experience, and I would certainly understand that a woman who had a C-section wouldn’t want to come back for more of that.
— EstherIsn’t it ironic that women try to avoid pain b C-section - and then have horrendous post-surgery pains? But I suspect it is more often the physicians who push for surgical delivery.
I had my two children without as much as a Tylenol. One doctor rushed in while I was in labor and asked if I wanted to reconsider taking an epidural. I said, no thanks. He pointed out I was screaming. I told him I was entitled to scream during childbirth.
If a mother has no help after Cesarian section, it is very hard to care for the baby while having wound pain.
Alexa Fleckenstein M.D., mother, author.
— Alexa Fleckenstein M.D.Isn’t correlational research fascinating? It’s especially interesting with very large sample sizes. I note how quickly we’ve generalized these correlations to our own population. Hmmmm. I did’t have any more children after the one that was delivered via C-section. But that was because (1) he was my 5th child, (2) I was 41 years old, and (2) he weighed 13.5 pounds. I’d be happy to participate in a qualitative research study :-)
BJ
— BJI had intended to have my children naturally, but ran into complications during labor with my first child and had to have an emergency c-section. When I was pregnant with my second child my OB/GYN could not determine why there were problems with my first delivery and recommended a c-section out of concern for my health. No complications after either surgery, relatively easy recovery, awful scars from the emergency nature of the first c-section, no trouble bonding. I think each situation and reason for the c-section have to be taken into consideration. If mother’s life was threatened, maybe having more children is not wise, and this could be the factor on not having more children–not the c-section itself.
— CatherineI had three c-sections! I do not think that having a c-section lessend my desire to have children. My first child was delivered by c-section after 14 hours of labor! My second was also a c-section because he was bigger than the first! the third was because after two, my doctor didn’t want me to push. I think that I’ll stop at three though!
— cherylI had three children, all by c-section. I couldn’t deliver my first child vaginally and had a c-section at midnight. For the other two, my OB recommended a c-section and we scheduled one.
Like LisaN, I was a little disappointed not to deliver naturally, but I didn’t find the c-section to be horrendously painful, or the recovery period particularly long. By the time I left the hospital I had no significant pain. Once I left the hospital, my only real concern was to not accidently pull out the stitches.
I can honestly say that in my experience, recovering from the c-section did not complicate caring for the baby or my other children.
— AmyThe article is based on numbers from the registry of births in Norway started in 1967 (compulsory registrations of all births). The prevalence of Caecarean sections is far lower in Norway than in the US. Only 5.2% of all deliveries were by Caecarean section during 1967 - 81, increasing to 12.9% during 1981 - 96.
Since the authors do not know the indications for the Caecarean sections nor the reasoning by the women for not having more than one child, any explanations as to why Caecarean sections negatively effect the fertility will be speculative at best.
- Posted by Hilde
— Hilde-Kari GuttormsenIt’s impossible to imagine the motivations of thousands of other mothers, especially ones from a different culture who may have different associations with cesareans than we do in the United States. I don’t know if c-sections are as common in Norway as they are here. (Perhaps Ms. Parker-Pope can supply the statistic.) Maybe there is some stigma associated with a surgical birth in countries where it is much less common?
I can only speak for myself, but my recovery from emergency c-section (due to a baby in distress at term) was lengthy and arduous. I realized the c-section was necessary but I was hampered in bonding with my child because 1) he was in intensive care and 2) the c-section hampered breast feeding due to a lot of swelling from the I.V. and other factors. Even after we both went home, I had problems getting out of bed to nurse at night for weeks. The first weeks are already incredibly difficult, and the c-section made it much harder.
I’m now pregnant with my second child and hope to VBAC because I have trouble imagining caring for a newborn and a toddler–with limited support–while also recovering from a c-section. The fear of a cesarean didn’t prevent me from wanting another child, but I do harbor that apprehension and can see how other mothers might as well.
— Catherine IIThere is a difference between planned c-sections and ones which follow an extended painful and non-productive labor, with its period of great fearfulness and helplessness on the part of the mother. Many labor and delivery staff do not give mothers much information about why there is a crisis nor do they get answers to their questions of any type. Many mothers end up feeling quite traumatized and demonstrate signs of acute stress disorder or frank post traumatic stress disorder. Some journal articles from the UK demonstrate the lengths some of these traumatized women went to in order to avoid the possibility of future pregnancies, including avoidance of sex, use of multiple birth control methods simultaniously or sterilization. I have heard of mothers in the USA who were so unhappy with their birth experiences that they opted for a home birth for their next child, even after a c-section.
— Karen Greene Ph.D.I was 34 when I had my son by C/S. He was a footling breech, and I had a natural, no medication labor for 26 hours before a nurse felt a foot.
My own OB/GYN was on vacation, and I got one of his partners, who had no idea who I was, or that the baby hadn’t gotten into position. It was a weekend, and the ultrasound tech didn’t know how to do the ultrasound and told me that I was having twins. At this point, I was a bit upset, and grabbed the doctor, screaming, “you can’t do this to me.”
Anyway, I decided against having any more. The scar, btw, is the bikini cut and isn’t visible except by very, very close scrutiny.
My son is now 23, and I raised him as a single mom. Do I wish I had had more? Yes and no. I very much enjoyed being a mother, but divorce and economic uncertainty were no picnic. My recommendation to all young women is–don’t have any more children than you can safely raise alone.
— TheresaIf you have an inheritance, squirrel it away for your children. Prenups are a good idea, at any age, but especially if you plan to leave anything for your children.
To “Believer in Birth” –
You are full of it. There is nothing worse than using “science” to prop up a basically mystical belief.
I had two wonderful healthy boys, and nursed them without a hitch, after scheduled c-sections imposed by my firstborn’s breech position. There was no shortage of oxytocin.
Everybody needs a religion. I guess “natural childbirth” is yours!
— AngelaHaving worked as a neonatal nurse practitioner (I catch babies) for almost 30 years, I have to say that the reason that many women have fewer children is that the primary reason for them having a c-section may be the reason that they choose not have more babies. C-sections are very intrusive, major surgeries. They may be performed because the either the mother or the baby is in trouble and the doctor just wants to get the baby out as quickly and safely as possible. Sometimes, the OB determines that the woman’s bone structure is too small to accommodate the large baby she is carrying. Sometimes the baby is breech, almost always requiring a section to deliver that baby safely. It used to be “Once a C-section, always a C-section,” but that rule does not hold true anymore as more women talk their doctors into letting them try a vaginal delivery the next time around, or a “V-back.” This can be very dangerous, as the uterus, previously cut and may not be fully healed or scarred, can rupture during a subsequent vaginal delivery. I have been in the delivery room when the doctor made the initial cut thru the abdominal skin, only to find the baby’s face already protruding (it was the mother’s 4th c-section). Sometimes, even though the mother has a “bikini cut” on the outside, the doctor may have cut her uterus vertically (the old-fashioned way) on the inside, without telling her. I have seen that many times, and a vertical cut is much more likely to rupture.
— SarahI guess I have seen the bad outcomes and horror stories more than the average woman, but I would not V-back. I was able to deliver all 3 of my children vaginally, although my OB at my first delivery was so sure I was going to have to be sectioned (my firstborn was bigger than my pelvis), she had already marked me as a section on the board.
Also, C-section babies are more likely to require more medical assistance after birth, as they didn’t get all that liquid squeezed out of their lungs that they would have during a vag. delivery, so that adds perhaps a trip to the NICU. After surgery and a baby in NICU, many families receive a hospital bill higher than they had planned on, so that is another reason they may not have as many babies as they once dreamed of. I have heard parents say they would have had more babies, but after having one C-section ordeal, and the chance being anymore babies would have to put them all thru the same thing again. Besides, who can afford that many C-sections?
Older mothers are at a higher risk for C-sections, especially first-time older mothers. They have more health problems in general, higher blood pressure, and their bodies do not accomodate the stress of delivery as well as the 20 year-olds. It’s just a sad fact.
Interesting study. My question is the same as several others — on what basis did the study authors determine that the underlying health problem that caused the C-section was not the reason that these women didn’t have more children? This was just posited without any backup… I would very much like to know how they came to this conclusion, because it seems like an obvious reason for this kind of correlation.
— Mary AnneFrom TPP — Because they also looked at complicated pregnancies where babies were stillborn or died and those mothers had the same rate of second or third pregnancies as mothers who delivered vaginally. If aversion to more children were related to having a complicated pregnancy, then there should have been a similar trend among these women and there was not.
If you ask me, I think that mothers who sit around and brag about how they gave birth “naturally without pain meds” are just asking for everyone to stop, pat them on the backs, and roll out the red carpet for them. I’m tired of these people thinking that they are better and stronger parents that those of us that had c-sections. Get off your high horses! I am not ashamed of having a c-section and it doesn’t make me less of a mother. I had no complications, no problems with recovery, no issues with bonding, and was able to care for my newborn just fine. I had an excellent OB/GYN. I am also not less likely to have another child based on my c section. Why not take advantage of modern medicine and have a c section. People forget that many women died of childbirth before modern medicine! The decision to have more children is a personal one made for a variety of reasons that may or may not have anything to do with c sections. I highly doubt that a c section would be the only reason to not have more children. We need to think about why people had the c section in the first place which may be a better correlate with whether or not women have more children.
— BrandieI agree with Angela #21 totally - believer in birth #4 is full of it. I have had both a vaginal delivery and a subsequent c-section. The oxytocin response is there regardless, it may be overshadowed a little by the distractions of the OR but only by a matter of a minute or so. And the fact it can be overshadowed shows it isn’t that significant really. Yes I loved my babies, but that’s not the test, I loved them for months before they were born too so it’s hardly surprising.
I also ditto Jillyflower - irrational fear of the surgery is worse than the surgery itself. I too had had several surgeries before including an appendectomy and gallstones removal. The c section was chickenfeed in comparison. Major surgery is generally defined as any procedure that requires more than topical anesthetic. Hardly a very useful definition in this context. I had my wisdom teeth out under general anesthetic (incidentally the aftermath was a LOT worse than a c section).
So its “major” surgery - so what? I was up and about the day after my evening c-section, same as for my appendectomy. Yes both were a bit tender, but hey I couldn’t sit down for 3 weeks after the vag birth either!
C sections are not a big deal in deveoped countries with good procedures in place to make them as safe as any procedure, or birth itself even, can be.
But obviously people THINK they’re a big deal. Mostly ignorance I suspect as there can’t be that many outlying horror stories or incompetent doctors.
Get educated about what is involved in a c section, what you can request, how you can make it more comfortable - that way you won’t be shocked or traumatized by it. Same goes for vaginal birth but people seem to think you don’t need the same education about c sections for some reason.
It matters not a jot how you give birth as long as you are both safe and healthy. C sections have saved countless lives.
— michelle