title: Mode of delivery and problems in subsequent births: a register-based study from Finland.
abstract: OBJECTIVE
  The purpose of this study was to investigate the effects of delivery on problems in subsequent births.
  
  
  METHODS
  This was a cohort study that used register data for 73,104 mothers who had their first birth from 1987 to 1989 and subsequent births from 1987 to1998. Three analyses were performed: (1) examination of second births by mode of delivery in the first birth, with adjustment for confounders, (2) same parameter, with exclusion of women with persistent problems, and (3) examination of third births for women with a first birth vaginal delivery.
  
  
  RESULTS
  More complications and poorer infant outcome were found at later births when the first or second birth was by cesarean delivery than after a first spontaneous vaginal delivery, even when women with persistent problems were excluded. Women with instrument first births had a similar rate of complications in the second birth to women with spontaneous vaginal births, but some infant outcomes were poorer.
  
  
  CONCLUSIONS
  Problems that are subsequent to cesarean delivery are unlikely to be explained entirely by indications for cesarean delivery.
authors: National Research and Development Centre for Welfare and Health, Health Services Research, Helsinki, Finland. elina.hemminki@stakes.fi
authors: Elina
authors: E
authors: Hemminki
authors: Julia
authors: J
authors: Shelley
authors: Mika
authors: M
authors: Gissler
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods*; D005113:Extraction, Obstetrical / Q000009:adverse effects; D005260:Female; D005387:Finland; D006801:Humans; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D011256:Pregnancy Outcome; D012042:Registries