Reduced fertility after cesarean delivery: a maternal choice.
OBJECTIVE
To explore the association between mode of delivery and subsequent fertility.


METHODS
Deliveries registered in the Medical Birth Registry of Norway were linked to mothers through national identification numbers. The study population was 596,341 women who had their first delivery during 1967-1996, and who were followed up through 2003. We compared rates of continuation to a subsequent birth according to mode of previous delivery (cesarean compared with vaginal).


RESULTS
If the first child survived the first year of life, cesarean delivery was associated with a significantly reduced probability of a second birth (relative risk [RR] 0.82, 95% confidence interval [CI] 0.81-0.83 during 1967-1981, and RR 0.88, 95% CI 0.88-0.89 during 1982-1996). Following a stillbirth or an infant loss, the association was less strong during 1967-1981 (RR 0.93, 95% CI 0.89-0.97) and no longer significant during 1982-1996 (RR 1.00, 95% CI 0.97-1.03). A similar pattern was observed from the second to the third birth and in subgroup analyses of women with preeclampsia or breech presentation and in an obstetric low-risk group.


CONCLUSIONS
Cesarean delivery was more strongly associated with reduced fertility if the infant survived than if it was stillborn or died. This suggests that the reduced fertility was to a large degree voluntary and not related to the indication, nor to any physical consequence, of the cesarean delivery.


METHODS
II.
Department of Public Health and Primary Health Care, University of Bergen, Norway. mette.tollanes@isf.uib.no
Mette C
MC
Tollånes
Kari K
KK
Melve
Lorentz M
LM
Irgens
Rolv
R
Skjaerven
D000328:Adult; D000367:Age Factors; D002585:Cesarean Section / Q000009:adverse effects*; D005193:Family Planning Services; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007247:Infertility, Female / Q000453:epidemiology*; D008423:Maternal Age; D009664:Norway / Q000453:epidemiology; D011247:Pregnancy; D012042:Registries; D012189:Retrospective Studies; D050497:Stillbirth