title: Physical health and recovery in the first 18 months postpartum: does cesarean section reduce long-term morbidity?
abstract: BACKGROUND
  Research examining long-term health outcomes for women after childbirth has been limited. The objective of this study was to investigate the natural history of common morbidities in the 18 months after the birth of a first child, and to explore the hypothesis that women who have a cesarean section for a first birth experience less overall morbidity in the postnatal period.
  
  
  METHODS
  A prospective nulliparous pregnancy cohort study was conducted of 1,507 women recruited in early pregnancy from six public hospitals in Melbourne, Australia (mean gestation 15 weeks). Follow-up questionnaires at 3, 6, 12, and 18 months postpartum included standardized measures of urinary and fecal incontinence, and a symptom checklist asking about common physical health problems.
  
  
  RESULTS
  At 6, 12, and 18 months postpartum, no statistically significant differences were found in the proportion of women reporting three or more health problems by method of birth. Compared with women who had a spontaneous vaginal birth, women who had a cesarean section were more likely to report extreme tiredness at 6 months postpartum (adjusted OR: 1.39; 95% CI: 1.07-1.82) and at 12 months postpartum (adjusted OR: 1.40; 95% CI: 1.05-1.85), and were more likely to report back pain at 6 months postpartum (adjusted OR: 1.37; 95% CI: 1.06-1.77) and at 12 months postpartum (adjusted OR: 1.41; 95% CI: 1.06-1.87). Women who had a cesarean section were less likely to report urinary incontinence at 3, 6, and 12 months postpartum, respectively (adjusted OR: 0.26; 95% CI: 0.19-0.36; adjusted OR: 0.36; 95% CI: 0.25-0.52; adjusted OR: 0.48; 95% CI: 0.33-0.68). For all other physical health problems the pattern of morbidity did not differ between cesarean section and spontaneous vaginal birth.
  
  
  CONCLUSIONS
  Physical health problems commonly persist or recur throughout the first 18 months postpartum, with potential long-term consequences for women's health. Cesarean section does not result in women experiencing less overall morbidity in the postpartum period compared with women who have a spontaneous vaginal birth.
authors.affiliation: Healthy Mothers Healthy Families Research Group at the Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors.forename: Hannah
authors.initials: H
authors.lastname: Woolhouse
authors.forename: Susan
authors.initials: S
authors.lastname: Perlen
authors.forename: Deirdre
authors.initials: D
authors.lastname: Gartland
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Brown
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D001416:Back Pain / Q000453:epidemiology / Q000209:etiology; D002585:Cesarean Section / Q000009:adverse effects / Q000534:rehabilitation / Q000706:statistics & numerical data; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D009321:Natural Childbirth / Q000009:adverse effects / Q000534:rehabilitation / Q000706:statistics & numerical data; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D049590:Postpartum Period; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology