Cesarean Birth & Infertility Risks

A study published in the British Journal of Obstetrics and Gynaecology has shown that women giving birth for the first time, who have cesarean sections have fewer children and more difficulty conceiving than those who birthed by normal vaginal delivery or by assisted vaginal delivery (use of forceps or vacuum).

It was also found that cesarean section or assisted vaginal delivery leaves many mothers frightened about future childbirth. In addition a primary cesarean delivery and to some extent assisted vaginal delivery is associated with an increased risk of voluntary and involuntary infertility.

Cesarean section delivery was clearly associated with more women who had no further children after five years compared with normal delivery. There were also fewer women who had two or more further children over five years following cesarean section.

After a primary assisted vaginal delivery, women who had a second child were just as likely to have a third as those women who delivered their first child normally. This did not seem to be the case following a primary cesarean section.

In the cesarean section group 63.8% of women had subsequent children delivered by cesarean. This compares with 9.5% in the assisted delivery group and 3.9% of mothers who had a normal delivery.

Mothers who had their only child by cesarean section were more likely to have tried but not been successful in having further children than mothers who had normal deliveries. Also they were less likely to want to go through childbirth again than normal deliveries. This trend was similar for women who had vaginal instrumental deliveries but not to the same extent.

Conversely, women who had normal deliveries were more likely to report relationship problems as their reason for no further children, compared with cesarean section and instrumental deliveries.
Over five years following primary cesarean section there were 13% more mothers with no subsequent children compared with normal deliveries.  Also, of women who had been delivered by cesarean section only 5% had two or more further children, compared with 12% following normal vaginal delivery and 11% following vaginal instrumental delivery.

Other studies have reported between 12% and 9% more mothers with no subsequent children following primary cesarean section compared with normal vaginal delivery. It seems clear that a primary cesarean delivery can affect family size by reducing future options for women.

Other studies have suggested that involuntary infertility is more common following cesarean section. The difference in fertility seemed to result largely from difficulties in having children after cesarean section, rather than lessened desire for children. In the cesarean section group 30% of women had tried, but had not been successful, in having another child. This compares with 28% in the vaginal instrumental group and 16% in the normal delivery group. Sub-fertility is greatest if there has been a post-operative pelvic abscess.

Results suggest that many women are frightened of having additional children, resulting in voluntary infertility, following cesarean and vaginal instrumental deliveries. Regional anaesthesia for delivery has been shown to reduce negative feelings following cesarean section. In many departments partners are allowed at the delivery when regional, as opposed to general, anaesthesia is used. Other studies have reported more positive feelings in couples where the father has been present at the delivery.  

The statistics paint a clear picture of higher risk of both voluntary and involuntary infertility after a first child was delivered by cesarean. It is not a risk that your caregiver is likely to discuss with you when you talk through risks of cesarean birth, they may not even be aware that it is!

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