Caesareans may not cause fertility issues

Wednesday April 30th, 2014

Giving birth by Caesarean section is unlikely to affect a woman's chance of having further children, British researchers say today.

Some previous studies indicated that having a baby delivered by caesarean section is linked to having fewer subsequent pregnancies and babies, and bigger gaps between later pregnancies. This impact would be important, as caesarean rates have risen over the past two decades.

So Dr Tahir Mahmood of the Spire Hospitals in Edinburgh, UK, and his team of experts from the Royal College of Obstetricians and Gynaecologists examined the evidence. They used figures on more than a million low-risk mothers who had their first babies in English NHS hospitals between April 2000 and March 2012. About one in five of the babies were delivered by caesarean, and less than 4% of the caesareans were planned.

Both emergency and planned caesareans led to fewer subsequent babies, but this was only the case for women having planned caesareans due to medical problems rather than, for example, a breech baby.

The analysis showed that the apparent reduction in fertility after a caesarean is due to "the medical and social circumstances leading to the decision to carry out a caesarean", rather than the procedure itself. Full details are published today (30 April) in the journal Human Reproduction.

"The possible effect of caesarean section on subsequent fertility is important as the age of first time mothers continue to rise, along with the rates of caesarean section," says Dr Mahmood. "By carefully distinguishing between different complications of pregnancy, we have found that having a caesarean section as a first-time mother leads to only a very small effect on subsequent fertility."

The UK Royal College of Midwives said the findings should not lead women to think opting for a Caesarean birth was safe.

Louise Silverton, from the college, said: “That fact that the effects on fertility may be minimal should go someway to reassure those women for whom a caesarean is needed and who may want another child in the future.

“However, even though there is less effect on fertility than was assumed this does not negate the other negative effects of caesarean sections. This is a major surgical operation that has the potential for increased complications every time a woman has the procedure carried out."

Gurol-Urganci, I. et al. A population-based cohort study of the effect of Caesarean section on subsequent fertility. Human Reproduction 30 April 2014 doi:10.1093/humrep/deu057

Tags: Childbirth and Pregnancy | Nursing & Midwifery | UK News | Women's Health & Gynaecology

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