Lisa M Masinter1, Joe Feinglass, William A Grobman, Melissa A Simon. 1. Departments of General Internal Medicine and Obstetrics and Gynecology-Maternal-Fetal Medicine, Center for Healthcare Studies-Institute for Public Health and Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Abstract
OBJECTIVE: To estimate the likelihood of continued childbearing as a function of mode of delivery and number of cesarean deliveries and to explore whether it varies by sociodemographic characteristics. METHODS: Cross-sectional data from the 2006-2010 National Survey of Family Growth were used to conduct an analysis of U.S. childbearing women. The birth trajectory for respondents who identified a live, singleton, first birth was assessed through four births. Population-weighted analyses were performed to test the association between route of delivery and sociodemographic characteristics with the likelihood of subsequent birth. RESULTS: Among 6,526 respondents, cesarean delivery, regardless of birth order, was associated with a lower likelihood of future birth, which decreased in a dose-response fashion as the number of cesarean deliveries increased. Among women with three births, those with two or three cesarean deliveries were 37% and 59% less likely (P<.05), respectively, to have a fourth birth when compared with women with three vaginal deliveries, adjusting for confounders. When interaction terms were added to the model, lower income women were significantly more likely to have a fourth birth after undergoing two or three cesarean deliveries than women with higher incomes (adjusted incidence rate ratio 2.50, 95% confidence interval [CI] 1.23-5.05 and adjusted incidence rate ratio 2.39, 95% CI 1.01-5.65, respectively). CONCLUSIONS: U.S. women who have cesarean deliveries are less likely to continue childbearing, especially because they undergo higher numbers of cesarean deliveries; however, this relationship is attenuated among low-income women. Given the risks associated with multiple cesarean deliveries, these findings underscore the need to further examine this relationship and what factors may be driving the income-based difference in childbearing after cesarean deliveries. LEVEL OF EVIDENCE: II.
OBJECTIVE: To estimate the likelihood of continued childbearing as a function of mode of delivery and number of cesarean deliveries and to explore whether it varies by sociodemographic characteristics. METHODS: Cross-sectional data from the 2006-2010 National Survey of Family Growth were used to conduct an analysis of U.S. childbearing women. The birth trajectory for respondents who identified a live, singleton, first birth was assessed through four births. Population-weighted analyses were performed to test the association between route of delivery and sociodemographic characteristics with the likelihood of subsequent birth. RESULTS: Among 6,526 respondents, cesarean delivery, regardless of birth order, was associated with a lower likelihood of future birth, which decreased in a dose-response fashion as the number of cesarean deliveries increased. Among women with three births, those with two or three cesarean deliveries were 37% and 59% less likely (P<.05), respectively, to have a fourth birth when compared with women with three vaginal deliveries, adjusting for confounders. When interaction terms were added to the model, lower income women were significantly more likely to have a fourth birth after undergoing two or three cesarean deliveries than women with higher incomes (adjusted incidence rate ratio 2.50, 95% confidence interval [CI] 1.23-5.05 and adjusted incidence rate ratio 2.39, 95% CI 1.01-5.65, respectively). CONCLUSIONS: U.S. women who have cesarean deliveries are less likely to continue childbearing, especially because they undergo higher numbers of cesarean deliveries; however, this relationship is attenuated among low-income women. Given the risks associated with multiple cesarean deliveries, these findings underscore the need to further examine this relationship and what factors may be driving the income-based difference in childbearing after cesarean deliveries. LEVEL OF EVIDENCE: II.
Authors: Kristen H Kjerulff; Ian M Paul; Carol S Weisman; Marianne M Hillemeier; Ming Wang; Richard S Legro; John T Repke Journal: JAMA Netw Open Date: 2020-04-01