Mode of First Delivery and Women's Intentions for Subsequent Childbearing: Findings from the First Baby Study

Abstract

Background More than a dozen studies have reported a reduced rate of childbearing after caesarean delivery (CD). It has been hypothesized that this is because women who deliver by CD are less likely to intend to have subsequent children than women who deliver vaginally -either before childbirth or as a consequence of CD. Little research has addressed either of these hypotheses. Methods As part of an ongoing prospective study, we interviewed 3006 women in their third trimester and 1 month after first childbirth to assess subsequent childbearing intentions. Results Women who delivered by CD were similar to those who delivered vaginally in intent to have at least one additional child, both before childbirth (90.1% vaginal, 89.9% CD; P=0.97) and after (87.8% vaginal, 87.1% CD; P=0.87); however, women who had CD were less likely to intend 2 or more additional children, both before childbirth (34.7% vaginal, 29.2% CD; P=0.03) and after (32.2% vaginal, 26.1% CD; P=0.01). Among women who intended to have at least 1 additional child before childbirth, 5.0% reported intending to have no additional children 1 month after delivery (5.1% vaginal, 4.6 % CD; P=0.52). Conclusions Women whose first delivery is by CD are less likely to intend a relatively large family of 3 or more children than those who deliver vaginally, but delivery by CD does not decrease women’s intentions to have at least one more child any more than does vaginal delivery, at least in the short-term.

Short Interpregnancy Intervals: Results from the First Baby Study

“…There were no significant differences in race/ethnicity (data not shown). Also in the final cohort, there was a greater proportion of non-Hispanic White, higher educated, higher income, and married or cohabitating women than women in the state of Pennsylvania as a whole, which has been noted in prior FBS publications (Kjerulff et al, 2013).…”

“…Detailed methodology of the FBS is available in prior publications (Kjerulff et al, 2013). To be eligible, women needed to be nulliparous, pregnant with a singleton pregnancy, between the ages of 18 and 35, planning to deliver in a Pennsylvania hospital, able to speak English or Spanish, and willing and able to participate in intermittent interviews for a 3-year period.…”

Breastfeeding Outcome Comparison by Parity

“…This is consistent with participation studies, where participants tend to be more educated and affluent than the general population. 18,19 Therefore, our results may not be generalized to all U.S. and international populations. Additionally, the study design itself collected breastfeeding information at three points during a 6-month period (2 weeks, 2 months, and 6 months), thus introducing the possibility of recall bias.…”

Reduced Breastfeeding Rates in Firstborn Late Preterm and Early Term Infants

“…In addition, participants in the FBS were more likely to be white non-Hispanic, more educated, older on average, and more likely to have private insurance, as commonly occurs in participation studies. 5,17 Another potential limitation is that most of the FBS participants (92.2%) reported that they intended to breastfeed in the prepartum interview. Although several studies have reported similar rates of breastfeeding intention among American women (92.8% among low-income women in Iowa 18 and 92.0% in a diverse urban population in New York 19 ), most report lower rates of prepartum plans to breastfeed, ranging from 48.2% among women in West Virginia 20 to 83.0% in a national study.…”