TY - JOUR
T1 - Likelihood of continued childbearing after cesarean delivery in the United States
AU - Masinter, Lisa M.
AU - Feinglass, Joe
AU - Grobman, William A.
AU - Simon, Melissa A.
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2014/7
Y1 - 2014/7
N2 - 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.
AB - 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.
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U2 - 10.1097/AOG.0000000000000294
DO - 10.1097/AOG.0000000000000294
M3 - Article
C2 - 24901285
AN - SCOPUS:84903200031
SN - 0029-7844
VL - 124
SP - 111
EP - 119
JO - Obstetrics and gynecology
JF - Obstetrics and gynecology
IS - 1
ER -