Identifying the Effect of Cesarean Delivery on Subsequent Childbearing

Olga Yakusheva, Marquette University
Marianne Weiss, Marquette University
Kandice Kapinos , RAND Corporation

Cesarean delivery is a surgery occurring in about 33% of births in the United States. Cesarean delivery has lower maternal and fetal risks, offers greater scheduling convenience, and its utilization has increased over time. However, Cesarean delivery has also been tentatively linked to decreased subsequent fertility. Previous studies do not address the endogeneity of Cesarean delivery to reproductive health. We used fetal malpresentation (position of the infant in the uterus at the time of delivery) as a conditionally exogenous indicator of Cesarean delivery. Using data for 96,258 first-time mothers giving birth in 31 hospitals in the state of WI from 2006 to 2013, we compared subsequent fertility between mothers who delivered via Cesarean due to fetal malpresentation and mothers who delivered vaginally, conditional on known medical risk factors for fetal malpresentation. We found that Cesarean delivery reduced the likelihood of subsequent childbearing by 6 to 33% compared to vaginal delivery.

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 Presented in Session 210. Flash Session: Recent Trends in Fertility and Contraception in the United States