Previous studies, conducted both in the US and other countries, have found that women who deliver their first child by cesarean section are less likely to bear subsequent children and bear fewer subsequent children than women who deliver their first child vaginally. However, nearly all of these studies were retrospective analyses of existing data sets, or surveys of women years after their first delivery. Consequently, it is not clear if women who deliver their first child via cesarean section are different from women who deliver vaginally prior to the first delivery in ways that both predispose them to require delivery by cesarean section and to be less likely to want to or be able to conceive and bear one or more subsequent children, or if there is something about the cesarean section itself that affects women's desire or ability to conceive or bear subsequent children. Given the recent increase in the rate of cesarean section in the US and in countries throughout the world, it is essential that well-designed, carefully conducted, prospective, longitudinal studies with adequate statistical power be conducted to improve scientific knowledge of the extent to which cesarean section increases a woman's risk of subsequent infertility, and if so, why. This prospective, longitudinal study of child-bearing patterns in relation to mode of first delivery is an investigation of both factors that increase a woman's risk of delivering her first child by cesarean section, and the effects of primary cesarean delivery on important outcomes, including subsequent child-bearing.
The specific aims of this study are: 1.) To measure pre-first delivery child-bearing desires and intentions among a diverse sample of 2790 pregnant women through interviews designed to assess pre-delivery factors that could explain post-cesarean deficits in subsequent child-bearing, 2.) To measure labor and delivery related factors in the hospital medical records of these 2790 women that could explain post-cesarean deficits in subsequent child-bearing, and 3.) To determine the effects of primary cesarean delivery on subsequent childbearing, via a 3-year prospective, longitudinal study of these 2790 women, with assessments at 1, 6, 12, 18, 24, 30 and 36 months post first delivery, comparing those who deliver by cesarean section to those who deliver vaginally, taking into account factors measured in the pre- delivery interview and the hospital medical records. Project Narrative The rate of cesarean delivery in the US has increased dramatically in the past decade and more than a million women deliver by cesarean section annually. This study will investigate the extent to which cesarean delivery increases a woman's risk of subsequent infertility and will substantially improve the current level of scientific knowledge about this issue.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD052990-05
Application #
8227937
Study Section
Social Sciences and Population Studies Study Section (SSPS)
Program Officer
King, Rosalind B
Project Start
2008-05-01
Project End
2014-02-28
Budget Start
2012-03-01
Budget End
2014-02-28
Support Year
5
Fiscal Year
2012
Total Cost
$634,207
Indirect Cost
$225,305
Name
Pennsylvania State University
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
129348186
City
Hershey
State
PA
Country
United States
Zip Code
17033
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Kjerulff, Kristen H; Brubaker, Laura H (2018) New mothers' feelings of disappointment and failure after cesarean delivery. Birth 45:19-27
Attanasio, Laura B; Kozhimannil, Katy B; Kjerulff, Kristen H (2018) Factors influencing women's perceptions of shared decision making during labor and delivery: Results from a large-scale cohort study of first childbirth. Patient Educ Couns 101:1130-1136
Adams, Elizabeth L; Marini, Michele E; Leonard, Krista S et al. (2018) Patterns of Gestational Weight Gain and Infants Born Large-for-Gestational Age Across Consecutive Pregnancies. Womens Health Issues :
Attanasio, Laura B; Kozhimannil, Katy B; Kjerulff, Kristen H (2018) Women's preference for vaginal birth after a first delivery by cesarean. Birth :
Kjerulff, Kristen H; Attanasio, Laura B (2018) Validity of Birth Certificate and Hospital Discharge Data Reporting of Labor Induction. Womens Health Issues 28:82-88
Attanasio, Laura B; Hardeman, Rachel R; Kozhimannil, Katy B et al. (2017) Prenatal attitudes toward vaginal delivery and actual delivery mode: Variation by race/ethnicity and socioeconomic status. Birth 44:306-314
Attanasio, Laura B; Kozhimannil, Katy B; Srinivas, Sindhu K et al. (2017) Concordance between Women's Self-Reported Reasons for Cesarean Delivery and Hospital Discharge Records. Womens Health Issues 27:329-335
Kjerulff, Kristen H; Attanasio, Laura B; Edmonds, Joyce K et al. (2017) Labor induction and cesarean delivery: A prospective cohort study of first births in Pennsylvania, USA. Birth 44:252-261
Alexander, C P; Zhu, J; Paul, I M et al. (2017) Fathers make a difference: positive relationships with mother and baby in relation to infant colic. Child Care Health Dev 43:687-696

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