Physical Health and Recovery in the First 18 Months Postpartum: Does Cesarean Section Reduce Long‐Term Morbidity?
Research examining long‐term health outcomes for women after childbirth has been limited. The objective of this study was to investigate
the natural history of common morbidities in the 18 months after the birth of a first child, and to explore the hypothesis that women who have a cesarean section for a first birth experience less overall morbidity in the postnatal period.
A prospective nulliparous pregnancy cohort study was conducted of 1,507 women recruited in early pregnancy from six public hospitals in Melbourne, Australia (mean gestation 15 weeks). Follow‐up questionnaires at 3, 6, 12, and 18 months
postpartum included standardized measures of urinary and fecal incontinence, and a symptom checklist asking about common physical health problems. Results
At 6, 12, and 18 months
postpartum, no statistically significant differences were found in the proportion of women reporting three or more health problems by method of birth. Compared with women who had a spontaneous vaginal birth, women who had a cesarean section were more likely to report extreme tiredness at 6 months
postpartum (adjusted OR: 1.39; 95% CI: 1.07–1.82) and at 12 months postpartum (adjusted OR: 1.40; 95% CI: 1.05–1.85), and were more likely to report back pain at 6 months postpartum (adjusted
OR: 1.37; 95% CI: 1.06–1.77) and at 12 months postpartum (adjusted OR: 1.41; 95% CI: 1.06–1.87). Women who had a cesarean section were less likely to report urinary incontinence at 3, 6, and
12 months postpartum, respectively (adjusted OR: 0.26; 95% CI: 0.19–0.36; adjusted OR: 0.36; 95% CI: 0.25–0.52; adjusted OR: 0.48; 95% CI: 0.33–0.68).
For all other physical health problems the pattern of morbidity did not differ between cesarean section and spontaneous vaginal birth. Conclusions
Physical health problems commonly persist
or recur throughout the first 18 months postpartum, with potential long‐term consequences for women's health. Cesarean section does not result in women experiencing less overall morbidity in the postpartum period compared with women who have a spontaneous vaginal birth. (BIRTH
39:3 September 2012).
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