Does the type of birth affect postpartum health?

My first child was born surgically via cesarean section, while my second arrived naturally by what maternity care providers call a “normal spontaneous vaginal delivery.” Surgical deliveries are rapidly becoming the norm rather than the exception in the U.S., reaching a record high of 31.8 percent of all births in 2007 (the 11th consecutive year that this percentage has increased). In most communities, trials of labor after a previous cesarean delivery are actively discouraged, even though 76% of women who attempt them (including my wife) have successful vaginal births.

The rising number of surgical deliveries is troubling, given that more than three-quarters of first-time mothers in the United States who are employed during pregnancy will return to the workforce within their infant’s first year of life. In a 2006 study in the Annals of Family Medicine, Dr. Pat McGovern and her colleagues at the University of Minnesota reported the relationship between delivery type and measures of postpartum health 5 weeks after childbirth.

Participants were 817 employed women who gave birth to single healthy infants at one of three Minneapolis-St. Paul community hospitals in 2001. Study personnel telephoned each woman to conduct an interview that lasted approximately 45 minutes. The interviews assessed overall physical and mental health as well as typical postpartum symptoms, including fatigue, decreased interest in sex, back and neck pain, constipation, hemorrhoids, and appetite problems.

The authors found that women who delivered by cesarean section reported significantly worse physical health 5 weeks after birth than women who delivered vaginally, although mental health scores were similar between the two groups. This is important to know, since while surgical deliveries aren’t always avoidable, there are some simple things that a woman can do to reduce her risk (such as asking her obstetrician, family physician, or midwife what the practice's average c-section rate is and their most common reasons for doing one). If you want more information, I refer you to a website that pulls no punches with the facts about how to avoid an unnecessary cesarean.

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Note: the above post is adapted from an article I wrote in the August 15, 2006 issue of American Family Physician.