Pregnancy 'harder after a Caesarean'

Women who opt to have their baby by Caesarean section could find it much harder to become pregnant the next time they want a child, doctors warn today.

Researchers have found that undergoing a Caesarean, rather than having a normal delivery, nearly doubles the risk of taking longer than a year to conceive. A conference of leading clinicians in Vienna heard that infections in the womb, and the scar tissue left from the surgery, can cause physical trauma which delays subsequent attempts to become pregnant.

Dr Deidre Murphy, an obstetrician at St Michael's Hospital in Bristol, looked at the cases of 7,000 women. The risk of taking longer than a year to conceive following a previous pregnancy was found to be 12 per cent for those who had had a Caesarean, compared with seven per cent for women who had not.

Dr Murphy said: "It's important that women are aware of all the risks, particularly if they are making the choice for themselves rather than because there is a medical indication [that there should be a Caesarean]. If they are planning to have two children in quick succession, they should realise there could be a delay of between one and three years as a result of a Caesarean section."

Dr Murphy said doctors needed to look at what was happening during the operation. The way the abdominal cavity is closed up by obstetricians after the birth, and new attempts to prevent infections creeping in, could be important.

About one in five women in Britain now have babies by Caesarean, a rate which has increased threefold in the past 25 years, without any evidence that it is better for mothers or babies.

There is also concern that the surgery is leaving women with chronic back problems in later life, as their abdominal muscles are weakened by the procedure, which in turn affects the back muscles.

But some women opt for surgery because they believe it allows them to get back into shape more quickly, or because they are worried about the pain of childbirth or the risks of being incontinent afterwards.

The results of the Avon Longitudinal Study, which started in the early Nineties, were presented today to the European Society of Human Reproduction and Embryology in Vienna. They are also published in the journal Human Reproduction.

Dr Murphy said further long-term studies in other populations were needed to confirm the results and develop a body of reliable evidence.

Professor James Walker, of the Royal College of Obstetricians and Gynaecologists, said: "This is not the first study to indicate that Caesarean section may affect a woman's subsequent ability to conceive.

"Neither the medical profession nor women themselves realise the extent of the long-term problems. For some women a Caesarean is a necessity to deliver the baby safely.

"On other occasions the decision may not be as clear cut. We need more research into long-term effects of all methods of delivery."