Subsequent obstetric performance related to primary mode of delivery

Objective To relate subsequent obstetric performance with primary mode of d elivery. Postal questionnaire survey of women who delivered their first chi ld five years ago. Design Postal questionnaire survey of women who delivered thier first child five years ago. Setting Huddersfield Royal Infirmary. Population Women who were delivered of their first baby in 1991: 250 by nor mal vaginal delivery; 250 by instrumental vaginal delivery; and 250 by caes arean section. Main outcome measures Answers to fixed choice questions on fear of future c hildbirth, number of subsequent children and reasons for no further childre n. Results The response rate was 64%. Overall, 222 (46.6%) women were initiall y frightened about future childbirth. According to mode of delivery: 93 (57 .1%) after instrumental vaginal; 79 (47.9%) after caesarean section; and 50 (33.8%) after normal vaginal delivery. Five years after the primary delive ry, 99 women (20.8%) were still frightened about future childbirth: instrum ental vaginal group 41 (25.2%); caesarean section group 43 (26.1%); and nor mal vaginal group 15 (10.1%). In the group of women who were delivered by c aesarean section 13% more women had not had a second child after five years compared with the normal vaginal delivery group ((P < 0.03, relative risk 1.46 (1.07-1.99)). In the group of women who had a Vaginal instrumental del ivery 6% more had not had a second child after five years compared with nor mal Vaginal delivery group. Of the women who had no further children, 30% w ho had caesarean section and 28% vaginal instrumental delivery had involunt ary infertility. Conclusions Caesarean section or vaginal instrumental delivery leaves many mothers frightened about future childbirth. Primary caesarean section and t o some extent vaginal instrumental delivery is associated with an increased risk of voluntary and involuntary infertility.