A study has found cesarean deliveries result in lower rates of subsequent conception as compared to vaginal births.

Cesarean deliveries are surgical procedures in which the fetus is delivered through an incision in the mother’s abdomen and uterus. They are necessary in case of specific pregnancy and delivery complications, especially when a baby needs to be delivered urgently.

In the current study, published in JAMA Network Open, researchers found a C-section delivery was associated with a 15% lower likelihood of a subsequent conception. For the study, they followed 2,021 women who had delivered their first babies, both vaginally and via C-sections. The women also reported the number of times they had unprotected sex in the three years following their first delivery. Keeping factors such as maternal age, previous infertility, prior miscarriage and other variables in mind, researchers found that a C-section delivery was associated with a lower rate of conception. According to lead author, Kristen H. Kjerulff, a professor of public health at Pennsylvania State University, this could be due to factors such as scarring of the inside of the uterus, making implantation difficult, and ensuing low-grade infection during the surgery.

“In recent years it has been reported that some women develop a defect at the site of the cesarean incision (referred to as isthmocele or niche) that may increase risk of subsequent infertility,” said Kjerulff in the study.

Although the study has limitations, such as the fact that most of the data was based on self-reports, which can some times be unreliable. Also, the women were of similar, relatively high socioeconomic status, and researchers can’t tell yet how the findings will be applicable women from different economic strata who have undergone C-section procedures.

A deeper understanding of the impact of C sections on conception is particularly important in the context of elective surgeries, which are reported to be rising recently in India.

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According to a study, led by researchers Christophe Guilmoto and Alexandre Dumont from Institute of Research for Development, between 2010 and 2016, the rate of C-sections in India was 17.2% — an estimated 4.38 million Cesarean births per year — which is almost twice the global average and far beyond the benchmark of 10% to 15% advised as necessary by the World Health Organization (WHO). According to a more recent 2019 report, in the last decade, there has been a 400% jump in the number of C-section deliveries in private hospitals and 300% in India’s public hospitals.

Elective C-sections are controversial in India. They have become a popular choice for patients and their families as a means to ensure a child is born on an auspicious date or a particular time; others cite cosmetic reasons for choosing a C-section over vaginal birth. Still others perceive a C-section as less risky than a vaginal birth, The Swaddle reported earlier. However, there is also a reported perception that obstetricians push for C-sections because of convenience and the higher revenue that comes with performing surgeries.