OBJECTIVE--The aim was to study whether women having had caesarean sections (index women) have more subsequent health problems, measured by hospital admissions, than women having had vaginal deliveries (control women). DESIGN--The study involved comparison of hospital admissions before (2-5 years) and after (7-10 years) the first caesarean section (exposure) among two cohorts of index and control women. SETTING--National data from the Swedish birth and hospital discharge registries were used. PARTICIPANTS--About 75% of all Swedish primiparas who had a caesarean section in 1973 (n = 2578) and in 1976 (n = 3822), and their age-matched controls, were studied; non-Swedish women and women with certain specific problems at their first birth were excluded. MEASUREMENTS AND MAIN RESULTS--Numbers of discharges from general and mental hospitals excluding discharges relating to birth, and in some analyses to pregnancy, were determined. Total numbers of discharges from general and mental hospitals, and the numbers of discharges with operations, were higher among index than control women both before and after exposure. In analyses by diagnosis, a caesarean section was a risk factor for ectopic pregnancies and sterilisations. CONCLUSIONS--The analyses suggest that the higher rate of hospital admission after caesarean section than after vaginal delivery is not due to the section itself, but to a continuation of a previous pattern of health service use. However, because this was not so for all diagnoses and alternative interpretations are possible, further studies on long term maternal morbidity are needed.
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