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Predicting Parity Difficult, Affects Elective C-Section Advisability


 

SAN FRANCISCO — A woman's prediction of the number of children she will have in her lifetime often falls short, Dr. Kristie Keeton said in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

An Internet survey asked women who said they had completed childbearing to look back to their first pregnancy and their thoughts at that time about how many children they planned to have.

Among 458 women who said they had planned on having one or two children, 41% were accurate, 16% had fewer children than they planned, and 42% had more children than expected, reported Dr. Keeton of the University of Michigan, Ann Arbor, and her associates.

Among women who had more children than predicted, 68% had three or more children.

The findings have implications for counseling of women who request cesarean delivery, which is a growing phenomenon, Dr. Keeton said in an interview at the poster.

A recent State of the Science statement by the National Institutes of Health said that “Cesarean delivery on maternal request is not recommended for women desiring several children,” she noted.

The risks of placenta previa, accreta, and surgical complications increase with each C-section.

The current study suggests that at the time of first pregnancy, women are unable to predict their final parity.

This information should be incorporated into counseling of women who desire a primary elective C-section, Dr. Keeton said.

The U.S. C-section rate for 2005 was over 30%, the highest rate ever, according to preliminary data from the National Center for Health Statistics, she noted.

Women in the present study were more likely to accurately predict their parity if they were older at the time of first pregnancy (25 years vs. 21 years) and if they had two siblings instead of three.

One flaw of the study design was that it could not take into account the potential for recall bias affecting respondents' answers. Also, although all women said they had completed childbearing, it is possible that some may have future pregnancies, which would increase the proportion of respondents who underpredicted the number of children they would have.

Perhaps because the survey was conducted over the Internet, the demographics of the respondents were not representative of the general population: 74% of the women were white, 69% had at least some college education, and 70% were married or had a domestic partner. The mean age of respondents was 39 years.

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