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Researcher Seeks to Understand Mode of Delivery in Childbirth and Its Impact on Women’s Health

The rate of cesarean delivery in the United States has increased dramatically in the past decade, with more than a million women delivering by cesarean section annually. Additionally, a number of studies have found that women who deliver their first child by cesarean section are less likely to bear subsequent children and fewer subsequent children than women who deliver their first child vaginally.

These findings raise serious questions about the impact that the mode of first delivery may have not only on subsequent child-bearing but on women’s health generally. Kristen Kjerulff, a professor in the Departments of Public Health Sciences and Obstetrics and Gynecology at the Pennsylvania State University College of Medicine in Hershey, has used Pennsylvania Health Care Cost Containment Council (PHC4) data in her research to help find answers to these questions.

In preparing to submit a grant proposal to the National Institutes of Health, Professor Kjerulff worked directly with analysts at PHC4 to create data sets containing hospital discharge data for all single-birth deliveries in 2000 linked to (vital statistics) birth data for each mother in order to track all of the mother’s subsequent deliveries for five years (2000 to 2004) and to look for any significant patterns of post-delivery complications that might be associated with mode of delivery. The preliminary analysis suggested that women delivering by cesarean section were less likely to have subsequent deliveries.

With these findings in hand, Professor Kjerulff obtained a five-year grant from the National Institute of Child Health and Human Development to expand her research. Currently, she is conducting a prospective, longitudinal study involving more than 3,000 women from across Pennsylvania to understand the factors that could increase a woman's risk of delivering her first child by cesarean section as well as the effects of primary cesarean delivery on important health outcomes, including subsequent child-bearing.

The broad-based, representative sample of women from diverse demographic, income and type-of-insurance-coverage backgrounds will be followed clinically throughout the course of their pregnancies and ensuing years and personally interviewed in order to understand the psychological, financial and even “stress” factors that could be potentially involved. This study will address two essential questions: Are women who deliver their first child via cesarean section different from women who deliver vaginally prior to the first delivery in ways that both predispose them to need delivery by cesarean section and to be less likely to want to or be able to conceive and bear one or more subsequent children? Or is there something about the cesarean section itself that affects women’s desire or ability to conceive and bear subsequent children?

While Professor Kjerulff is collecting data for her prospective study, she will also be working with PHC4 again to obtain follow-up data for the years since she did the preliminary analysis.

“The extensive databases and expert analytical support provided by the Pennsylvania Health Care Cost Containment Council have been indispensable to my research,” said Professor Kjerulff. “And I would strongly encourage other researchers to utilize these valuable health care information resources.”

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Photo of Kristen Kjerulff, PhD, MA

Kristen Kjerulff, PhD, MA
Professor, Pennsylvania State College of Medicine

Kristen Kjerulff, Ph.D., M.A., is a Professor in the Division of Health Services Research, Department of Public Health Sciences, Pennsylvania State College of Medicine in Hershey, Pennsylvania and has been conducting research in the area of women’s health for more than 20 years. Her research has been funded by the Agency for Healthcare Research and Quality (AHRQ), National Institutes of Health (NIH) and other sources through a series of large-scale, long-term studies focusing on outcomes of common treatments, such as hysterectomy, and risk factors for common gynecologic disorders, such as uterine fibroids, using both population-based data sets and clinical studies. Beginning in the 1980s, she has built a portfolio of research addressing under-studied reproductive health issues in women while at the University of Maryland and Johns Hopkins Schools of Medicine. In 2004, she moved to Penn State, where her current research is focusing on the fertility consequences of cesarean section and the effects of poverty on stress and depression among women of reproductive age. Dr. Kjerulff recently began a five-year study of the issue of fertility following primary cesarean delivery, which will enroll nearly 3,000 women who will be followed for a three-year period, funded by the National Institute of Child Health and Human Development, NIH.

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